Abstract
The impact and prevalence of antimicrobial drug resistance in rural community healthcare settings is uncertain. Prospective surveillance in 51 rural hospitals in Idaho and Utah examined the epidemiologic features of clinical cases of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Thirty-two cases of VRE were reported; for 6, the patient had no prior healthcare exposure or coexisting condition. Among the 724 MRSA cases available for evaluation, 405 (56%) were healthcare-associated (HA-MRSA), and 319 (44%) were community-associated (CA-MRSA). The characteristics of HA-MRSA and CA-MRSA patients with coexisting factors were similar, which suggests community transmission of healthcare strains. CA-MRSA cases without coexisting factors, however, demonstrated features previously reported for community strains. MRSA infections were substantially more frequent than VRE in rural communities in the western United States. Based on epidemiologic criteria, a large proportion of MRSA cases were community-associated. CA-MRSA rates were predictive of institutional MRSA rates.
Highlights
The impact and prevalence of antimicrobial drug resistance in rural community healthcare settings is uncertain
Case Ascertainment A total of 34 unique vancomycin-resistant enterococci (VRE) and 799 unique methicillin-resistant Staphylococcus aureus (MRSA) cases were reported by participating rural healthcare institutions in Idaho and Utah from October 1, 2002, to December 31, 2003
Epidemiologic data on MRSA and VRE cases were collected from a large number of rural hospitals in Idaho and Utah during a 15-month period
Summary
The impact and prevalence of antimicrobial drug resistance in rural community healthcare settings is uncertain. Prospective surveillance in 51 rural hospitals in Idaho and Utah examined the epidemiologic features of clinical cases of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Thirty-two cases of VRE were reported; for 6, the patient had no prior healthcare exposure or coexisting condition. Additional patient risk factors for nosocomial MRSA infections, when compared to methicillin-susceptible S. aureus, include increased number of coexisting factors; increased length of hospital stay; exposure to antimicrobial drug agents, especially fluoroquinolones; enteral feedings; and surgery [11]. In the past few years, reports of patients with serious MRSA infections who had no known risk factors or exposure to healthcare settings have been increasing [12,13,14,15,16,17,18,19,20]. None had performed active surveillance cultures to detect patients needing isolation
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