Elsevier

Medicina Clínica

Volume 152, Issue 6, 15 March 2019, Pages 222-225
Medicina Clínica

Brief report
Factors for persistence of MRSA carriage one year after initial detection in individuals from various healthcare institutionsFactores de persistencia de la colonización por SARM un año más tarde de la detección inicial de portadores en distintos centros sanitarios

https://doi.org/10.1016/j.medcli.2018.03.035Get rights and content

Abstract

Introduction and objective

We studied the natural history of patients with chronic stable illnesses that are colonized by Methicillin Resistant Staphylococcus aureus (MRSA). The aim was to determine the persistence colonization 1 year after. Moreover, we intended to disclose factors that predict MRSA persistence.

Material and methods

A multicentric, prospective observational study was designed. Patients from an acute-care hospital and 4 long-term healthcare facilities were included. Demographic, clinical and microbiological data (nasal and skin swabs) were obtained every 3 months during a year. MRSA carriers were decolonized with nasal mupirocin.

Results

Among the 699 screened patients, 114 MRSA carriers were identified. MRSA carriage persisted in 59.4% of those who completed the follow-up. Baseline factors associated to MRSA persistence were heart failure, comorbidities, antibiotics, and ulcers. At one year: LTHF, underweight, Barthel < 60, and ulcers (the two latest were independent predictors). Persistence was not associated to decolonization.

Conclusion

Our study disclosed a high MRSA persistence rate and identified several associated factors (both at baseline and one year later). This information may be useful to identify individuals at high-risk of being MRSA carriers at hospital admission.

Resumen

Introducción y objetivo

Se estudió la evolución natural de los pacientes con enfermedades crónicas que son colonizados por Staphylococcus aureus resistente a la meticilina (SARM) para determinar la persistencia de colonización al año, e identificar factores predictores de persistencia.

Material y métodos

Estudio multicéntrico, prospectivo y observacional. Se incluyeron los ingresados en un hospital y los 4 centros sociosanitarios de referencia, recogiendo datos estadísticos, clínicos y microbiológicos (muestras nasales y cutáneas), trimestralmente durante un año. Los portadores recibieron mupirocina.

Resultados

Se identificaron 114 portadores de SARM entre los 699 ingresados. Fueron portadores persistentes el 59,4% de aquellos que completaron el seguimiento. Los factores basales asociados a la persistencia fueron la insuficiencia cardíaca, las comorbilidades, la antibioterapia y las úlceras. Al año: CSS, bajo peso, índice de Barthel < 60, y úlceras (estos 2 últimos de forma independiente). Persistencia y descolonización no estuvieron estadísticamente relacionados.

Conclusión

Se detectó una elevada persistencia de SARM al año, independientemente asociada a dependencia funcional y úlceras. Esta información es útil para detectar el riesgo de ser portador de SARM desde su ingreso.

Introduction

Methicillin resistant Staphylococcus aureus (MRSA) colonization is prevalent in long-term healthcare facilities (LTHF), where many aged individuals with known risk factors and high antibiotic exposure reside.1 Moreover, transmission may be facilitated by close physical contact among residents and staff.2 Since LTHF residents are likely to require frequent admissions to acute care hospitals, epidemiology of MRSA infection in the latter may be influenced by its prevalence in LTHFs in their catchment areas.3 MRSA infection worsens the prognosis of hospitalized patients,4 but the significance of MRSA colonization has been less extensively evaluated. LTHF residents may be especially suited for epidemiological studies on the potential consequences of MRSA colonization and its long-term prognosis.2

Section snippets

Methods

During a month, patients admitted to the Hospital de Mataró (acute care reference hospital [ACH]) and residents in 4 of the LTHFs in its catchment area were tested for MRSA carriage. The ACH has 342 beds and the LTHFs a total of 421. They operate in an area with 220,000 inhabitants.

Nasal and ulcer swabs were performed in all adults admitted to/residing in any of the participating institutions. Each sample was given an encrypted identification code and processed in the Microbiological

Results

Among the 699 included individuals, 114 MRSA carriers were identified, 93 in LTHFs and 21 in the ACH, resulting in prevalence of 22.5% and 7.3%, respectively (p < 0.001). Carriers were aged 76.1 ± 11.9 years, and 55.3% were female. MRSA was isolated only from the nasal fossae in 61.4% of carriers, only from skin lesions in 21.1% and from both locations in 17.5%. 30% of MRSA carriers met criteria for infection.

Follow-up was complete for 56.6% of MRSA carriers. Fifty participants were lost to

Discussion

MRSA persistence was detected in 59.4% of the 64 colonized residents who completed the year of follow-up. Most of the factors independently associated to PC at F12 in our study were not easily modifiable: antibiotic exposure in the previous 6 months, having PU and more than 2 morbidities at baseline, and having PU or a poor functional status at the end of follow-up.

Previous works have established that a majority of MRSA colonized LTHF residents continue to be carriers after 1 year.6, 7 We found

Data protection

The authors claim that consent has been received for each patient enrolled, and that in this article patients’ personal data do not appear.

Conflict of interest

There is no conflict of interest in this study, including financial, personal or any other potential conflict.

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