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Updated: Oct 27, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition
Diego Schaps1, Andrew W Godfrey2, Deverick J Anderson3
1School of Medicine, Duke University, Durham, North Carolina.
Objective:
To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport.
Methods:
We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome.
Results:
In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09-12.71; P = .04).
Conclusions:
Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport-associated infection burden to eventually develop interventions to address it.
Insights
Patients arriving by ambulance had a nearly fourfold increased risk of developing MRSA or VRE infections within 30 days. This study highlights the potential burden of infections associated with medical transport.
Area of Science:
- Infectious Diseases
- Epidemiology
- Healthcare-Associated Infections
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) are significant healthcare-associated pathogens.
- Understanding transmission routes is crucial for infection control.
Purpose of the Study:
- To estimate the relative risk (RR) of developing MRSA or VRE colonization or infection within 30 days following ambulance transport.
- To investigate the association between ambulance use and subsequent pathogen acquisition.
Main Methods:
- Retrospective cohort study of emergency department (ED) patients diagnosed with chest pain over four years.
- Propensity score matching and multivariable logistic regression were used to compare outcomes between ambulance and private vehicle arrivals.
- Patients were included if they presented from and were discharged to non-healthcare settings without admission.
Main Results:
- A total of 11,324 patients were included after matching (3,903 ambulance, 7,421 private vehicle).
- The 30-day incidence of MRSA or VRE was 0.20% in the ambulance group versus 0.05% in the unexposed group (P = .02).
- Ambulance transport was associated with a nearly fourfold increased likelihood of MRSA or VRE within 30 days (RR, 3.72; P = .04).
Conclusions:
- This study is the first to demonstrate an association between ambulance exposure and pathogen incidence.
- Findings suggest a potential link between medical transport and infection burden.
- Further research is needed to develop interventions addressing medical-transport-associated infections.
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