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Risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition during ambulance transport: A retrospective propensity-score–matched cohort analysis

Published online by Cambridge University Press:  21 July 2021

Diego Schaps Open the ORCID record for Diego Schaps [Opens in a new window] ,
Andrew W. Godfrey  and
Deverick J. Anderson
Diego Schaps
Affiliation:
School of Medicine, Duke University, Durham, North Carolina
Andrew W. Godfrey
Affiliation:
Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
Deverick J. Anderson*
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
*
Author for correspondence: Deverick J. Anderson, E-mail: deverick.anderson@duke.edu
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Abstract

Objective:

To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport.

Methods:

We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome.

Results:

In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09–12.71; P = .04).

Conclusions:

Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport–associated infection burden to eventually develop interventions to address it.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 4 , April 2022 , pp. 442 - 447
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: This study was accepted in abstract form for a poster presentation at The Society for Healthcare Epidemiology of America (SHEA) Spring Conference, which took place virtually April 13–16, 2021.

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