title: Surveillance of colonization and infection with Staphylococcus aureus susceptible or resistant to methicillin in a community skilled-nursing facility.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen in acute care hospitals and long-term care facilities. Few studies have been reported in private skilled nursing facilities (SNFs) not experiencing outbreaks of infections caused by MRSA.
  
  
  METHODS
  From a 149-bed SNF with no outbreaks, we report a 1-year prospective surveillance study of S. aureus colonization and infection, with focus on S. aureus phenotypes, both methicillin susceptible (MS) and methicillin resistant (MR). Nasal and stool or rectal screening cultures were done on admission, and all patients underwent screening on at least a quarterly basis for 1 year.
  
  
  RESULTS
  Overall, 35% of patients were colonized at least once with S. aureus, (72% MS, 25% MR, and 3% mixed phenotypes), 94% of the MRSA were ciprofloxacin resistant. Nasal colonization with any S. aureus was more frequent, but 13% of patients had positive results only in rectal specimens. Twenty-one percent of the newly admitted and 15% of continuing patients acquired colonization during their stay in the SNE Colonization was transient or persistent, persisted longer in the nares compared with colonization in rectal specimens, and was more stable for methicillin-susceptible S. aureus. Nine percent of patients had development of infection with S. aureus. There was no indication that MRSA colonization led to more infections than methicillin-susceptible S. aureus. Of the 13 infected patients in whom cultures had previously been obtained, seven (54%) had been colonized by the same phenotype strains.
  
  
  CONCLUSIONS
  In this private SNF, endemic S. aureus infections occur at a low frequency, reflecting a moderate level of colonization with S. aureus. However, a trend showing gradual increases in frequencies of colonization and infection is of concern and suggests that in this SNF, future intervention could become warranted.
authors.affiliation: Department of Medicine, University of California Irvine, Orange 92668, USA.
authors.forename: Y L
authors.initials: YL
authors.lastname: Lee
authors.forename: T
authors.initials: T
authors.lastname: Cesario
authors.forename: G
authors.initials: G
authors.lastname: Gupta
authors.forename: L
authors.initials: L
authors.lastname: Flionis
authors.forename: C
authors.initials: C
authors.lastname: Tran
authors.forename: M
authors.initials: M
authors.lastname: Decker
authors.forename: L
authors.initials: L
authors.lastname: Thrupp
mesh_terms: D000368:Aged; D002353:Carrier State / Q000382:microbiology / Q000517:prevention & control*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008403:Mass Screening; D016106:Methicillin Resistance; D011446:Prospective Studies; D012703:Serotyping; D012866:Skilled Nursing Facilities; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects