Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-24T16:33:17.568Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital- and Community-Based Surveillance of Methicillin-Resistant Staphylococcus aureus: Previous Hospitalization is the Major Risk Factor

Published online by Cambridge University Press:  02 January 2015

Bryna Warshawsky ,
Zafar Hussain ,
Daniel B. Gregson ,
Robert Alder ,
Marilyn Austin ,
Debra Bruckschwaiger ,
Abdul H. Chagla ,
Jackie Daley ,
Cam Duhaime  and
Kathy McGhie
...Show all authors
Bryna Warshawsky
Affiliation:
Faculty of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada Middlesex-London Health Unit, London, Ontario, Canada
Zafar Hussain*
Affiliation:
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada Faculty of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
Daniel B. Gregson
Affiliation:
St Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada Faculty of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
Robert Alder
Affiliation:
Middlesex-London Health Unit, London, Ontario, Canada
Marilyn Austin
Affiliation:
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Debra Bruckschwaiger
Affiliation:
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Abdul H. Chagla
Affiliation:
London Regional Public Health Laboratory, University of Western Ontario, London, Ontario, Canada
Jackie Daley
Affiliation:
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
Cam Duhaime
Affiliation:
Parkwood Hospital, London, Ontario, Canada
Kathy McGhie
Affiliation:
St Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada
Graham Pollett
Affiliation:
Faculty of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada Middlesex-London Health Unit, London, Ontario, Canada
Harriet Potters
Affiliation:
Parkwood Hospital, London, Ontario, Canada
Lorraine Schiedel
Affiliation:
Middlesex-London Health Unit, London, Ontario, Canada
*
Department of Microbiology and Infection Control, Victoria Campus, London Health Sciences Centre, Box 5010, London, Ontario N6A 4G5, Canada
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The purpose of the study was to determine the incidence and risk factors for the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in our community.

Design:

This study used a cross-sectional design to assess patients colonized or infected with MRSA.

Patients:

The study population consisted of residents of London, Ontario, Canada, who were identified as MRSA-positive for the first time in 1997.

Setting:

All acute- and chronic-care hospitals, long-term healthcare facilities, and community physicians' offices in the city of London participated in the study.

Main Outcome Measure:

Incidence of MRSA in the community, risk factors for acquisition, especially previous hospitalization over a defined period, and strain type were evaluated.

Results:

In 1997, 331 residents of London were newly identified as MRSA-positive, representing an annual incidence of 100/100,000 persons (95% confidence interval, 88.8-110.7). Thirty-one (9.4%) individuals were not healthcare-facility patients in the previous month, and 11 (3.3%), 10 (3.0%), and 6 (1.8%) individuals had no such contact in the previous 3, 6, and 12 months, respectively. One hundred seventy-seven strains, including five of the isolates from patients with no healthcare-facility contact in the previous year, were typed. One hundred sixty (90.3%) of these isolates, including all typed strains from patients with no healthcare facility contact, belonged to a single clone.

Conclusion:

These findings demonstrate that the incidence of MRSA is higher than previously reported and that hospital contact is the single most important risk factor for the acquisition of MRSA in our community. Screening for MRSA in previously hospitalized patients at the time of hospitalization may reduce nosocomial spread and indirectly reduce the incidence of MRSA in the community.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 11 , November 2000 , pp. 724 - 727
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Barrett, FF, McGehee, RF Jr, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologie and epidemiologic observations. N Engl J Med 1968;279:441–448.Google Scholar
2.Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.CrossRefGoogle ScholarPubMed
3.Cohen, SH, Morita, MM, Bradford, M. A seven-year experience with methicillin-resistant Staphylococcus aureus. Am J Med 1991;91(suppl 3B):233S–237S.Google Scholar
4.Rosenberg, J. Methicillin-resistant Staphylococcus aureus (MRSA) in the community: who's watching? Lancet 1995;346:132–133.Google Scholar
5.Moreno, F, Crisp, C, Jorgensen, JH, Patterson, JE. Methicillin-resistant Staphylococcus aureus as a community organism. Clin Infect Dis 1995;21:1308–1312.CrossRefGoogle ScholarPubMed
6.Lindenmayer, JM, Schoenfeld, S, O'Grady, R, Carney, JK. Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895–899.Google Scholar
7.Akram, J, Glatt, AE. True community-acquired methicillin-resistant Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 1998;19:106–107.Google Scholar
8.Torvaldesen, S, Roberts, C, Riley, TV. The continuing evolution of methicillin-resistant Staphylococcus aureus in Western Australia. Infect Control Hosp Epidemiol 1999;20:133–135.CrossRefGoogle Scholar
9.McGeer, ALow, D, Conly, J, Campbell, I, Devlin, R, Simor, A, et al. Methicillin-resistant Staphylococcus aureus in Ontario. Can Commun Dis Rep 1997;23:45–46.Google Scholar
10.Preston, M, Borczyk, A, Jamieson, F. Epidemie methicillin-resistant Staphylococcus aureus strain—Ontario. Can Commun Dis Rep 1998;24:47–49.Google Scholar
11.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. Approved standards. 4th ed. M7A4, Vol. 17 No. 2. Villanova, PA: NCCLS. 1997.Google Scholar
12.Maslow, JN, Slutsky, A, Arbeit, RD. The application of pulse-field gel electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TE, Tenover, FC, White, TJ, eds. Diagnostic Molecular Microbiology: Principles and Applications. Washington, DC: American Society of Microbiology; 1993:563–572.Google Scholar
13.Goering, RV. Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infect Control Hosp Epidemiol 1993;14:595–600.Google Scholar
14.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.Google Scholar
15.Sumrall, B, Nolan, R. Retrospective study of community acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) occurring during an epidemic of MRSA at a Veterans Affairs Hospital. Infect Control Hosp Epidemiol 1996;17(suppl):P28. Abstract 78.Google Scholar
16.Troillet, N, Carmeli, Y, Samore, MH, Dakos, J, Eichelberger, K, DeGirolami, PC, et al. Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181–185.Google Scholar
17.Mulhausen, PL, Harrell, LJ, Weinberger, M, Kochersberger, GG, Feussner, JR. Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes. Am J Med 1996;100:24–31.Google Scholar
18.Saravolatz, LD, Pohlod, DJ, Arking, LM. Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks. Ann Intern Med 1982;97:325–329.Google Scholar
19.Layton, MC, Hierholzer, WJ Jr, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital Infect Control Hosp Epidemiol 1995;16:12–17.Google Scholar
20.Herold, BC, Immergluck, LC, Maranan, MC, Lauderdale, DS, Gaskin, RE, Boyle-Vavra, S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.Google Scholar
21.Suggs, AH, Maranan, MC, Boyle-Vavra, S, Daum, RS. Methicillin-resistant and borderline methicillin-resistant asymptomatic Staphylococcus aureus colonization in children without identifiable risk factors. Pediatr Infect Dis J 1999;18:410–414.Google Scholar
22.Hoffis, RJ, Barr, JL, Doebbeling, BN, Pfaller, MA, Wenzel, RP. Familial carriage of methicillin-resistant Staphylococcus aureus and subsequent infection in a premature neonate. Clin Infect Dis 1995;21:328–332.Google Scholar
23.Hicks, NR, Moore, EP, Williams, EW. Carriage and community treatment of methicillin-resistant Staphylococcus aureus: what happens to colonized patients after discharge? J Hosp Infect 1991;19:17–24.Google Scholar
24.Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus— Minnesota and North Dakota, 1997-1999. MMWR 1999;48:707–710.Google Scholar
25.Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504. Published erratum appears in Am J Epidemiol 1996;143:1079.Google Scholar