Invasive Methicillin-Resistant Staphylococcus aureus Infections in Residents of Long-Term Care Facilities: Targeted Prevention Efforts Needed
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Long-term care facility (LTCF) residence is a well described risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization, with prevalence as high as 58%. Studies examining MRSA in LTCFs have focused on risk factors for carriage but less is known about MRSA infections in this setting. We describe characteristics and healthcare exposures of LTCF residents with invasive MRSA infections, and compare LTCF-onset and hospital-onset (HO) infections. Methods. We analyzed data on invasive MRSA infections (i.e. cultured from sterile body sites) from surveillance areas in 9 states reported to CDC's Emerging Infections Program (EIP) from 2009 to 2013. Onset location was defined as the facility where patients resided 3 days before infection. We described characteristics of LTCF-onset MRSA infections from all 9 sites. Using nursing home utilization data from California (CA), we estimated pooled mean MRSA bloodstream infection (BSI) incidence (per 100,000 patient-days) from LTCFs within the CA EIP catchment area and compared to HO MRSA BSI incidence from general acute-care hospitals within the same area (obtained from publicly reported data). Results. Of invasive MRSA infections reported from 9 sites, 4607 were LTCF-onset compared to 4344 HO infections. Most LTCF-onset infections were BSI (91%), with an in-hospital case-fatality rate of 19%. Among LTCF residents with invasive MRSA infections, known risk factors for infection were common: 1014 (22%) had decubitus ulcers, 1455 (32%) had previous MRSA infection or colonization, 1098 (24%) had a central venous catheter in the 2 days before initial culture, and 1101 (24%) were chronic dialysis patients; 958 (30%) were discharged from an acute-care hospital in the prior 30 days. In 2013 the pooled mean incidence of LTCF-onset MRSA BSI in the CA EIP catchment area was 3.3 per 100,000 patient days, compared to 4.3 HO infections per 100,000 patient days (P = 0.10) (median facility HO rate: 3.4 per 100,000 patient-days). Conclusion. These data suggest the burden of LTCF-onset invasive MRSA infections may now be comparable to HO infections. While infection control measures have shown success in preventing invasive MRSA infections in hospitals, future strategies to reduce the burden of invasive MRSA infections should address the LTCF population. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2340038249