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Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes
P L Mulhausen1, L J Harrell, M Weinberger
1Geriatric Research, Education, and Clinical Center, VAMC Durham, North Carolina, USA.
Purpose:
To compare the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, the patterns of MRSA acquisition, and the risk for subsequent MRSA infection between a hospital-based, Department of Veterans Affairs (VA) nursing home care unit (NHCU) and community-based nursing homes.
Patients And Methods:
In this prospective study, 148 residents of three community nursing homes and 55 residents of a VA NHCU had their anterior nares swabbed; repeat cultures were obtained from hospitalized patients and/or individuals colonized with MRSA. Subjects were followed up prospectively for 1 year to note hospitalizations and the development of MRSA infections.
Results:
The prevalence of MRSA colonization was significantly higher in the VA NHCU than in the community nursing homes (mean +/- SD 30.3% +/- 11% versus 9.9% +/- 4%). The rate of MRSA nares colonization was similar in the two settings. Acquisition of MRSA took place in both the long-term care facilities and hospitals, with 23.8% of incident cases occurring during a hospitalization. Only 3 of the 27 individuals colonized at baseline developed an MRSA infection. A trend toward an increased rate of infection was seen in colonized individuals residing in the community nursing homes versus those in the VA NHCU (relative risk 4.67; 95% Cl 0.55 to 39.9). Forty-seven percent of the 55 subjects hospitalized were colonized at some point during the study. In contrast to residents of the VA NHCU, MRSA colonization in the community facilities was a marker for high mortality.
Conclusions:
Outcomes from colonization may be different in the VA NHCU population and the community nursing home population.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) colonization is more prevalent in VA nursing homes. However, MRSA infection outcomes differ between VA and community nursing home residents.
Area of Science:
- Infectious Diseases
- Epidemiology
- Geriatric Medicine
Background:
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a significant threat in healthcare settings, particularly in long-term care facilities.
- Understanding MRSA colonization and infection dynamics is crucial for effective infection control strategies.
- Differences in patient populations and healthcare environments may influence MRSA prevalence and outcomes.
Purpose of the Study:
- To compare MRSA nares colonization prevalence between a hospital-based VA nursing home care unit (NHCU) and community nursing homes.
- To investigate patterns of MRSA acquisition in these settings.
- To assess the risk of subsequent MRSA infection in relation to colonization.
Main Methods:
- Prospective study involving 148 community nursing home residents and 55 VA NHCU residents.
- Anterior nares swabs for MRSA culture, with repeat cultures for hospitalized or colonized individuals.
- 1-year prospective follow-up for hospitalizations and MRSA infections.
Main Results:
- MRSA colonization prevalence was significantly higher in the VA NHCU (30.3%) compared to community nursing homes (9.9%).
- MRSA acquisition occurred in both settings and during hospitalizations (23.8% of incident cases).
- MRSA colonization was a marker for high mortality in community nursing homes, unlike in the VA NHCU.
Conclusions:
- The prevalence of MRSA colonization differs significantly between VA NHCUs and community nursing homes.
- MRSA acquisition is a concern in both long-term care and hospital settings.
- The clinical outcomes and implications of MRSA colonization vary between VA and community nursing home populations.