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Long-term carriage, and transmission of methicillin-resistant Staphylococcus aureus after discharge from hospital
H M Frénay1, C M Vandenbroucke-Grauls, M J Molkenboer
1Department of Clinical Microbiology, Utrecht University Hospital, The Netherlands.
Abstract:
The purpose of this study was to determine whether patients who become carriers of methicillin-resistant Staphylococcus aureus (MRSA) during their stay in hospital, remain colonized after discharge. Thirty-six patients colonized with MRSA during one of three outbreaks at Utrecht University Hospital (1986-89) were screened 2 or 3 years after they had become carriers. Patients were also interviewed to determine factors contributing to persistent carriage, such as antibiotics, re-admissions to the hospital, presence of skin lesions and chronic diseases. At the same time transmission of MRSA to family members was determined. The epidemic MRSA strain was still found in three patients (8%). One was a cystic fibrosis patient who had had frequent re-admissions to the hospital and had received several course of antibiotic treatment. Both of the other patients had skin lesions: a fistula and a colostomy respectively. None of the 44 family members of the patients was colonized or infected with MRSA. We conclude that long-term MRSA carriage occurs with low frequency and is comparable to persistent carriage of methicillin-sensitive Staphylococcus aureus (MSSA). Transmission of MRSA to healthy individuals in an antibiotic-free environment is a rare event.
Insights
Long-term methicillin-resistant Staphylococcus aureus (MRSA) carriage after hospital discharge is rare. Most patients clear MRSA, with transmission to family members being uncommon.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant healthcare challenge.
- Understanding long-term carriage and transmission dynamics post-hospitalization is crucial for infection control.
Observation:
- Thirty-six patients previously colonized with MRSA during hospital outbreaks were followed up 2-3 years post-discharge.
- Factors such as antibiotic use, re-admissions, skin lesions, and chronic diseases were assessed for their role in persistent carriage.
Findings:
- Only 8% (3 out of 36) of patients remained colonized with the epidemic MRSA strain.
- Persistent carriage was associated with specific conditions like cystic fibrosis with frequent re-admissions and antibiotic treatment, or presence of skin lesions (fistula, colostomy).
- No MRSA transmission was detected among 44 household family members.
Implications:
- Long-term MRSA carriage after discharge is infrequent and comparable to methicillin-sensitive Staphylococcus aureus (MSSA).
- Transmission of MRSA to healthy contacts in non-hospital settings is rare.
- These findings suggest that intensive decolonization strategies may not be necessary for all patients post-discharge.