Risk Factors for Invasive Methicillin-resistant Staphylococcus aureus Infection after Recent Discharge from an Acute Care Hospitalization, 2011-2013

Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. We assessed risk factors for developing invasive MRSA infections following acute care hospitalizations to inform prevention strategies.

We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible cases were identified from 15 hospitals across 6 U.S. states. For each case, two controls were matched on hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for post-discharge invasive MRSA.

From February 1, 2011 through March 31, 2013, 194 cases and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range: 1–83 days). Factors independently associated with post-discharge MRSA infection included MRSA colonization (mOR 7.71, 95%CI 3.60-16.51), discharge to a nursing home (mOR 2.65, 95%CI 1.41-4.99), presence of a chronic wound during the post-discharge period (mOR 4.41, 95%CI 2.14-9.09), and discharge with a central venous catheter (CVC) (mOR 2.16, 95%CI 1.13-4.99) or a non-CVC invasive device (mOR 3.03, 95%CI 1.24-7.39) in place.

Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted.

Full reference: Epstein, L. et al Risk Factors for Invasive Methicillin-resistant Staphylococcus aureus Infection after Recent Discharge from an Acute Care Hospitalization, 2011-2013  Clinical Infectious Diseases. First published online: September 2015

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