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Comparison of the Methicillin-Resistant Staphylococcus aureus Acquisition among Rehabilitation and Nursing Home Residents

Published online by Cambridge University Press:  02 January 2015

Jon P. Furuno*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Simone M. Shurland
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Min Zhan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Richard A. Venezia
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland VA Maryland Health Care System, Baltimore, Maryland
Mary-Claire Roghmann
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland VA Maryland Health Care System, Baltimore, Maryland
*
Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore St., Room 334C, Baltimore, MD, 21201 (jfuruno@epi.umaryland.edu)

Abstract

Objective.

To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident.

Design.

Prospective cohort study.

Setting.

Extended care units at 2 healthcare systems in Maryland.

Participants.

Four hundred forty-three residents with no history of MRSA and negative MRSA surveillance cultures of the anterior nares and areas of skin breakdown at enrollment.

Methods.

Follow-up cultures were collected every 4 weeks and/or at discharge for a period of 12 weeks. Study data were collected by a research nurse from the medical staff and the electronic medical records. Cox proportional hazards modeling was used to calculate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs).

Results.

Residents in rehabilitation care had 4-fold higher risk of MRSA acquisition compared with residents in residential care (hazard ratio [HR], 4. [95% CI, 2.2-8.8]). Being bedbound was significantly associated with MRSA acquisition in both populations (residential care, aHR, 4.3 [95% CI, 1.5-12.2]; rehabilitation care, aHR, 4.8 [95% CI, 1.2-18.7]). Having an MRSA-positive roommate was not significantly associated with acquisition in either population (residential care, aHR, 1.4 [95% CI, 0.5-3.9]; rehabilitation care, aHR, 0.5 [95% CI, 0.1-2.2]); based on concordant spa typing, only 2 of 8 residents who acquired MRSA and had room placement with an MRSA-positive resident acquired their MRSA isolate from their roommate.

Conclusion.

Residents in rehabilitation care appear at higher risk and have different risk factors for MRSA acquisition compared to those in residential care.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

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