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

Abstract

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.

Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen

“…Die MRSA-Prävalenzen in Rehabilitationskliniken in anderen Ländern liegen deutlich höher [75,77,78] [89].…”

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

“…Characteristics of this population have been described previously [2]. Nine community LTCFs for the elderly, located in two communities in Spain (Catalonia and Balearic Islands) with 1586 beds (median 120, range 72-552) were included.…”

“…Methicillin-resistant Staphylococcus aureus (MRSA) has a high prevalence in acute-care hospitals in Spain, and also in long-term-care facilities (LTCFs) [1][2][3]. This scenario is similar to other countries of the European Union [4][5][6][7][8].…”

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

“…MDRO are regarded as a potentially serious threat to elderly people living in long-term care facilities (LTCFs). Although various studies on the prevalence of MRSA in LTCFs in Germany [7][8][9][10][11][12][13] and other European countries [14][15][16][17][18][19][20][21][22][23][24][25] have been published (< 1% in the Netherlands and Sweden, > 20% in Ireland and the United Kingdom (UK)), studies on the prevalence of MRGN such as extended-spectrum betalactamase (ESBL)-producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) among nursing home residents in German and in European LTCFs are scarce [7,14,24,26,27]. Although an increasing trend in the occurrence of ESBL-producing Enterobacteriaceae and even CRO is found in hospitals all over Europe [1,3,28,29], a lack of knowledge on multidrug-resistant organisms (MDRO) in nursing homes has to be stated.…”