title: Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates.
abstract: OBJECTIVE
  To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.
  
  
  METHODS
  A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA. Risk factors associated with the likelihood of MRSA colonization on admission were investigated.
  
  
  METHODS
  Tertiary-care military medical facility.
  
  
  METHODS
  All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.
  
  
  RESULTS
  Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.
  
  
  CONCLUSIONS
  Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.
authors.affiliation: Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Fishbain
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Lee
authors.forename: Honghung D
authors.initials: HD
authors.lastname: Nguyen
authors.forename: Jeffery A
authors.initials: JA
authors.lastname: Mikita
authors.forename: Cecilia P
authors.initials: CP
authors.lastname: Mikita
authors.forename: Catherine F T
authors.initials: CF
authors.lastname: Uyehara
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
mesh_terms: D000328:Adult; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D005260:Female; D006254:Hawaii; D006760:Hospitalization; D006772:Hospitals, Military; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D011159:Population Surveillance; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D013211:Staphylococcus aureus / Q000302:isolation & purification*