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Determining risk factors for methicillin-resistant Staphylococcus aureus carriage after discharge from hospital
D J Beaujean1, A J Weersink, H E Blok
1Eijkman-Winkler Institute of Medical Microbiology, University Hospital Utrecht, The Netherlands.
Abstract:
At the University Medical Center, Utrecht, methicillin-resistant Staphylococcus aureus (MRSA) patients are considered lifelong MRSA carriers and potentially contagious when readmitted. The purpose of this study was to determine whether patients who become MRSA carriers while in hospital remain colonized after discharge, and whether risk factors for prolonged carriage exist. Thirty-six patients colonized with MRSA during three outbreaks at University Medical Center, Utrecht (group I: 1986-1989), and twenty patients already colonized with MRSA on, or during, admission to the hospital (group II: 1990-1995) were screened for MRSA in two studies. The patients had been discharged from the hospital for periods varying from 15 days to 4.6 years. MRSA was found in five (9%). Four of these patients had skin lesions (wounds), one with an external fixture. The presence of skin- and underlying diseases differed significantly between carriers and non-carriers, supporting the hypothesis that wounds are a major risk factor for long-term MRSA carriage. This study led us to revise our policy concerning readmission of former MRSA patients. We now consider that patients who contracted MRSA in the past no longer need isolation if the following two criteria are met. Absence for at least six months of open wounds, skin lesions, tracheostomy, infections and sources of infection such as abscesses and furuncles, orthopaedic implants, drains, catheters, or tubes. Three MRSA-negative sets of swabs from nose, throat, perineum, urine, and sputum taken at least one hour apart after this six-month period.
Insights
Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) may not remain carriers long-term. Skin lesions significantly increase the risk of prolonged MRSA carriage, leading to revised hospital readmission policies.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) patients are often presumed lifelong carriers upon hospital readmission.
- Current hospital policies mandate isolation for former MRSA patients due to potential contagiousness.
Purpose of the Study:
- To investigate the duration of MRSA colonization in patients after hospital discharge.
- To identify risk factors associated with prolonged MRSA carriage.
Main Methods:
- Screening of 36 patients colonized during outbreaks (1986-1989) and 20 patients colonized on admission (1990-1995) for MRSA.
- Patients were screened after discharge periods ranging from 15 days to 4.6 years.
- Analysis of risk factors, including skin lesions and underlying diseases, in relation to MRSA carriage.
Main Results:
- MRSA was detected in 9% (5/56) of previously colonized patients.
- Four of the five MRSA-positive patients had skin lesions, with one also having an external fixture.
- Significant differences in skin and underlying diseases were observed between MRSA carriers and non-carriers.
Conclusions:
- Prolonged MRSA carriage after hospital discharge is less common than presumed.
- Open wounds and skin lesions are identified as major risk factors for long-term MRSA carriage.
- Hospital readmission policies for former MRSA patients were revised, no longer requiring isolation if specific criteria for absence of wounds and negative MRSA swabs are met.