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Predictors of Hospitals with Endemic Community-Associated Methicillin-Resistant Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Courtney R. Murphy ,
Lyndsey O. Hudson ,
Brian G. Spratt ,
Kristen Elkins ,
Leah Terpstra ,
Adrijana Gombosev ,
Christopher Nguyen ,
Paul Hannah ,
Richard Alexander  and
Mark C. Enright
...Show all authors
Courtney R. Murphy*
Affiliation:
School of Social Ecology and Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
Lyndsey O. Hudson
Affiliation:
Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
Brian G. Spratt
Affiliation:
Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
Kristen Elkins
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Leah Terpstra
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Adrijana Gombosev
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Christopher Nguyen
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Paul Hannah
Affiliation:
Orange County Health Care Agency, Santa Ana, California
Richard Alexander
Affiliation:
Orange County Health Care Agency, Santa Ana, California
Mark C. Enright
Affiliation:
AmpliPhi Biosciences, Colworth Science Park, Sharnbrook, Bedfordshire, United Kingdom
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
*
Health Policy Research Institute, 100 Theory Drive, Suite 110, Irvine, CA 92617 (courtner@uci.edu).
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Abstract

Objective.

We 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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 6 , June 2013 , pp. 581 - 587
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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