1. Predictors of Hospitals with Endemic Community-Associated Methicillin-Resistant Staphylococcus aureus
- Author
-
Murphy, Courtney R, Hudson, Lyndsey O, Spratt, Brian G, Elkins, Kristen, Terpstra, Leah, Gombosev, Adrijana, Nguyen, Christopher, Hannah, Paul, Alexander, Richard, Enright, Mark C, and Huang, Susan S
- Subjects
Emerging Infectious Diseases ,Vaccine Related ,Prevention ,Clinical Research ,Infectious Diseases ,Antimicrobial Resistance ,Biodefense ,2.2 Factors relating to the physical environment ,Aetiology ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,California ,Carrier State ,Community-Acquired Infections ,Comorbidity ,Female ,Hospital Bed Capacity ,Hospitals ,Humans ,Male ,Medicaid ,Methicillin-Resistant Staphylococcus aureus ,Middle Aged ,Prevalence ,Prospective Studies ,Staphylococcal Infections ,United States ,Young Adult ,adult ,aged ,article ,bacterium isolate ,cohort analysis ,community associated methicillin resistant Staphylococcus aureus infection ,comorbidity ,endemic disease ,female ,gender ,hospital ,hospital infection ,hospital patient ,human ,major clinical study ,male ,methicillin resistant Staphylococcus aureus infection ,molecular typing ,multilocus sequence typing ,prediction ,prospective study ,Medical and Health Sciences ,Epidemiology - Abstract
ObjectiveWe sought to identify hospital characteristics associated with community-associated 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.
- Published
- 2013