Clinical risk factors for methicillin-resistant Staphylococcus aureus bacteriuria in a skilled-care nursing home.
OBJECTIVE
To establish the risk factors for methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria in a nursing home population.


METHODS
A case-control study was conducted in a 360-bed skilled-care nursing facility in the northeastern United States that was experiencing an outbreak of MRSA. Fifteen residents were identified as having had MRSA isolated from their urine over an 18-month period and were compared with 40 controls who were randomly selected from all nursing facility residents.


RESULTS
In bivariate analysis, MRSA bacteriuria was associated with the presence of an indwelling urinary catheter (odds ratio [OR], 36; 95% confidence interval [CI], 7.0 to 184.2), antibiotic use in the prior 6 months (OR, 2.9; 95% CI, 1.5 to 5.5), and impaired physical function (OR, 5.8; 95% CI, 1.3 to 26.6). Urinary catheter use and antibiotic use remained significantly associated with MRSA bacteriuria even when controlling for impaired physical function.


CONCLUSIONS
Methicillin-resistant S aureus is being isolated with increasing frequency in nursing homes, and MRSA bacteriuria may prove to be an important reservoir for the spread of organisms in long-term-care settings. Conservative use of indwelling urinary catheters and of broad-spectrum antibiotics should be investigated as potential control measures to reduce the spread of MRSA in nursing homes.
Department of Family Medicine, University of Connecticut.
P P
PP
Coll
B F
BF
Crabtree
P J
PJ
O'Connor
S
S
Klenzak
D001437:Bacteriuria / Q000453:epidemiology / Q000382:microbiology*; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D017053:Infection Control; D016106:Methicillin Resistance; D009511:New England; D012307:Risk Factors; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*; D013211:Staphylococcus aureus / Q000187:drug effects