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Clin Infect Dis. 2016 Jan 1;62(1):45-52. doi: 10.1093/cid/civ777. Epub 2015 Sep 3.

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013.

Author information

1
Division of Healthcare Quality Promotion Epidemic Intelligence Service, Centers for Disease Control and Prevention.
2
Division of Healthcare Quality Promotion.
3
Georgia Emerging Infections Program, Decatur.
4
Emory University School of Medicine, Atlanta Georgia Emerging Infections Program, Decatur.
5
University of Rochester Medical Center, New York.
6
Connecticut Department of Public Health, Hartford.
7
Connecticut Emerging Infections Program, Yale School of Public Health, New Haven.
8
California Emerging Infections Program, Oakland.
9
Minnesota Department of Health, St Paul.
10
Vanderbilt University School of Medicine Tennessee Emerging Infections Program, Nashville.

Abstract

BACKGROUND:

Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. To inform prevention strategies, we assessed risk factors for invasive MRSA infection after acute-care hospitalizations.

METHODS:

We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible case patients were identified from 15 hospitals across 6 US states. For each case patient, 2 controls were matched for hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for postdischarge invasive MRSA.

RESULTS:

From 1 February 2011 through 31 March 2013, 194 case patients and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range, 1-83 days). Factors independently associated with postdischarge MRSA infection included MRSA colonization (matched odds ratio [mOR], 7.71; 95% confidence interval [CI], 3.60-16.51), discharge to a nursing home (mOR, 2.65; 95% CI, 1.41-4.99), presence of a chronic wound during the postdischarge period (mOR, 4.41; 95% CI, 2.14-9.09), and discharge with a central venous catheter (mOR, 2.16; 95% CI, 1.13-4.99) or a different invasive device (mOR, 3.03; 95% CI, 1.24-7.39) in place.

CONCLUSIONS:

Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted.

KEYWORDS:

bacteremia; epidemiology; methicillin-resistant Staphylococcus aureus; risk-factors

PMID:
26338787
DOI:
10.1093/cid/civ777
[Indexed for MEDLINE]
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