Clinical significance of methicillin-resistantStaphylococcus aureuscolonization in residents in community long-term-care facilities in Spain

Abstract

SUMMARYMethicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in Spanish hospitals and community long-term-care facilities (LTCFs). This longitudinal study was performed in community LTCFs to determine whether MRSA colonization is associated with MRSA infections and overall mortality. Nasal and decubitus ulcer cultures were performed every 6 months for an 18-month period on 178 MRSA-colonized residents (86 490 patient-days) and 196 non-MRSA carriers (97 470 patient-days). Fourteen residents developed MRSA infections and 10 of these were skin and soft tissue infections. Two patients with respiratory infections required hospitalization. The incidence rate of MRSA infection was 0 . 12/1000 patient-days in MRSA carriers and 0 . 05/1000 patient-days in non-carriers (P=0 . 46). No difference in MRSA infection rate was found according to the duration of MRSA colonization (P=0 . 69). The mortality rate was 20 . 8% in colonized residents and 16 . 8 % in non-carriers ; four residents with MRSA infection died. Overall mortality was statistically similar in both cohorts. Our results suggest that despite a high prevalence of MRSA colonization in LTCFs, MRSA infections are neither frequent nor severe while colonized residents remain at the facility. The epidemiological impact of an MRSA reservoir is more relevant than the clinical impact of this colonization for an individual resident and supports current recommendations to control MRSA spread in community LTCFs.

Staphylococcus aureus Colonization and Long-Term Risk for Death, United States

“…Regarding MSSA, our results are consistent with studies conducted in inpatient and nursing home participants that also failed to find an association ( 4 – 7 ). Many of these studies were underpowered, calling for larger scale investigations.…”

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

“…Muder et al showed that 25% of rehabilitation and long-term-care residents colonized with MRSA developed MRSA infections compared to 4% of those not colonized with MRSA [55]. Despite some earlier literature linking MDR infections to an increase in mortality in at least certain scenarios and in the short term [60, 61], the majority of observations failed to show significant changes in long term all-cause mortality [62]; in a study focusing on colonization by MRSA and ESBL-producing GNB, colonization did not increase mortality or morbidity as assessed after 12 months [63]. Lee et al used a mathematical model to predict that use of contact precautions for all MRSA carriers would reduce prevalence of MRSA, but they did not anticipate changes in clinical outcome [64].…”

Risk factors for anti-MRSA drug resistance

“…MRSA-related infection has been debated for some time now and some authors believe it is very important to diagnose MRSArelated infection or colonisation for preventing further spread of MRSA [11][12][13]. MRSA-related infections tend to be more severe or even fatal [14].…”