Epidemiological relatedness of methicillin-resistant Staphylococcus aureus from a tertiary hospital and a geriatric institution in Spain

Gopegui, Enrique Ruíz de; Oliver, Antonio; Ramírez, Antonio; Gutiérrez, Olivia; Andreu, Carlos Manuel Fernández; Pérez, José Luís

doi:10.1111/j.1198-743x.2004.00867.x

Cited by 16 publications

(7 citation statements)

References 15 publications

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“…Several studies have highlighted the relevance of this epidemiological aspect which might influence the infection control practices implemented by acutecare hospitals [18][19][20][21][22] but there are limited data on the relationship of MRSA colonization and the development of infection in residents of LTCFs [12,14]. This aspect has usually been assessed in settings where patients are at great risk of MRSA infection, such as intensive care units [10].…”

Section: Discussionmentioning

confidence: 99%

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

Manzur¹,

Gopegui

Domı́nguez

et al. 2011

Epidemiol. Infect.

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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.

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Section: Discussionmentioning

confidence: 99%

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

Manzur¹,

Gopegui

Domı́nguez

et al. 2011

Epidemiol. Infect.

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Section: Discussionmentioning

confidence: 99%

“…The increase in MRSA infections in healthcare institutions other than hospitals could also contribute to this inverted flux. A study of patients with decubitus ulcers in a geriatric institution in Majorca between January 2000 and June 2002 revealed a very high prevalence of MRSA (70%), and the proportion of clone C (EMRSA-15) was already high (30%) during that period compared with 10% in the hospital setting [33]. A further interesting finding associated with EMRSA-15 is that, despite showing the lowest frequency of multidrug resistance among the three major clones, it was apparently more virulent, since it was associated significantly with bacteraemia.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Majorcan hospitals: high prevalence of the epidemic clone EMRSA-15

Alcoceba

Mena

Pérez

et al. 2007

Clinical Microbiology and Infection

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Clinical isolates (n = 389) of methicillin-resistant Staphylococcus aureus (MRSA) recovered from 371 patients between January 2003 and June 2004 at the three major public hospitals on the island of Majorca, Spain were studied. The clonal relatedness of MRSA isolates was determined by pulsed-field gel electrophoresis (PFGE) after digestion with SmaI. During the study period, MRSA was found in 31% of patients with S. aureus-positive cultures. PFGE analysis identified three predominant clones, affecting 94% of the patients. The three clones had been detected since 1999 in one hospital, and were designated as clones A, B and C. Whereas clones A and B (multidrug-resistant) were related to the two most prevalent clones in Spain at this time, clone C was identical to EMRSA-15, currently one of the most common MRSA clones in UK hospitals and also detected in other countries, but rarely in Spanish hospitals. This imported epidemic clone was detected in c. 10% of patients admitted to one of the three hospitals in 2002, but its prevalence has increased significantly (32% of the patients investigated in the three hospitals in the present study), and this clone also accounted for 44% of the isolates from non-hospitalised patients. Even though EMRSA-15 showed the least multidrug resistance of the three major clones, it was apparently more virulent, since it was associated significantly (p 0.001) with bacteraemia, and positive blood cultures were documented for 21% of the patients infected by this clone, compared with only 10% and 7% of patients infected with clones A and B, respectively.

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“…In Europe, some studies have recently evaluated the prevalence of MRSA colonization in these facilities [7][8][9][10]. In Spain, only a few studies have addressed the interaction of MRSA strains between hospitals and other healthcare facilities [11][12][13][14]. An interesting finding is that patients with S. aureus bloodstream infection diagnosed at hospital admission following referral from an LTCF were associated with the presence of methicillin resistance [14].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community long-term-care facilities in Spain

Manzur¹,

Gavaldà

Gopegui

et al. 2008

Clinical Microbiology and Infection

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Hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) strains are no longer limited to acute-care hospitals but have now spread to other healthcare settings such as long-term-care facilities (LTCFs), in most of which they are endemic. In Europe, few studies have addressed the MRSA situation in LTCFs. A cross-sectional study to determine MRSA prevalence and factors associated with S. aureus carriage in community LTCF residents is reported here. Nasal and decubitus ulcer cultures were performed for residents of nine community LTCFs. Residents were classified as MRSA carriers, methicillin-susceptible S. aureus carriers and non-carriers. Overall, 1377 nasal swabs and 82 decubitus ulcer cultures were performed. MRSA was isolated from 15.5% and 59.0% of the former and latter, respectively. The prevalence of MRSA colonization was 16.8% (95% CI 14.9-18.8), varying from 6.7% to 35.8% (p <0.001) among LTCFs. Several independent variables were related to MRSA colonization. It is noteworthy that residents in an LTCF with fewer than 150 beds had at least a two-fold higher probability of being MRSA carriers. Modifiable factors were medical devices, decubitus ulcers and previous antibiotic treatment. An age of 85 years or older, a Charlson index >or=2 and transfer from an acute-care facility were non-modifiable factors also related to MRSA colonization. A high MRSA prevalence among residents in community LTCFs in Spain, with great variability among facilities, was found. The factors identified as being associated with MRSA colonization could be prevented by the implementation of several measures. Control strategies need to be coordinated between LTCFs and acute-care hospitals.

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Epidemiological relatedness of methicillin-resistant Staphylococcus aureus from a tertiary hospital and a geriatric institution in Spain

Cited by 16 publications

References 15 publications

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

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

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Majorcan hospitals: high prevalence of the epidemic clone EMRSA-15

Prevalence of methicillin-resistant Staphylococcus aureus and factors associated with colonization among residents in community long-term-care facilities in Spain

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