title: Methicillin-resistant Staphylococcus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control study.
abstract: In early 1996 a hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) epidemic was recognized in a 900-bed university hospital. In order to investigate hospital-specific transmission routes, a case-control study was carried out. Cases and controls were matched for age (+/- 10 years), sex, admission date (+/- 10 days) and clinical department on admission. Data on potential risk factors, were retrieved by chart review. Between June 1996 and February 1997, 67 patients with hospital-acquired MRSA were identified. Molecular typing showed that 85% of the cases carried an indistinguishable strain. The average time at risk for cases and controls was 17.3 and 23.7 days, respectively (P= 0.01). Seventeen patients (25.4%) developed infection. Conditional multivariate regression analysis showed that intensity of care (P= 0.002), number of transfers (P= 0.019), and fluoroquinolone therapy (P= 0.025) were independently associated with acquisition of MRSA. Intensity of care can be considered as a surrogate marker for a number of manipulations which represent the main risk factors for MRSA transmission. Frequent transfers within the hospital hinder, not only the epidemiological analyses, but also efforts to bring an outbreak under control. Our findings give epidemiological support to recent molecular studies which suggest that fluoroquinolone use may increase the transmissibility of MRSA in hospitals.
authors.affiliation: Institutes of Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, Hugstetterstr. 55, D-79106 Freiburg, Germany. gdziekan@iuk.ukl.uni-freiburg.de
authors.forename: G
authors.initials: G
authors.lastname: Dziekan
authors.forename: A
authors.initials: A
authors.lastname: Hahn
authors.forename: K
authors.initials: K
authors.lastname: Thüne
authors.forename: G
authors.initials: G
authors.lastname: Schwarzer
authors.forename: K
authors.initials: K
authors.lastname: Schäfer
authors.forename: F D
authors.initials: FD
authors.lastname: Daschner
authors.forename: H
authors.initials: H
authors.lastname: Grundmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000032:analysis / Q000235:genetics; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D024841:Fluoroquinolones; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D016555:Matched-Pair Analysis; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D010360:Patient Transfer; D016133:Polymerase Chain Reaction; D012044:Regression Analysis; D012307:Risk Factors; D012703:Serotyping; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D013211:Staphylococcus aureus / Q000145:classification
chemical_list: D000890:Anti-Infective Agents; D004269:DNA, Bacterial; D024841:Fluoroquinolones