title: Assessment of risk factors related to healthcare-associated methicillin-resistant Staphylococcus aureus infection at patient admission to an intensive care unit in Japan.
abstract: BACKGROUND
  Healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infection in intensive care unit (ICU) patients prolongs ICU stay and causes high mortality. Predicting HA-MRSA infection on admission can strengthen precautions against MRSA transmission. This study aimed to clarify the risk factors for HA-MRSA infection in an ICU from data obtained within 24 hours of patient ICU admission.
  
  
  METHODS
  We prospectively studied HA-MRSA infection in 474 consecutive patients admitted for more than 2 days to our medical, surgical, and trauma ICU in a tertiary referral hospital in Japan. Data obtained from patients within 24 hours of ICU admission on 11 prognostic variables possibly related to outcome were evaluated to predict infection risk in the early phase of ICU stay. Stepwise multivariate logistic regression analysis was used to identify independent risk factors for HA-MRSA infection.
  
  
  RESULTS
  Thirty patients (6.3%) had MRSA infection, and 444 patients (93.7%) were infection-free. Intubation, existence of open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission, were detected as independent prognostic indicators. Patients with intubation or open wound comprised 96.7% of MRSA-infected patients but only 57.4% of all patients admitted.
  
  
  CONCLUSIONS
  Four prognostic variables were found to be risk factors for HA-MRSA infection in ICU: intubation, open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission. Preemptive infection control in patients with these risk factors might effectively decrease HA-MRSA infection.
authors: Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan. k.yamakawa0911@gmail.com
authors: Kazuma
authors: K
authors: Yamakawa
authors: Osamu
authors: O
authors: Tasaki
authors: Miyuki
authors: M
authors: Fukuyama
authors: Junichi
authors: J
authors: Kitayama
authors: Hiroki
authors: H
authors: Matsuda
authors: Yasushi
authors: Y
authors: Nakamori
authors: Satoshi
authors: S
authors: Fujimi
authors: Hiroshi
authors: H
authors: Ogura
authors: Yasuyuki
authors: Y
authors: Kuwagata
authors: Toshimitsu
authors: T
authors: Hamasaki
authors: Takeshi
authors: T
authors: Shimazu
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007564:Japan; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000517:prevention & control*