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Daily Hazard of Acquisition of Methicillin-Resistant Staphylococcus aureus Infection in the Intensive Care Unit

  • Caroline Marshall (a1) (a2), Denis Spelman (a3), Glenys Harrington (a3) and Emma McBryde (a2)

Abstract

Objective.

Increasing length of hospital stay is associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition. The exact risk of becoming colonized with MRSA on a given day has not been clearly elucidated. We determined the hazard of MRSA acquisition in relation to the length of time spent in an intensive care unit in which only standard precautions were used for MRSA-colonized and MRSA-infected patients.

Methods.

This study took place at a tertiary referral hospital intensive care unit in which patients were screened for MRSA at hospital admission, at hospital discharge, and twice weekly during intensive care unit stay. We analyzed the hazard of MRSA acquisition by using a statistical smoothing kernel for hazard with a width of 5 days. Patients were stratified according to age, sex, medical unit, and length of hospital stay.

Results.

Of the patients who were at risk of colonization or infection, 12.8% acquired MRSA. The mean length of stay in the intensive care unit was 7.2 days. The daily hazard of acquiring MRSA was less than 1% at admission to the intensive care unit and increased linearly to more than 2% risk per day by day 12, followed by a leveling out of risk.

Conclusions.

The daily hazard of acquiring MRSA is not constant. This has implications for studies that assume a constant hazard in their analysis and should be considered.

Copyright

Corresponding author

Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan St., Parkville, Victoria, 3050, Australia (caroline.marshall@mh.org.au)

References

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7.Thompson, DS. Methicillin-resistant Staphylococcus aureus in a general intensive care unit. J R Soc Med 2004;97:521526.
8.Lim, MSC, Marshall, CL, Spelman, D. Carriage of multiple subtypes of methicillin-resistant Staphylococcus aureus (MRSA) by intensive care unit patients. Infect Control Hosp Epidemiol 2006;27:10631067.

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