Methicillin-Resistant Staphylococcal Colonization and Infection in a Long-Term Care Facility

Muder, Robert R.; Brennen, Carole; Wagener, Marilyn M.; Vickers, Richard M.; Rihs, John D.; Hancock, Gary A.; Yee, Y. Cheung; Miller, Jacqueline; Yu, Victor L.

doi:10.7326/0003-4819-114-2-1-107

Cited by 364 publications

(171 citation statements)

References 29 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%

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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%

“…5% [13] and a relative risk of 3 . 6 in MRSA carriers in LTCFs [12]. Persistent MRSA carriers are more often colonized at multiple sites, are more likely to transmit to others, and become infected than transient carriers [24].…”

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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“…In the first follow-up year, we found that 56% of MRSA carriers, 32% of MSSA carriers, and 30% of non– S. aureus carriers developed skin infections. A similar study by Muder et al in a long-term care facility showed infection rates of 25%, 4%, and 4% for the same carriage groups, respectively, but patients were only followed while in the hospital and median duration of follow-up was <1 year for the carriage groups ( 24 ). Another prospective study of soldiers by Ellis et al found that 38% of MRSA carriers, 3% of MSSA carriers, and 2% of non– S. aureus carriers developed subsequent skin infections ( 18 ).…”

Section: Discussionmentioning

confidence: 81%

“…Risk factors found in these community settings are frequent skin-to-skin contact ( 11 , 12 , 14 , 15 ), sharing of personal items without frequent cleaning ( 11 – 14 ), and MRSA carriage ( 18 , 20 ). Nasal colonization is also a risk factor for infections in hospital settings ( 4 – 6 , 21 – 23 ) and long-term care facilities ( 24 , 25 ). However, all of these previous studies have used a case–control study design, making it impossible to determine if MRSA carriage preceded infection.…”

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confidence: 99%

Methicillin-ResistantStaphylococcus aureusCarriage and Risk Factors for Skin Infections, Southwestern Alaska, USA

Stevens¹,

Hennessy²,

Baggett³

et al. 2010

Emerg. Infect. Dis.

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“…Murder et al [24] evaluated the development of staphylococcal infection in methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus nasal carriers and found that 25% of patients who developed infection were MRSA carriers, whereas among MSSA carriers or non-carriers, as few as 4% and 4.5% respectively developed infections (73% of all MRSA infections occurred in nasal carriers of the microorganism). They also concluded that the management of carriers may be used as a control measure.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

et al. 2007

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Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2%) were nasal carrier. Mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). Nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.

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Methicillin-Resistant Staphylococcal Colonization and Infection in a Long-Term Care Facility

Cited by 364 publications

References 29 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

Methicillin-ResistantStaphylococcus aureusCarriage and Risk Factors for Skin Infections, Southwestern Alaska, USA

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

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