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Prevalence, Prediction, and Clonality of Methicillin-Resistant Staphylococcus aureus Carriage at Admission to Medical Units in Hong Kong, China

Published online by Cambridge University Press:  10 May 2016

Shik Luk ,
Alex Yat Man Ho ,
Tak Keung Ng ,
Iris Hoi Ling Tsang ,
Eliza Hoi Ying Chan ,
Kin Wing Choi ,
Ngai Chong Tsang ,
Rodney Allan Lee ,
Vincent Chi Chung Cheng  and
Sau Chun Fung
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Shik Luk*
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Alex Yat Man Ho
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Tak Keung Ng
Affiliation:
Department of Pathology, Princess Margaret Hospital, Hong Kong, China
Iris Hoi Ling Tsang
Affiliation:
Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
Eliza Hoi Ying Chan
Affiliation:
Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
Kin Wing Choi
Affiliation:
Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
Ngai Chong Tsang
Affiliation:
Chief Infection Control Officer Office, Hospital Authority, Hong Kong, China Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China
Rodney Allan Lee
Affiliation:
Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
Vincent Chi Chung Cheng
Affiliation:
Department of Microbiology, Queen Mary Hospital, Hong Kong, China
Sau Chun Fung
Affiliation:
Department of Pathology, United Christian Hospital, Hong Kong, China
Wai Man Lai
Affiliation:
Department of Microbiology, Prince of Wales Hospital, Hong Kong, China
Tak Lun Que
Affiliation:
Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong, China
Andrew Tin Yau Wong
Affiliation:
Infection Control Branch, Centre for Health Protection, Department of Health, Hong Kong, China; Infectious Disease Control Training Centre, Hospital Authority, Hong Kong, China
*
12/F, Department of Pathology, Block G, Princess Margaret Hospital, Hong Kong, China (sluk@ha.org.hk)
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Abstract

Objective.

To determine the prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) colonization at the time of admission to acute medical units and to develop a cost-effective screening strategy.

Methods.

Nasal and groin screening cultures were performed for patients at admission to 15 acute medical units in all 7 catchment regions in Hong Kong. All MRSA isolates were subjected to spa typing.

Results.

The overall carriage rate of MRSA was 14.3% (95% confidence interval [CI], 13.5–15.1). MRSA history within the past 12 months (adjusted odds ratio [OR], 4.60 [95% CI, 3.28–6.44]), old age home residence (adjusted OR, 3.32 [95% CI, 2.78–3.98]), and bedbound state (adjusted OR, 2.19 [95% CI, 1.75–2.74]) were risk factors selected as MRSA screening criteria that provided reasonable sensitivity (67.4%) and specificity (81.8%), with an affordable burden (25.2%). spa typing showed that 89.5% (848/948) of the isolates were clustered into the 4 spa clonal complexes (CCs): spa CC1081, spa CC032, spa CC002, and spa CC4677. Patients colonized with MRSA spa types t1081 (OR, 1.77 [95% CI, 1.49–2.09]) and t4677 (OR, 3.09 [95% CI, 1.54–6.02]) were more likely to be old age home residents.

Conclusions.

MRSA carriage at admission to acute medical units was prevalent in Hong Kong. Our results suggest that targeted screening is a pragmatic approach to increase the detection of the MRSA reservoir. Molecular typing suggests that old age homes are epicenters in amplifying the MRSA burden in acute hospitals. Enhancement of infection control measures in old age homes is important for the control of MRSA in hospitals.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 1 , January 2014 , pp. 42 - 48
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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