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Staphylococcus aureus carrier state among elderly residents of a long-term care facility
Gad Mendelson1, Yelena Yearmack, Ester Granot
1Shoham Geriatric Center, Pardes Hanna, Israel. gcmendelson@matat.health.gov.il
Introduction:
Methicillin-resistant Staphylococcus aureus (MRSA) infections have recently become a major concern in long-term care facilities (LTCF). Patients that have been colonized with MRSA in general hospitals may introduce the organisms into LTCF, and these can become reservoirs for the pathogen. Our objective was to evaluate the rate of colonization by S aureus, especially MRSA, in elderly residents of a large LTCF, and to find factors that predispose to it.
Methods:
A nasal culture was obtained from randomly selected patients in an Israeli LTCF. Inclusion criteria were absence of active infection and no antibiotic treatment in the preceding month. The carrier state was defined when two consecutive cultures were positive for S aureus.
Results:
The study population comprised 270 patients, aged 81 +/- 9.3 years and from all types of wards. Of these, 63 (23.3%) were carriers of S aureus and 17 of those (27%) had MRSA. From univariate analysis, the carrier state was associated with antibiotic treatment or an invasive procedure in the previous 3 months, and with a prior MRSA infection. Subacute LTCF departments had a higher carrier rate than the chronic care wards.
Conclusions:
In this large multilevel facility, 6.2% of the patients were MRSA carriers, and came predominantly from the subacute departments, suggesting an influx from general hospitals. This information and the identification of factors associated with MRSA infection permit the development of an institutional infection control program.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) is a growing concern in long-term care facilities (LTCF). This study found 6.2% of elderly LTCF residents were MRSA carriers, often linked to prior antibiotic use or hospital stays.
Area of Science:
- Infectious Diseases
- Geriatric Medicine
- Epidemiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in long-term care facilities (LTCFs).
- Patients transferred from general hospitals can introduce and sustain MRSA within LTCFs, creating reservoirs.
- Understanding MRSA colonization rates and risk factors in LTCF residents is crucial for infection control.
Purpose of the Study:
- To determine the prevalence of Staphylococcus aureus and MRSA colonization in elderly residents of a large Israeli LTCF.
- To identify demographic and clinical factors associated with MRSA colonization in this population.
Main Methods:
- Nasal cultures were collected from 270 randomly selected LTCF residents in Israel.
- Inclusion criteria included absence of active infection and no antibiotic use in the prior month.
- The carrier state was confirmed by two consecutive positive Staphylococcus aureus cultures.
Main Results:
- Overall, 23.3% of residents carried Staphylococcus aureus, with 27% of these carriers (6.2% of total population) having MRSA.
- Factors associated with carrier status included recent antibiotic treatment, invasive procedures (within 3 months), and prior MRSA infection.
- Subacute care departments exhibited higher MRSA carrier rates compared to chronic care wards.
Conclusions:
- Approximately 6.2% of residents in this large LTCF were MRSA carriers, primarily originating from subacute units, suggesting hospital-to-LTCF transmission.
- Identifying MRSA carriers and associated risk factors enables the development of targeted infection control strategies.
- Implementing an institutional infection control program is recommended to mitigate MRSA spread in LTCFs.