Journal Article

Risk Factors for Colonization with Methicillin-Resistant <i>Staphylococcus aureus</i> (MRSA) in Patients Admitted to an Urban Hospital: Emergence of Community-Associated MRSA Nasal Carriage

Alicia I. Hidron, Ekaterina V. Kourbatova, J. Sue Halvosa, Bianca J. Terrell, Linda K. McDougal, Fred C. Tenover, Henry M. Blumberg and Mark D. King

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 2, pages 159-166
Published in print July 2005 | ISSN: 1058-4838
Published online July 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/430910
Risk Factors for Colonization with Methicillin-Resistant Staphylococcus aureus (MRSA) in Patients Admitted to an Urban Hospital: Emergence of Community-Associated MRSA Nasal Carriage

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Background. Surveillance cultures performed at hospital admission have been recommended to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) but require substantial resources. We determined the prevalence of and risk factors for MRSA colonization at the time of hospital admission among patients cared for at a public urban hospital.

Methods. Anterior nares cultures were obtained within 48 h after admission during a 1-month period. A case-control study and molecular typing studies were performed.

Results. A total of 53 (7.3%) of 726 patients had a nares culture positive for MRSA, and 119 (16.4%) had a nares culture that was positive for methicillin-susceptible S. aureus. In multivariate analysis, risk factors for MRSA colonization included antibiotic use within 3 months before admission (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.2–5.0), hospitalization during the past 12 months (OR, 4.0; 95% CI, 2.0–8.2), diagnosis of skin or soft-tissue infection at admission (OR, 3.4; 95% CI, 1.5–7.9), and HIV infection. A total of 47 (89%) of 53 case patients colonized with MRSA had at least 1 of these independent risk factors, in contrast to 343 (51%) of 673 control patients (OR, 7.5; 95% CI, 3.2 –17.9). Molecular typing demonstrated that 16 (30%) of 53 MRSA nares isolates (2.2% of the 726 isolates) belonged to the USA300 community-associated MRSA (CA-MRSA) genotype.

Conclusion. The prevalence of MRSA colonization at the time of patient admission was high (>7%). Limiting surveillance cultures to patients with ⩾1 of the identified risk factors may allow for targeted screening. The emergence of CA-MRSA colonization represents a new, unrecognized reservoir of MRSA within hospitals, potentially increasing the risk for horizontal transmission.

Journal Article.  4351 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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