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Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Carriage in Residents of Veterans Affairs Long-Term Care Facilities: Role of Antimicrobial Exposure and MRSA Acquisition

Published online by Cambridge University Press:  02 January 2015

Nimalie D. Stone ,
Donna R. Lewis ,
Theodore M. Johnson II ,
Thomas Hartney ,
Doris Chandler ,
Johnita Byrd-Sellers ,
John E. McGowan Jr ,
Fred C. Tenover ,
John A. Jernigan  and
Robert P. Gaynes
Nimalie D. Stone*
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Donna R. Lewis
Affiliation:
Atlanta Veterans Affairs Medical Center, Atlanta Veterans Affairs Health Services Research and Development Service, and Birmingham-Atlanta Geriatric Research Education and Clinical Centers, Decatur, Georgia
Theodore M. Johnson II
Affiliation:
Emory University School of Medicine, Atlanta, Georgia Atlanta Veterans Affairs Medical Center, Atlanta Veterans Affairs Health Services Research and Development Service, and Birmingham-Atlanta Geriatric Research Education and Clinical Centers, Decatur, Georgia
Thomas Hartney
Affiliation:
Augusta Veterans Affairs Medical Center, Augusta, Georgia
Doris Chandler
Affiliation:
Tuscaloosa Veterans Affairs Medical Center, Tuscaloosa, Alabama
Johnita Byrd-Sellers
Affiliation:
Atlanta Veterans Affairs Medical Center, Atlanta Veterans Affairs Health Services Research and Development Service, and Birmingham-Atlanta Geriatric Research Education and Clinical Centers, Decatur, Georgia
John E. McGowan Jr
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
Fred C. Tenover
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Gaynes
Affiliation:
Atlanta Veterans Affairs Medical Center, Atlanta Veterans Affairs Health Services Research and Development Service, and Birmingham-Atlanta Geriatric Research Education and Clinical Centers, Decatur, Georgia
*
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Building 16, MS:A-31, Atlanta, GA 30333 (nstone@cdc.gov)
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Abstract

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Objective.

To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents.

Design.

Multicenter, prospective cohort followed over 6 months.

Setting.

Three Veterans Affairs (VA) LTCFs.

Participants.

All current and new residents except those with short stay (<2 weeks).

Methods.

MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE).

Results.

Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1–28.6]; P = .002). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers.

Conclusions.

MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 6 , June 2012 , pp. 551 - 557
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

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