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Nasal colonization by methicillin-resistant coagulase-negative staphylococcus in community skilled nursing facility
Background:
Methicillin-resistant coagulase-negative staphylococci (MRCNS) are increasing nosocomial pathogens in acute care hospital patients. However, there is little information on the epidemiology of MRCNS in skilled nursing facilities (SNFs). We report a pilot survey of the prevalence of MRCNS colonization in SNF patients.
Methods:
Anterior nasal swabs were plated on oxacillin salt screening agar for selection of MRCNS. Suspected MRCNS were confirmed by coagulase and catalase tests and standard disc-diffusion antimicrobial susceptibility tests.
Results:
The overall prevalence of MRCNS was 40% for in-house continuing SNF patients, 49% for newly admitted patients, and 60% for SNF nursing personnel. The prevalence was 13% in a "control" group of nonmedical personnel. Forty-six percent of MRCNS were resistant to ciprofloxacin. The frequency of colonization with MRCNS increased over time. After an average 17 months of facility stay, 32% of noncarriers acquired MRCNS. High frequency of colonization was associated with greater disability.
Conclusion:
Colonization with MRCNS is common among SNF patients, who can serve as a reservoir for transfer of such strains to acute care hospitals. Careful infection control practice, including judicious use of antibiotics with frequent handwashing, will remain critical policies for limiting spread of such strains.
Insights
Methicillin-resistant coagulase-negative staphylococci (MRCNS) are common in skilled nursing facilities (SNFs). SNF patients and staff can act as reservoirs, potentially spreading these resistant bacteria to hospitals.
Area of Science:
- Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Methicillin-resistant coagulase-negative staphylococci (MRCNS) are emerging nosocomial pathogens.
- Limited data exists on MRCNS epidemiology in skilled nursing facilities (SNFs).
- This study presents a pilot survey of MRCNS colonization prevalence in SNF patients.
Purpose of the Study:
- To determine the prevalence of MRCNS colonization in SNF patients and personnel.
- To assess the risk factors associated with MRCNS colonization in SNFs.
- To understand the potential role of SNFs as reservoirs for MRCNS transmission.
Main Methods:
- Anterior nasal swabs were collected from SNF patients and personnel.
- Samples were cultured on oxacillin salt screening agar to select for MRCNS.
- Confirmed MRCNS isolates underwent antimicrobial susceptibility testing.
Main Results:
- Overall MRCNS prevalence was 40% in continuing SNF patients and 49% in new admissions.
- Nursing personnel showed a 60% prevalence of MRCNS colonization.
- Colonization increased over time, with 32% of non-carriers acquiring MRCNS after 17 months; higher colonization correlated with greater disability.
Conclusions:
- MRCNS colonization is prevalent among SNF patients and staff.
- SNFs may serve as reservoirs for MRCNS, facilitating transfer to acute care settings.
- Strict infection control, judicious antibiotic use, and hand hygiene are crucial to limit spread.