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Predictors of hospitals with endemic community-associated methicillin-resistant Staphylococcus aureus.
- Author(s): Murphy, Courtney R;
- Hudson, Lyndsey O;
- Spratt, Brian G;
- Elkins, Kristen;
- Terpstra, Leah;
- Gombosev, Adrijana;
- Nguyen, Christopher;
- Hannah, Paul;
- Alexander, Richard;
- Enright, Mark C;
- Huang, Susan S
- et al.
Published Web Locationhttps://doi.org/10.1086/670631
ObjectiveWe sought to identify hospital characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among inpatients.
DesignProspective cohort study.
SettingOrange County, California.
ParticipantsThirty hospitals in a single county.
MethodsWe 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.
ResultsCA-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.
ConclusionsAmong 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.
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