Epidemiology of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in a rural state.
BACKGROUND
Most data on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) isolates come from large tertiary care centers. Infection control personnel need to understand the epidemiology of MRSA and VRE across the continuum of care, including small rural hospitals, to develop effective control strategies.


OBJECTIVE
To describe the epidemiology of MRSA and VRE in Iowa.


METHODS
Fifteen hospitals in Iowa. Methods Between July 1998 and June 2001, a total of 1,968 S. aureus isolates and 1,845 Enterococcus isolates from patients infected with these pathogens were examined. Multivariate models were developed to evaluate patient and institutional risk factors for MRSA infection and VRE infection.


RESULTS
The proportion of S. aureus isolates resistant to methicillin was 31%, and the proportion of Enterococcus isolates resistant to vancomycin was 6%. Independent risk factors for MRSA infection included residence in a long-term care facility, age of more than 60 years, hospitalization in a hospital with less than 200 short-term care beds, and acquiring the infection in the hospital. Independent risk factors for VRE infection included use of a central venous catheter, residence in a long-term care facility, acquisition of infection in the hospital, and hospitalization in a hospital with more than 200 short-term care beds.


CONCLUSIONS
In Iowa, the epidemiology of MRSA differ from those of VRE. MRSA has become established in small rural hospitals. Effective MRSA control strategies may require inclusion of all hospitals in a state or region.
Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, 52246, USA.
Philip M
PM
Polgreen
Susan E
SE
Beekmann
Yi Yi
YY
Chen
Gary V
GV
Doern
Michael A
MA
Pfaller
Angela B
AB
Brueggemann
Loreen A
LA
Herwaldt
Daniel J
DJ
Diekema
D000368:Aged; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D004812:Epidemiologic Methods; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods*; D007484:Iowa / Q000453:epidemiology; D016015:Logistic Models; D016106:Methicillin Resistance; D008875:Middle Aged; D012424:Rural Population; D020713:Vancomycin Resistance