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Infections Caused by Staphylococcus aureus in a Veterans' Affairs Nursing Home Care Unit: A 5-Year Experience

Published online by Cambridge University Press:  02 January 2015

Steven J. Spindel ,
Larry J. Strausbaugh  and
Cleone Jacobson
Steven J. Spindel
Affiliation:
Infectious Disease Section, Medical Service, School of Medicine, Oregon Health Sciences University, Portland, Oregon
Larry J. Strausbaugh*
Affiliation:
Infectious Disease Section, Medical Service, School of Medicine, Oregon Health Sciences University, Portland, Oregon Veterans' Affairs Medical Center, and the Division of lnfectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, Oregon
Cleone Jacobson
Affiliation:
Nursing Service, School of Medicine, Oregon Health Sciences University, Portland, Oregon
*
(111F) Veterans' Affairs Medical Center, P.O. Box 1034, Portland, OR 97207
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Abstract

Objectives:

To describe the frequency and patterns of infection caused by methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S aureus (MRSA) infections in a single nursing home population and to determine the effect of MRSA's entry into the facility on subsequent experience with both MSSA and MRSA infections.

Design:

Observational and descriptive. Surveillance data on nursing home-acquired infections were reviewed to identify all patients with MSSA and MRSA infections occurring during the 5-year period from 1987 to 1991. The medical records of these patients were reviewed retrospectively to collect additional information about the patients and their infections.

Setting and Patients:

A 120-bed Veterans' Affairs nursing home care unit (NHCU) whose residents predominantly were elderly men with severe underlying diseases and functional impairments,

Results:

During the 5-year study period, 40 MSSA and 28 MRSA infections were acquired by NHCU residents. Twelve to 19 S aureus infections occurred each year. S aureus accounted for 13% to 17% of all NHCU-acquired infections during the years of study, occurring with a frequency of 0.29 to 0.47 infections per 1,000 resident-care days. MRSA infections, first detected in 1988, accounted for an increasing percentage of S aureus infections in subsequent years, but this increase had little effect on the facility's overall infection rates, the composite S aureus infection rates, or the types of infections observed. MSSA and MRSA infections acquired in the NHCU were comparable. Both affected patients with severe underlying diseases and functional impairments. Pneumonia, urinary tract infections, skin and soft tissue infections, and conjunctivitis were the types of infections observed most frequently, accounting for 28%, 25%, 22%, and 15% of all S aureus infections, respectively. Four bacteremic infections occurred in the MSSA group, and five in the MRSA group (P=.47). Four of the MSSA and three of the MRSA infections resulted in death (P= 1.0). Nine of the MSSA and 12 of the MRSA infections resulted in the patient's transfer to the associated acute care hospital for additional care (P= .13).

Conclusions:

In the NHCU setting, MSSA and MRSA infections were similar in terms of the types of residents affected, the sites involved, and the frequency of adverse outcomes. The entry of MRSA into the facility appeared to have no effect on the subsequent experience with NHCU-acquired infections caused by S aureus.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 4 , April 1995 , pp. 217 - 223
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995

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References

1.Storch, GA, Radcliff, JL, Meyer, PL, Hinrichs, JH. Methicilhin-resistant Staphylococcus aureus in a nursing home. Infect Control 1987;8:24–29.Google Scholar
2.Thomas, JC, Bridge, J, Waterman, S, Vogt, J, Kilman, L, Hancock, G. Transmission and control of methicillin-resistant Staphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol 1989;10:106–110.Google Scholar
3.Hsu, CCS, Macaluso, CP, Special, L, Hubble, RH. High rate of methicillin resistance of Staphylococcus aureus isolated from hospitalized nursing home patients. Arch Intern Med 1988;148:569–570.Google Scholar
4.Cederna, JE, Terpenning, MS, Ensberg, M, Bradley, SF, Kauffman, CA. Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin. Infect Control Hosp Epidemiol 1990;11:13–16.Google Scholar
5.Kauffman, CA, Bradley, SF, Terpenning, MS. Methicillin-resistant Staphylococcus aureus in long-term care facilities. Infect Control Hosp Epidemio1 1990;11:600–603.Google Scholar
6.Strausbaugh, LS, Jacobson, C, Sewell, DL, Potter, S, Ward, ITMethicillin-resistant Staphylococcus aureus in extended-care facilities: experiences in a Veterans' Affairs nursing home and a review of the literature. Infect Control Hosp Epidemiol 1991;12:36–45.Google Scholar
7.Muder, RR, Brennen, C, Wagener, MM, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
8.Boyce, JM. Methicillin-resistant Staphylococcus aureus in nursing homes: putting the problem in perspective. Infect Control Hosp Epidemiol 1991;12:413–415.Google Scholar
9.Hsu, CCS. Serial survey of methicillin-resistant Staphylococcus aureus nasal carriage among residents in a nursing home. Infect Control Hosp Epidemiol 1991;12:416421.Google Scholar
10.Bradley, SF, Terpenning, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.Google Scholar
11.Strausbaueh, LJ, Jacobson, C, Sewell, DL, Potter, S. Ward, TT. Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans' Affairs Nursing Home Care Unit. Infect Control Hosp Epidemiol 1992;13:151–159.Google Scholar
12.Ward, TT, Strausbaugh, LJ. Increasing prevalence of methicillin-resistant Staphylococcus aureus in hospitals and nursing homes: the Oregon experience. Infections in Medicine 1992;9:46–51.Google Scholar
13.Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.Google Scholar
14.Mylotte, JM, Karuza, J, Bentley, DW. Methicillin-resistant Staphy1ococcus aureus: a questionnaire survey of 75 long-term care facilities in western New York. Infect Control Hosp Epidemiol 1992;13:711–718.Google Scholar
15.Kauffman, CA, ‘Ipenning, MS, He, X, et al.Attempts to eradicate methicillin-resistant Staphylococcus aureus from a long-term care facility with the use of mupirocin ointment. Am J Med 1993;94:371–378.Google Scholar
16.Strausbaugh, LJ, Jacobson, C, Yost, T. Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four-year perspective. Infect Control Hosp Epidemiol 1993;14:331–336.Google Scholar
17.Jacobson, C, Strausbaugh, LJ. Incidence and impact of infection in a nursing home care unit. Am J Infect Control 1990;18:151–159.Google Scholar
18.Smith, PW, Rusnak, PG. APIC guideline for infection prevention and control in the long-term care facility. Am J Infect Control 1991;19:198–215.Google Scholar
19.Boyce, JM, White, RL, Spruill, EY. Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections. J Infect Dis 1983;148:763.Google Scholar
20.Mylotte, JM, White, DW, McDermott, C, Hodan, C. Nosocomial bloodstream infections at a Veterans hospital: 1979-1987. Infect Control Hosp Epidemiol 1989;10:455–464.Google Scholar
21.Stamm, AM, Long, MN, Belcher, B. Higher overall nosocomial infection rate because of increased attack rate of methicillin-resistant Staphylococcus aureus. Am J Infect Control 1993;21:70–74.Google Scholar
22.Gambert, SR, Duthie, EH JrPriefer, B, Rabinovitch, RA. Bacterial infections in a hospital-based skilled nursing faci1ity. J Chron Dis 1982;35:781–786.Google Scholar
23.Standfast, SJ, Michelsen, PB, Baltch, AL, et al.A prevalence survey of infections in a combined acute and long-term care hospital. Infect Control Hosp Epidemiol 1984;5:177–184.Google Scholar
24.Setia, U, Serventi, I, Lorenz, P. Nosocomial infections among patients in a long-term care facility: spectrum, prevalence, and risk factors. Am J Infect Control 1985;13:57–62.Google Scholar
25.Magnussen, MH, Robb, SS. Nosocomial infections in a long-term care facility. Am J Infect Control 1980;8:12–17.Google Scholar
26.Damowski, SB, Gordon, M, Simor, AE. Two years of infection surveillance in a geriatric long-term care facility. Am J Infect Control 1991;19:185–190.Google Scholar
27.Alvarez, S, Shell, CG, Woolley, TW, Berk, SL, Smith, JK. Nosocomial infections in long-term facilities. J Gerontol 1988;43:M9–M17.Google Scholar
28.Scheckler, WE, Peterson, PJ. Infections and infection control among residents of eight rural Wisconsin nursing homes. Arch Intern Med 1986;146:1981–1984.Google Scholar
29.Nicolle, LE, Biornson, I. Harding, GKM. MacDonell, IA. Bacteriuria in elderly institutionalized mer. N Engl J Med 1983;309:1420–1425.Google Scholar
30.Marrie, TJ, Durant, H, Kwan, C. Nursing home-acquired pneumonia: a case-control study. J Am Geriatr Soc 1986;34:697–702.Google Scholar
31.McDonald, AM, Dietsche, L, Litsche, M, et al.A retrospective study of nosocomial pneumonia at a long-term care facility. Am J Infect Control 1992;20:234–238.Google Scholar
32.Setia, U, Serventi, I, Lorenz, P. Bacteremia in a long-term care facility: spectrum and mortality. Arch Intern Med 1984;144:1633–1635.Google Scholar
33.Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long-term care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647–654.Google Scholar
34.Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: clinical studies. J Infect Dis 1979;139:273–279.Google Scholar
35.Peacock, JE, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.Google Scholar
36.Boyce, JM, Landry, M, Deetz, TR, DuPont, HL. Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control Hosp Epidemiol 1981;2:110–116.Google Scholar
37.McManus, AT, Mason, AD JrMcManus, WEPruitt, BA Jr. What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? Arch Surg 1989;124:1456–1459.Google Scholar
38.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al.Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
39.Boyce, JM, Jackson, MM, Pugliese, G, et al.Methicillm-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–115.Google Scholar
40.Mylotte, JM. Control of methicillin-resistant Staphylococcus aureus: the ambivalence persists, Infect Control Hosp Epidemiol 1994;15:73–77.Google Scholar
41.Lynch, P, Jackson, MM, Cummings, MJ, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107:243–246.Google Scholar