Nursing home characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) Burden and Transmission

BMC Infectious Diseases

Susan S Huang²  Dana B Mukamel³  Bruce Y Lee⁵  Michele Cheung¹  Hildy Meyers¹  Kaye Evans⁴  Grace Tan⁴  Matthew Whealon²  Ellena Peterson⁴  Diane Kim²  Victor Quan²  Courtney R Murphy² 

[1]Epidemiology and Assessment Program, Orange County Health Care Agency, Santa Ana, USA

[2]Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, USA

[3]Department of Medicine and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, USA

[4]Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, Irvine, USA

[5]Department of Medicine, Epidemiology and Biomedical Informatics, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pittsburgh, USA

关键词: Nursing home;    Long-term care;    Healthcare-associated infection;    MRSA;   

Others  :  1159622
DOI  :  10.1186/1471-2334-12-269

 received in 2012-01-09, accepted in 2012-10-17,  发布年份 2012

【 摘 要 】

Background

MRSA prevalence in nursing homes often exceeds that in hospitals, but reasons for this are not well understood. We sought to measure MRSA burden in a large number of nursing homes and identify facility characteristics associated with high MRSA burden.

Methods

We performed nasal swabs of residents from 26 nursing homes to measure MRSA importation and point prevalence, and estimate transmission. Using nursing home administrative data, we identified facility characteristics associated with MRSA point prevalence and estimated transmission risk in multivariate models.

Results

We obtained 1,649 admission and 2,111 point prevalence swabs. Mean MRSA point prevalence was 24%, significantly higher than mean MRSA admission prevalence, 16%, (paired t-test, p<0.001), with a mean estimated MRSA transmission risk of 16%.

In multivariate models, higher MRSA point prevalence was associated with higher admission prevalence (p=0.005) and higher proportions of residents with indwelling devices (p=0.01). Higher estimated MRSA transmission risk was associated with higher proportions of residents with diabetes (p=0.01) and lower levels of social engagement (p=0.03).

Conclusions

MRSA importation was a strong predictor of MRSA prevalence, but MRSA burden and transmission were also associated with nursing homes caring for more residents with chronic illnesses or indwelling devices. Frequent social interaction among residents appeared to be protective of MRSA transmission, suggesting that residents healthy enough to engage in group activities do not incur substantial risks of MRSA from social contact. Identifying characteristics of nursing homes at risk for high MRSA burden and transmission may allow facilities to tailor infection control policies and interventions to mitigate MRSA spread.

【 授权许可】

   
2012 Murphy et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bradley SF, Terpenning MS, Ramsey MA, Zarins LT, Jorgensen KA, Sottile WS, Schaberg DR, Kauffman CA: Methicillin-resistant Staphylococcus aureus: Colonization and Infection in a long-term care facility. Ann Intern Med 1991, 115(6):417-422.
• [2]Muder RR, Brennen C, Wagener MM, Vickers RM, Rihs JD, Hancock GA, Yee YC, Miller JM, Yu VL: Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991, 114(2):107-112.
• [3]Garazi M, Edwards B, Caccavale D, Auerbach C, Wolf-Klein G: Nursing homes as reservoirs of MRSA: myth or reality? J Am Med Dir Assoc 2009, 10(6):414-418.
• [4]Mody L, Kauffman CA, Donabedian S, Zervos M, Bradley SF: Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Inf Diseases 2008, 46:1368-1373.
• [5]Trick WE, Weinstein RA, DeMarais PL, Kuehnert MJ, Tomaska W, Nathan C, Rice TW, McAllister SK, Carson LA, Jarvis WR: Colonization of Skilled-Care Facility Residents with Antimicrobial-Resistant Pathogens. J Amer Geriatrics Soc 2001, 49:270-276.
• [6]Furuno JP, Hebden JN, Standjford HC, Perencevich EN, Miller RR, Moore AC, Strauss SM, Harris AD: Prevalence of Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a Long-term Acute Care Facility. Am J Infect Control 2008, 36(7):468-471.
• [7]Reynolds C, Quan V, Kim D, Peterson E, Dunn J, Whealon M, Terpstra L, Meyers H, Cheung M, Lee B, Huang SS: Methicillin-Resistant Stap hylococcus aureus (MRSA) Carriage in 10 Nursing Homes in Orange County, California. Infect Control Hosp Epidemiol 2011, 32(1):91-93.
• [8]Kreman T, Hu J, Pottinger J, Herwaldt LA: Survey of Long-term-care Facilities in Iowa for Policies and Practices Regarding Residents with Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci. Infect Control Hosp Epidemiol 2005, 26(10):811-821.
• [9]Robicsek A, Beaumont JL, Paule SM, Hacek DM, Thomson RB Jr, Kaul KL, King P, Peterson LR: Universal Surveillance for Methicillin-Resistant Staphylococcus aureus in 3 Affiliated Hospitals. Ann Intern Med 2008, 148(6):409-418.
• [10]Mulhausen PL, Harrell LJ, Weinberger M, Kochersberger GG, Feussner JR: Contrasting Methicillin-Resistant Staphylococcus aureus Colonization in Veterans Affairs and Community Nursing Homes. Am J Med 1996, 100(1):24-31.
• [11]Lucet JC, Paoletti X, Demontpion C, Degrave M, Vanjak D, Vincent C, Adremont A, Jarlier V, Mentre F, Nicolas-Chanoline MH, Staphylococcus aureus Resistant a la Meticilline en Hospitalisation A Domicile (SARM HAD) Study Group: Carriage of Methicillin-Resistant Staphylococcus aureus in Home Care Settings: Prevalence, Duration, and Transmission to Household Members. Arch Intern Med 2009, 169(15):1372-1378.
• [12]Huang SS, Rifas-Shiman SL, Warren DK, Fraser VJ, Climo MW, Wong ES, Cosgrove SE, Perl TM, Pottinger JM, Herwaldt LA, Jernigan JA, Tokars JL, Diekema DJ, Hinrichsen VL, Yokoe DS, Platt R: Improving MRSA surveillance and reporting in ICUs. J Infect Dis 2007, 195(3):330-338.
• [13]Kurup A, Chlebicka N, Tan KY, Chen EX, Oon L, Ling TA, Ling ML, Hong JL: Active Surveillance Testing and Decontamination Strategies in Intensive Care Units to Reduce Methicillin-Resistant Staphylococcus aureus Infections. Am J Infect Control 2010, 38(5):361-367.
• [14]Honda H, Krauss MJ, Coopersmith CM, Kollef MH, Richmond AM, Fraser VJ, Warren DK: Staphylococcus aureus Nasal Colonization and Subsequent Infection in Intensive Care Unit Patients: Does Methicillin Resistance Matter? Infect Control Hosp Epidemiol 2010, 31(6):584-591.
• [15]Dang CN, Prasad YDM, Boulton AJM, Jude EB: Methicillin-resistant Staphylococcus aureus in the diabetic foot clinic: a worsening problem. Diabetic Med 2003, 20(2):159-161.
• [16]Lucet JC, Chevret S, Durand-Zaleski I, Chastang C, Regnier B, Multicenter Study Group: Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003, 163(2):181-188.
• [17]Lederer SR, Riedelsdorf G, Schiffl H: Nasal Carriage of Methicillin-resistant Staphylococcus aureus: the Prevalence, Patients at Risk and the Effect of Elimination on Outcomes Among Outpatient Haemodialysis Patients. Eur J Med Res 2007, 12(7):284-288.
• [18]Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K: SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility. Infect Control Hosp Epidemiol 2008, 29:785-814.
• [19]March A, Aschbacher R, Dhanji H, Livermore DM, Bottcher A, Sleghel F, Maggi S, Noale M, Larcher C, Woodford N: Colonization of Residents and Staff of a Long-Term-Care Facility and Adjacent Acute-Care Hospital Geriatric Unit by Multiresistant Bacteria. Clin Microbiol Infect 2010, 16(7):934-944.
• [20]Robert SA: Community-Level Socioeconomic Status Effects on Adult Health. J Health Soc Behav 1998, 39:18-37.
• [21]Figueroa JB, Breen N: Significance of Underclass Residence on the Stage of Breast or Cervical Cancer Diagnosis. Am Econ Rev 1995, 85(2):112-116.
• [22]Research Data Assistance Center. http://www.resdac.org/MDS/data_available.asp webcite
• [23]Hendrix CC, Sakauye KM, Karabatsos G, et al.: The use of the Minimum Data Set to identify depression in the elderly. J Am Med Dir Assoc 2003, 4(6):308-312.
• [24]Perlman CM, Hirdes JP: The aggressive behavior scale: a new scale to measure aggression based on the minimum data set. J Am Geriatr Soc 2008, 56(12):2298-2303.
• [25]Kiely DK, Flacker JM: The Protective Effect of Social Engagement on 1-year Mortality in a Long-Stay Nursing Home Population. J Clin Epidemiol 2003, 56:472-478.
• [26]Long Term Care Focus. http://www.ltcfocus.org webcite
• [27]Mylotte JM, Karuza J, Bentley DW: Methicillin-Resistant Staphylococcus aureus: A Questionnaire Survey of 75 Long-Term Care Facilities in Western New York. Infect Control Hosp Epidemiol 1992, 13(12):711-718.
• [28]Hughes C, Smith M, Tunney M: Infection Control Strategies for Preventing the Transmission of Methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 2008, 23(1):CD006354.
• [29]Stevenson KB, Loeb M: Performance improvement in the long-term-care setting: building on the foundation of infection control. Infect Control Hosp Epidemiol 2004, 25(1):72-9.
• [30]Kutlu SS, Cevahir N, Akalin S, Akin F, Dirgen CS, Bastermir M, Tekin K: Prevalence and Risk Factors for Methicillin-resistant Staphylococcus aureus Colonization in a Diabetic Outpatient Population: a Prospective Cohort Study. Am J Infect Control 2011. epub ahead of print
• [31]Huang SS, Datta R, Rifas-Shiman S, Kleinman K, Placzek H, Lankiewicz JD, Platt R: Colonization with Antibiotic-Susceptible Strains Protects against Methicillin-Resistant Staphylococcus aureus but not Vancomycin-Resistant Enterococci Acquisition: A Nested Case–control Study. Crit Care 2011, 15(5):R210. BioMed Central Full Text
• [32]Wibbenmeyer L, Williams I, Ward M, Xiao X, Light T, Latenser B, Lewis R, Kealey GP, Herwaldt L: Risk factors for acquiring vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on a burn surgery step-down unit. J Burn Care Res 2010, 31(2):269-79.
• [33]van Velzen EVH, Reilly JS, Kavanagh K, Leanord A, Edwards GF, Girvan EK, Gould IM, Mackenzie FM, Masterton R: A Retrospective Cohort Study into Acquisition of MRSA and Associated Risk Factors after Implementation of Universal Screening in Scottish Hospitals. Infect Control Hosp Epidemiol 2011, 32(9):889-896.
• [34]Miller R, Esmail H, Peto T, Walker S, Crook D, Wyllie D: Is MRSA admission bacteraemia community-acquired? A case control study. J Infect 2008, 56(3):163-170.
• [35]Warren DK, Guth RM, Coopersmith CM, Merz LR, Zack JE, Fraser VJ: Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol 2006, 27(10):1140-1.
• [36]Moore C, Dhaliwal J, Tong A, Eden S, Wigston C, Willey B, McGeer A: Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in roommate contacts of patients colonized or infected with MRSA in an acute-care hospital. Infect Control Hosp Epidemiol 2008, 29(7):600-6.
• [37]Center for Medicare and Medicaid Services: Guidance to Surveyors of Long Term Care Facilities. 2009, 100-107.