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Length of stay and odds of MRSA acquisition: a dose-response relationship?

H Y Loke1, W M Kyaw1, M I C Chen2

  • 1Department of Clinical Epidemiology,Office of Clinical Epidemiology, Analytics, and Knowledge,Tan Tock Seng Hospital,Singapore.

Epidemiology and Infection
|August 1, 2019
PubMed

Insights

Longer hospital stays significantly increase the risk of acquiring methicillin-resistant Staphylococcus aureus (MRSA) infections. Identifying modifiable risk factors like extended duration is crucial for preventing MRSA spread in hospitals.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Clinical Microbiology

Background:

  • Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of hospital-acquired infections, leading to increased morbidity and mortality.
  • Understanding modifiable risk factors for MRSA acquisition is essential for effective infection control strategies in healthcare settings.

Purpose of the Study:

  • To identify modifiable risk factors associated with the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection.
  • To build upon previous studies by analyzing data from a universal on-admission MRSA screening program.

Main Methods:

  • Retrospective cohort study design involving patients admitted through the Emergency Department of an acute tertiary-care general hospital in Singapore.
  • Logistic regression models were used to identify factors associated with MRSA acquisition, with patients categorized into acquisition and non-acquisition groups.
  • Analysis included 1302 patients in the acquisition group and 37,949 in the non-acquisition group, with 15 variables in the multivariate model.

Main Results:

  • Length of hospital stay demonstrated a dose-response relationship with MRSA acquisition, with stays of 3 weeks or longer being the strongest predictor (Adjusted Odds Ratio 11.78-57.36).
  • Other significant risk factors identified include male gender, age 65 years or older, prior MRSA colonization or infection, exposure to specific antibiotics, surgery, and a history of diabetes.
  • The study highlights multiple contributing factors to MRSA acquisition in a hospital setting.

Conclusions:

  • Extended hospital length of stay is a critical, modifiable risk factor for MRSA acquisition.
  • Targeting interventions towards high-risk patient groups (elderly, those with prior MRSA, specific comorbidities) and optimizing antibiotic use and surgical protocols can help mitigate MRSA spread.
  • Universal on-admission screening combined with risk factor identification provides a comprehensive approach to controlling MRSA in hospitals.
Keywords:
Bacterial infectionshospital-acquired (nosocomial) infectionsmethicillin-resistant S. aureus (MRSA)

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