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Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst
R Coello1, J R Glynn, C Gaspar
1Servicio de Medicina Preventiva, Hospital Universitario San Carlos, Madrid, Spain.
Abstract:
In hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) many patients are initially colonized without infection. The reasons why some progress to infection while others do not are not known. A cohort of 479 hospital patients, initially only colonized with MRSA, was followed prospectively for the development of MRSA infection. Risk factors for progression to infection were assessed using Cox proportional hazards survival analysis. Fifty-three patients (11.1%) developed 68 MRSA infections. Intensive care setting, administration of three or more antibiotics, ulcers, surgical wounds, nasogastric or endotracheal tubes, drains, and urinary or intravenous catheterization were all associated with increased rates of MRSA infection. Multivariate analysis showed that intensive care patients, compared with medical patients, had a higher rate of developing MRSA infection within the first four days of admission, with a hazard ratio of 26.9 (95% CI 5.7-126). Surgical wounds, pressure ulcers and intravenous catheterization were also independent risk factors, with hazard ratios (and 95% CI) of 2.9 (1.3-6.3); 3.0 (1.6-5.7) and 4.7 (1.4-15.6), respectively. These findings suggest that, during an MRSA outbreak, clinical infection would be reduced if surgical and intensive care patients received priority for the prevention of initial colonization with MRSA. Prevention of pressure ulcers, and strict aseptic care of intravenous catheters and surgical wounds would also reduce the development of MRSA infection. Since early treatment with vancomycin is known to reduce the mortality, patients colonized with MRSA who also have one or more of these risk factors may warrant empirical vancomycin therapy at the earliest suggestion of infection.
Insights
Hospitalized patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) face infection risks. Intensive care, wounds, and catheters increase MRSA infection rates, suggesting targeted prevention for high-risk groups.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Clinical Microbiology
Background:
- Hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) frequently involve patient colonization without active infection.
- The transition from MRSA colonization to clinical infection remains poorly understood.
- Identifying risk factors for MRSA infection progression is crucial for effective patient management.
Purpose of the Study:
- To prospectively identify risk factors associated with the development of MRSA infection in hospitalized patients initially colonized with MRSA.
- To inform targeted prevention strategies during MRSA outbreaks.
Main Methods:
- A cohort of 479 MRSA-colonized patients was followed prospectively.
- Cox proportional hazards survival analysis was used to assess risk factors for MRSA infection.
- Multivariate analysis identified independent predictors of MRSA infection.
Main Results:
- 11.1% of patients developed MRSA infections.
- Intensive care setting, multiple antibiotic use, ulcers, surgical wounds, invasive devices (tubes, drains, catheters) were associated with increased MRSA infection rates.
- Independent risk factors included intensive care (HR 26.9), surgical wounds (HR 2.9), pressure ulcers (HR 3.0), and IV catheterization (HR 4.7).
Conclusions:
- Intensive care and surgical patients require priority for MRSA colonization prevention.
- Preventing pressure ulcers and maintaining aseptic care for wounds and catheters can reduce MRSA infection.
- MRSA-colonized patients with risk factors may benefit from early empirical vancomycin therapy.