Predicting High Prevalence of Community Methicillin-Resistant Staphylococcus aureus Strains in Nursing Homes

Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine, School of Medicine, Irvine, California.
Infection Control and Hospital Epidemiology (Impact Factor: 4.18). 03/2013; 34(3):325-6. DOI: 10.1086/669519
Source: PubMed


We assessed characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among residents of 22 nursing homes. Of MRSA-positive swabs, 25% (208/824) were positive for CA-MRSA. Median facility CA-MRSA percentage was 22% (range, 0%-44%). In multivariate models, carriage was associated with age less than 65 years (odds ratio, 1.2; [Formula: see text]) and Hispanic ethnicity (odds ratio, 1.2; [Formula: see text]). Interventions are needed to target CA-MRSA.

Download full-text


Available from: Dana Mukamel, Mar 24, 2014
  • Source
    • "The presence of pathogens like MSSA and MRSA suggests the potential for serious complications from the use of US therapy should a patient be exposed to MSSA or MRSA. Although the rate of increase of invasive MRSA infections acquired from healthcare facilities appears to be in decline in the United States (Kallen et al, 2010), troubling recent news regarding CAMRSA infections suggesting that these infections are becoming more prevalent requires that any and all possible sources of infection be reevaluated (Farr et al, 2012; Murphy et al, 2013). Since outpatient PT clinics appear to have little oversight regarding nosocomial infections, the results of this study will hopefully draw new attention to these clinics. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract A procedure commonly used in physical therapy (PT) clinics is therapeutic ultrasound (US). This equipment and associated gel comes in contact with patient skin, potentially serving as a reservoir for bacteria. In this study, we sampled US heads, gel bottle tips and gel from nine outpatient PT clinics in Southeastern Tennessee. Samples were collected using sterile swabs. At the microbiology laboratory, these swabs were used to inoculate mannitol salt agar and CHROM-MRSA agar (for Staphylococcal species) and tryptic soy broth to determine non-specific bacterial contamination. US heads, gel bottle tips and gel had variable levels of contamination. Tips of gel bottles had the highest contamination, with 52.7% positive for non-specific bacterial contamination and 3.6% positive for methicillin-resistant Staphylococcus aureus (MRSA). Contamination of gel by non-specific bacteria was found in 14.5% of bottles sampled. US heads (35.5% of those sampled) had non-specific bacterial contamination, with no MRSA detected. Disinfecting US heads after initial swabbing resulted in removal of 90.9% of non-specific contamination. Gel storage at temperatures below 40 °C was found to encourage the growth of mesophilic bacteria. This study demonstrates the need for better cleaning and storage protocols for US heads and gel bottles in PT clinics.
    Full-text · Article · Mar 2014 · Physiotherapy Theory and Practice
  • [Show abstract] [Hide abstract]
    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of morbidity and mortality in healthcare facilities. Residents of nursing homes are commonly colonized with MRSA and acquisition within these facilities is common. While treatment of MRSA infection in the NH is more costly than treatment of infections caused by methicillin-susceptible strains, the frequency of serious infections and attributable mortality remains uncommon. Consequently, controlling the spread of MRSA in NHs is primarily a population health concern and interventions to control intrafacility transmissions should be balanced with a concern for resident quality-of-life.
    No preview · Article · Sep 2013
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Chlorhexidine and mupirocin are used in health care facilities to eradicate methicillin-resistant Staphylococcus aureus (MRSA) carriage. The objective of this study was to assess the frequency of chlorhexidine and mupirocin resistance in isolates from nares carriers in multiple nursing homes and to examine characteristics associated with resistance. Nasal swab samples were collected from approximately 100 new admissions and 100 current residents in 26 nursing homes in Orange County, CA, from October 2008 to May 2011. MRSA isolates were tested for susceptibility by using broth microdilution, disk diffusion, and Etest; for genetic relatedness using pulsed-field gel electrophoresis; and for qac gene carriage by PCR. Characteristics of the nursing homes and their residents were collected from the Medicare Minimum Data Set and Long-Term Care Focus. A total of 829 MRSA isolates were obtained from swabbing 3,806 residents in 26 nursing homes. All isolates had a chlorhexidine MIC of ≤4 μg/ml. Five (0.6%) isolates harbored the qacA and/or qacB gene loci. Mupirocin resistance was identified in 101 (12%) isolates, with 78 (9%) isolates exhibiting high-level mupirocin resistance (HLMR). HLMR rates per facility ranged from 0 to 31%. None of the isolates with HLMR displayed qacA or qacB, while two isolates carried qacA and exhibited low-level mupirocin resistance. Detection of HLMR was associated with having a multidrug-resistant MRSA isolate (odds ratio [OR], 2.69; P = 0.004), a history of MRSA (OR, 2.34; P < 0.001), and dependency in activities of daily living (OR, 1.25; P = 0.004). In some facilities, HLMR was found in nearly one-third of MRSA isolates. These findings may have implications for the increasingly widespread practice of MRSA decolonization using intranasal mupirocin.
    Preview · Article · Nov 2012 · Antimicrobial Agents and Chemotherapy
Show more

We use cookies to give you the best possible experience on ResearchGate. Read our cookies policy to learn more.