Abstract
Nursing homes represent a unique and important methicillin-resistant Staphylococcus aureus (MRSA) reservoir. Not only are strains imported from hospitals and the community, strains can be transported back into these settings from nursing homes. Since MRSA bacteria are prevalent in nursing homes and yet relatively poorly studied in this setting, a multicenter, regional assessment of the frequency and diversity of MRSA in the nursing home reservoir was carried out and compared to that of the MRSA from hospitals in the same region. The prospective study collected MRSA from nasal swabbing of residents of 26 nursing homes in Orange County, California, and characterized each isolate by spa typing. A total of 837 MRSA isolates were collected from the nursing homes. Estimates of admission prevalence and point prevalence of MRSA were 16% and 26%, respectively. The spa type genetic diversity was heterogeneous between nursing homes and significantly higher overall (77%) than the diversity in Orange County hospitals (72%). MRSA burden in nursing homes appears largely due to importation from hospitals. As seen in Orange County hospitals, USA300 (sequence type 8 [ST8]/t008), USA100 (ST5/t002), and a USA100 variant (ST5/t242) were the dominant MRSA clones in Orange County nursing homes, representing 83% of all isolates, although the USA100 variant was predominant in nursing homes, whereas USA300 was predominant in hospitals. Control strategies tailored to the complex problem of MRSA transmission and infection in nursing homes are needed in order to minimize the impact of this unique reservoir on the overall regional MRSA burden.
Highlights
Nursing homes represent a unique and important methicillin-resistant Staphylococcus aureus (MRSA) reservoir
community-associated MRSA (CA-MRSA) has become increasingly dominant in recent years, and the MRSA clone USA300 in particular has several characteristics that may offer a selective advantage over the traditional health care-associated MRSA (HA-MRSA), including higher transmissibility and increased pathogenicity [22, 23]
Between January 2009 and April 2011, 3,806 nasal swabs were taken from residents of 26 nursing homes in Orange County, California, either on admission or for estimating MRSA point prevalence
Summary
Nursing homes represent a unique and important methicillin-resistant Staphylococcus aureus (MRSA) reservoir. The reservoir represented by colonized patients is often large due to the high MRSA prevalence in nursing homes, sometimes higher than 30%, which increases the risk of MRSA transmission in these facilities [10, 13,14,15]. A study of 32 nursing homes in northern Germany listed indwelling devices, wounds, preceding hospital admission, and highgrade resident care as risk factors for carriage [21]. Both studies found that the predominant MRSA strains among nursing home residents were identical to those found in hospital inpatients, highlighting the need for synergistic infection control between nursing homes and hospitals [20, 21]. We conducted a prospective study of MRSA isolates in nursing home residents in a large U.S metropolitan county to investigate the frequency and genetic diversity of MRSA in these facilities, and gain a better understanding of the nature of the nursing home MRSA reservoir
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