Abstract
BackgroundThere are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution.MethodsA cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization.ResultsAfter screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days).ConclusionsThe identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.
Highlights
There are few studies in Brazil that address baseline prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization
The present study aims to estimate the prevalence of MRSA colonization and infection in clinical adult and pediatric patients at the time of admission to hospital; the incidence of colonization and infection during hospitalization; and the potential risk factors for both, in a hospital in southern Brazil, in order to obtain information to support infection control planning for MRSA policy in the institution
There is a protocol for vancomycin-resistant enterococci (VRE) screening in patients transferred from other healthcare facilities, but there is no screening for MRSA colonization
Summary
The fact that a patient can harbor MRSA at hospital admission has consequences not just for the choice of patient treatment: it impacts on the effectiveness of Recently-published studies have arrived at different results regarding identification and isolation of MRSA colonized patients. These differences may be attributable to many factors, ranging from differences between the settings and patients to methodological issues, and the multifaceted nature of infection control practices. Another study in an intensive care unit (ICU) compared two interventions to reduce transmission of MRSA, after identification of colonized patients by the pathogen: cohort-isolation o single room isolation, and found no difference in cross-transmission between the two periods [10]
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