Predictors of Hospitals with Endemic Community-Associated Methicillin-Resistant Staphylococcus aureus
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
OBJECTIVE—We sought to identify hospital characteristics associated with communityassociated
methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among inpatients.
DESIGN—Prospective cohort study.
SETTING—Orange County, California.
PARTICIPANTS—Thirty hospitals in a single county.
METHODS—We collected clinical MRSA isolates from inpatients in 30 of 31 hospitals in
Orange County, California, from October 2008 through April 2010. We characterized isolates by
spa typing to identify CA-MRSA strains. Using California’s mandatory hospitalization data set,
we identified hospital-level predictors of CA-MRSA isolation.
RESULTS—CA-MRSA strains represented 1,033 (46%) of 2,246 of MRSA isolates. By hospital,
the median percentage of CA-MRSA isolates was 46% (range, 14%–81%). In multivariate
models, CA-MRSA isolation was associated with smaller hospitals (odds ratio [OR], 0.97, or 3%
decreased odds of CA-MRSA isolation per 1,000 annual admissions; P < .001), hospitals with
more Medicaid-insured patients (OR, 1.2; P = .002), and hospitals with more patients with low comorbidity scores (OR, 1.3; P < .001). Results were similar when restricted to isolates from
patients with hospital-onset infection.
CONCLUSIONS—Among 30 hospitals, CA-MRSA comprised nearly half of MRSA isolates.
There was substantial variability in CA-MRSA penetration across hospitals, with more CA-MRSA
in smaller hospitals with healthier but socially disadvantaged patient populations. Additional
research is needed to determine whether infection control strategies can be successful in targeting
CA-MRSA influx.
methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among inpatients.
DESIGN—Prospective cohort study.
SETTING—Orange County, California.
PARTICIPANTS—Thirty hospitals in a single county.
METHODS—We collected clinical MRSA isolates from inpatients in 30 of 31 hospitals in
Orange County, California, from October 2008 through April 2010. We characterized isolates by
spa typing to identify CA-MRSA strains. Using California’s mandatory hospitalization data set,
we identified hospital-level predictors of CA-MRSA isolation.
RESULTS—CA-MRSA strains represented 1,033 (46%) of 2,246 of MRSA isolates. By hospital,
the median percentage of CA-MRSA isolates was 46% (range, 14%–81%). In multivariate
models, CA-MRSA isolation was associated with smaller hospitals (odds ratio [OR], 0.97, or 3%
decreased odds of CA-MRSA isolation per 1,000 annual admissions; P < .001), hospitals with
more Medicaid-insured patients (OR, 1.2; P = .002), and hospitals with more patients with low comorbidity scores (OR, 1.3; P < .001). Results were similar when restricted to isolates from
patients with hospital-onset infection.
CONCLUSIONS—Among 30 hospitals, CA-MRSA comprised nearly half of MRSA isolates.
There was substantial variability in CA-MRSA penetration across hospitals, with more CA-MRSA
in smaller hospitals with healthier but socially disadvantaged patient populations. Additional
research is needed to determine whether infection control strategies can be successful in targeting
CA-MRSA influx.
Date Issued
2013-06-01
Date Acceptance
2013-01-14
Citation
Infection Control and Hospital Epidemiology, 2013, 34 (6), pp.581-587
ISSN
1559-6834
Publisher
Cambridge University Press
Start Page
581
End Page
587
Journal / Book Title
Infection Control and Hospital Epidemiology
Volume
34
Issue
6
Copyright Statement
© 2013 by The Society for Healthcare Epidemiology of America. All rights reserved.
The final publication is available via Cambridge Journals Online at http://dx.doi.org/10.1086/670631
The final publication is available via Cambridge Journals Online at http://dx.doi.org/10.1086/670631
Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Infectious Diseases
INFECTIOUS DISEASES
PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH, SCI
BLOOD-STREAM INFECTIONS
SKIN INFECTIONS
RISK-FACTORS
VIRULENCE
USA300
COLONIZATION
EPIDEMIOLOGY
PATHOGENESIS
CALIFORNIA
PNEUMONIA
Publication Status
Published