Opioid Dependence and Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization or Infection in Hospitalized Patients in Florida: A Retrospective Study

Abstract

Background: Prescriptions for opioid medications has increased during the past two decades. In 2016, there were 17,087 deaths involving prescription opioids, or approximately 46 deaths per day. This is a significant increase from 15,281 in 2015 (p < 0.05). The use of injectable opioids are often associated with skin infections, such as Methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this study is to examine the association between opioid dependence and MRSA colonization or infection in hospitalized patients in Florida during 2009-2016. Methods: Florida's Agency for Health Care Administration (AHCA) database was used for this study and includes discharge data from 299 hospitals in Florida. Patients 18 years or older with diagnoses of opioid dependence or MRSA infection or colonization were identified. Admissions to psychiatric and rehabilitation hospitals were not included in the analysis. Data was aggregated by the 11 Local Health Council (LHC) regions and includes all 67 counties. Results: We examined more than 17 million hospitals admissions reported to AHCA between 2009 and 2016. We identified 177,752 (1.0%) admissions of patients with opioid dependence diagnosis, and 359,420 (2.1%) admissions of patients with MRSA. The rate of opioid dependence increased from 5.3 per 1,000 hospital admissions in 2009 to 16.6 in 2016. Substantial increases were evident in all LHC regions. MRSA infections were identified in 8,345 (4.7%) of the admissions of patients with opioid dependence, and in 351,075 (2.0%) of the patients without opioid dependence. The patients in opioid dependence group were 2.4 times more likely to have a MRSA diagnosis compared to the patients in non-opioid dependence group (OR = 2.38, 95% CI 2.33, 2.43, p < 0.001). Significant association between opioid dependence and MRSA was found in all LHC regions. Conclusions: This study identified significant associations between opioid dependence and MRSA infection or colonization, overall, and in all LHC regions. Although preventive efforts such as screening, isolation, and handwashing are taking place in hospitals and communities, the findings illustrate the importance of implementing routine screening for MRSA in people with opioid dependence, as well in bringing awareness about MRSA transmission within communities.