title: Comparison of the methicillin-resistant Staphylococcus aureus acquisition among rehabilitation and nursing home residents.
abstract: OBJECTIVE
  To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Extended care units at 2 healthcare systems in Maryland.
  
  
  METHODS
  Four hundred forty-three residents with no history of MRSA and negative MRSA surveillance cultures of the anterior nares and areas of skin breakdown at enrollment.
  
  
  METHODS
  Follow-up cultures were collected every 4 weeks and/or at discharge for a period of 12 weeks. Study data were collected by a research nurse from the medical staff and the electronic medical records. Cox proportional hazards modeling was used to calculate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Residents in rehabilitation care had 4-fold higher risk of MRSA acquisition compared with residents in residential care (hazard ratio [HR], 4. [95% CI, 2.2-8.8]). Being bedbound was significantly associated with MRSA acquisition in both populations (residential care, aHR, 4.3 [95% CI, 1.5-12.2]; rehabilitation care, aHR, 4.8 [95% CI, 1.2-18.7]). Having an MRSA-positive roommate was not significantly associated with acquisition in either population (residential care, aHR, 1.4 [95% CI, 0.5-3.9]; rehabilitation care, aHR, 0.5 [95% CI, 0.1-2.2]); based on concordant spa typing, only 2 of 8 residents who acquired MRSA and had room placement with an MRSA-positive resident acquired their MRSA isolate from their roommate.
  
  
  CONCLUSIONS
  Residents in rehabilitation care appear at higher risk and have different risk factors for MRSA acquisition compared to those in residential care.
authors: Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. jfuruno@epi.umaryland.edu
authors: Jon P
authors: JP
authors: Furuno
authors: Simone M
authors: SM
authors: Shurland
authors: Min
authors: M
authors: Zhan
authors: J Kristie
authors: JK
authors: Johnson
authors: Richard A
authors: RA
authors: Venezia
authors: Anthony D
authors: AD
authors: Harris
authors: Mary-Claire
authors: MC
authors: Roghmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology*; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D009735:Nursing Homes; D010362:Patients' Rooms; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*
chemical_list: D004269:DNA, Bacterial