Inpatient MRSA colonization tied to postdischarge infections

  • Nelson RE & al.
  • Clin Infect Dis
  • 11 Aug 2018

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Inpatient methicillin-resistant Staphylococcus aureus (MRSA) colonization significantly increases risk for subsequent infections after discharge.
  • According to the authors, the effect extends for up to 1 year postdischarge.

Why this matters

  • Contact precautions may have a larger effect on postdischarge:
    • Initiation of contact precautions should consider context, i.e., infections in those who acquire MRSA while hospitalized (acquirers) and implementation continue during routine follow-up at least 1 year postdischarge.

Key results

  • 985,626 with MRSA surveillance, 91.6% (903,190) not colonized, 7.3% (72,388) importers (colonized at admission), 1.0% (10,048) acquired MRSA postadmission.
  • Across all MRSA definitions and venues, the unadjusted relative risk for infection was 11.7-60.3 for colonized vs noncolonized patients.
  • Predischarge MRSA vs noncolonized was: importers (HR=29.6; 95% CI, 26.5-32.9) and acquirers (HR=28.8; 95% CI, 23.5-35.3), respectively (P<.0001>
  • During 180-day postdischarge period, OR for infections vs those not colonized was 7.7 (95% CI, 7.3-8.1 in importers) and 7.5 (95% CI, 6.8-8.3 in acquirers), respectively (P<.0001>

Study design

  • Retrospective surveillance cohort evaluating: 1) MRSA infection rates among patients not colonized during hospital admission vs importers and acquirers; 2) proportion of patients who develop invasive MRSA infection postdischarge.
  • Funding: Veteran Affairs (VA) Health Services Research and Development Service.

Limitations

  • Postdischarge encounters limited to VA.
  • Misclassification bias.
  • Multiple MRSA definitions.
  • Clonality unconfirmed.

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