METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS - COLONIZATION AND INFECTION IN A LONG-TERM CARE FACILITY

Objective: To assess methicillin-resistant Staphylococcus aureus (MRSA) colonization, transmission, and infection over a 1-year period in a long-term care facility with endemic MRSA. Design: Monthly surveillance for MRSA colonization of nares, perineum, rectum, and wounds. Setting: Long-term care facility attached to an acute care Veterans Affairs medical center. Patients: All 341 patients in the facility had monthly surveillance cultures for 1 year. Outcome Measurements: Colonization and infection with MRSA. Main Results: The monthly MRSA colonization rate was 23% +/- 1.0%; colonization occurred most commonly in the nares and wounds. Poor functional status was associated with MRSA colonization. Most patients (65%) never acquired MRSA; 25% of patients were already colonized at admission to the facility or at the start of the study, and only 10% of newly admitted patients acquired MRSA while in the facility. These latter patients acquired several different strains in a pattern of acquisition similar to that generally seen within the facility. In the course of 1 year, only nine patients who acquired MRSA had a roommate with the same phage type; no clustering was evident, and none of these patients developed infection. Nine other patients (3%) developed MRSA infection; five of these patients required hospitalization, but none died as a result of infection. Conclusions: In the long-term care facility in which our study took place, MRSA was endemic, and the infection rate was low. In such settings, the cost effectiveness of aggressive management of MRSA (wide-spread screening for MRSA and eradication with antimicrobial agents) needs to be assessed.