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[Study of methicillin-resistant Staphylococcus aureus colonization among intermediate-care facility patients]
P Giret1, F Roblot, J Y Poupet
1Laboratoire de bactériologie et d'hygiène hospitalière, hôpital La Milétrie, CHU, B.P. 577, 86021 Poitiers, France.
Purpose:
Prevalence of methicillin-resistant Staphylococcus aureus is high in the Poitiers teaching hospital, particularly in the intermediate care facilities. We performed a survey of methicillin-resistant Staphylococcus aureus colonization in the intermediate care facilities and 265 patients were included.
Methods:
Nasal, cutaneous and wound swab cultures were done at the time of admission and at the time of the patients' departure. A decolonization procedure of methicillin-resistant Staphylococcus aureus carriers was performed using nasal application of fusidic acid and different soaps for the skin. At entry, 17.7% of patients were methicillin-resistant Staphylococcus aureus carriers (of at least one location). At departure, 30.4% were methicillin-resistant Staphylococcus aureus carriers. Among methicillin-resistant Staphylococcus aureus non-carriers at entry, 24.3% became methicillin-resistant Staphylococcus aureus carriers.
Results:
The principal risk factor of carriage was the initial presence of a wound (RR = 3.6). The incidence rate of methicillin-resistant Staphylococcus aureus infection among the 265 patients included was 3%.
Conclusion:
The systematic screening of patients at the time of admission is expensive and isolation technically hard to manage in the intermediate care facilities. The risk factor we found in this study allow us to propose a 'light' screening limited to patients with wounds.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) colonization is high in intermediate care facilities. Screening patients with wounds can help target MRSA decolonization efforts effectively.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Context:
- High prevalence of methicillin-resistant Staphylococcus aureus (MRSA) observed in Poitiers teaching hospital.
- Intermediate care facilities identified as a particular hotspot for MRSA colonization.
Purpose:
- To survey MRSA colonization in intermediate care facilities.
- To identify risk factors for MRSA carriage and infection.
- To evaluate the effectiveness of a decolonization procedure.
Summary:
- A survey of 265 patients in intermediate care facilities revealed MRSA colonization rates of 17.7% on admission and 30.4% on departure.
- A significant increase in MRSA carriage was observed among patients admitted as non-carriers (24.3%).
- The presence of a wound was the primary risk factor for MRSA carriage (RR = 3.6), with an overall MRSA infection incidence of 3%.
Impact:
- Findings suggest that systematic MRSA screening is costly and difficult to implement in intermediate care.
- A targeted screening approach focusing on patients with wounds is proposed to optimize resource allocation.
- This study informs infection control strategies for MRSA in hospital settings.