Prevalence and risk factors for meticillin-resistant Staphylococcus aureus in adult emergency admissions – a case for screening all patients?

• Published in: The Journal of hospital infection Vol. 66; no. 1; pp. 15 - 21
• Main Authors: Gopal Rao, G, Michalczyk, P, Nayeem, N, Walker, G, Wigmore, L
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01-05-2007; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - epidemiology; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Carrier State - epidemiology; Cohort Studies; Cross Infection - epidemiology; Cross Infection - prevention & control; Emergency admissions; Emergency Service, Hospital; Female; Human bacterial diseases; Humans; Infectious Disease; Infectious diseases; London - epidemiology; Male; Mass Screening; Medical sciences; Methicillin Resistance; Meticillin-resistant Staphylococcus aureus; Middle Aged; Patient Admission - statistics & numerical data; Pharmacology. Drug treatments; Population Surveillance; Prevalence; Risk Factors; Screening; Staphylococcal Infections - epidemiology; Staphylococcal Infections - etiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - drug effects; London; United Kingdom > UK; England; Screening; Emergency admissions; Meticillin-resistant Staphylococcus aureus; Risk factors; Human; Prevalence; β-Lactams; Medical screening; Epidemiology; Bacteremia; Meticillin; Infection; Penicillin derivatives; Antibiotic; Risk factor; Bacteriosis; Bacteria; Micrococcales; Adult; Micrococcaceae; Emergency; Antibacterial agent; Staphylococcal infection; Staphylococcus aureus
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2007.01.013

Summary In this study we describe the prevalence and frequency of risk factors for meticillin-resistant Staphylococcus aureus (MRSA) colonization in emergency admissions during a one-year MRSA screening programme. Overall, 7801/13 826 (56.4%) adult emergency admissions by 6469 patients were screened for MRSA. Of those screened, 670/7801 (8.6%) admissions by 433 patients (6.7%) were colonized with MRSA. Risk factors studied were previous hospital admission, previous MRSA colonization and residence in care homes. Patients with any risk factor (MRSA positive: 366/3952 (9.3%) vs MRSA negative: 67/2450 (2.7%), P < 0.001), advanced age (mean ages for MRSA positive and negative patients were 74.4 and 56.2 years, respectively ( P < 0.001)), and increasing frequency of hospital admissions ( P < 0.001), patients from care homes (41/184, 22.2%) and previous MRSA colonization (232/1855, 12.5%) had a significantly higher MRSA colonization rate. The cost of the screening programme was nearly £24,500. It was noticed that there was a substantial reduction in hospital-acquired MRSA and MRSA bacteraemia during the study period. The study was not designed to establish whether this reduction was causally associated with the screening programme. We conclude that there is a high MRSA colonization rate among emergency admissions, especially those with risk factors. Using a selective risk factor based screening strategy more than 60% of the patients would have to be screened but still 3952/6469, 67 (15.5%) MRSA carriers would have been missed. Screening of all emergency admissions to detect MRSA colonization is preferable to selective screening, relatively inexpensive, and might reduce the MRSA colonization rate of hospital-acquired MRSA and MRSA bacteraemia among emergency admissions.