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- Title
Methicillin-resistant staphylococcal colonization and infection in a long-term care facility.
- Authors
Muder, Robert R.; Brennen, Carole; Wagener, Marilyn M.; Vickers, Richard M.; Ribs, John D.; Hancock, Gary A.; Yee, Ying C.; Miller, J. Michael; Yu, Victor L.; Muder, R R; Brennen, C; Wagener, M M; Vickers, R M; Rihs, J D; Hancock, G A; Yee, Y C; Miller, J M; Yu, V L
- Abstract
<bold>Objective: </bold>To determine the natural history of colonization by methicillin-resistant Staphylococcus aureus (MRSA) among patients in a long-term care facility. We specifically sought to determine if MRSA colonization was predictive of subsequent infection.<bold>Design: </bold>Cohort study.<bold>Setting: </bold>Long-term Veterans Affairs Medical Center.<bold>Patients: </bold>A total of 197 patients residing on two units were followed with regular surveillance cultures of the anterior nares.<bold>Main Outcome Measurement: </bold>The development of staphylococcal infection.<bold>Results: </bold>Thirty-two patients were persistent carriers of MRSA and 44 were persistent carriers of methicillin-susceptible strains (MSSA). Twenty-five percent of MRSA carriers had an episode of staphylococcal infection compared with 4% of MSSA carriers and 4.5% of non-carriers (P less than 0.01; relative risk 3.8; 95% CI, 2.0 to 6.4). The rate of development of infection among MRSA carriers was 15% for every 100 days of carriage. Using logistic regression analysis, persistent MRSA carriage was the most significant predictor of infection (P less than 0.001; odds ratio, 3.7). Seventy-three percent of all MRSA infections occurred among MRSA carriers. Isolates of MRSA from 7 patients were typed. Colonizing and infecting strains had the same phage type in all 7 patients and the same pattern of plasmid EcoRI restriction endonuclease fragments in 5 patients.<bold>Conclusions: </bold>Colonization of the anterior nares by MRSA predicts the development of staphylococcal infection in long-term care patients; most infections arise from endogenously carried strains. Colonization by MRSA indicates a significantly greater risk for infection than does colonization by MSSA. The results offer a theoretic rationale for reduction in MRSA infections by interventions aimed at eliminating the carrier state.
- Subjects
METHICILLIN resistance; DRUG resistance in microorganisms; STAPHYLOCOCCUS aureus; BACTERIOPHAGE typing; CARRIER state (Communicable diseases); CROSS infection; GENES; LONGITUDINAL method; NOSE; NURSING care facilities; STAPHYLOCOCCAL diseases
- Publication
Annals of Internal Medicine, 1991, Vol 114, Issue 2, p107
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-114-2-1-107