title: Predictors of hospitals with endemic community-associated methicillin-resistant Staphylococcus aureus.
abstract: OBJECTIVE
  We sought to identify hospital characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among inpatients.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Orange County, California.
  
  
  METHODS
  Thirty hospitals in a single county.
  
  
  METHODS
  We collected clinical MRSA isolates from inpatients in 30 of 31 hospitals in Orange County, California, from October 2008 through April 2010. We characterized isolates by spa typing to identify CA-MRSA strains. Using California's mandatory hospitalization data set, we identified hospital-level predictors of CA-MRSA isolation.
  
  
  RESULTS
  CA-MRSA strains represented 1,033 (46%) of 2,246 of MRSA isolates. By hospital, the median percentage of CA-MRSA isolates was 46% (range, 14%-81%). In multivariate models, CA-MRSA isolation was associated with smaller hospitals (odds ratio [OR], 0.97, or 3% decreased odds of CA-MRSA isolation per 1,000 annual admissions; P < .001, hospitals with more Medicaid-insured patients (OR, 1.2; P = .002), and hospitals with more patients with low comorbidity scores (OR, 1.3; P < .001). Results were similar when restricted to isolates from patients with hospital-onset infection.
  
  
  CONCLUSIONS
  Among 30 hospitals, CA-MRSA comprised nearly half of MRSA isolates. There was substantial variability in CA-MRSA penetration across hospitals, with more CA-MRSA in smaller hospitals with healthier but socially disadvantaged patient populations. Additional research is needed to determine whether infection control strategies can be successful in targeting CA-MRSA influx.
authors: School of Social Ecology and Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California. courtner@uci.edu
authors: Courtney R
authors: CR
authors: Murphy
authors: Lyndsey O
authors: LO
authors: Hudson
authors: Brian G
authors: BG
authors: Spratt
authors: Kristen
authors: K
authors: Elkins
authors: Leah
authors: L
authors: Terpstra
authors: Adrijana
authors: A
authors: Gombosev
authors: Christopher
authors: C
authors: Nguyen
authors: Paul
authors: P
authors: Hannah
authors: Richard
authors: R
authors: Alexander
authors: Mark C
authors: MC
authors: Enright
authors: Susan S
authors: SS
authors: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology; D015897:Comorbidity; D005260:Female; D006742:Hospital Bed Capacity; D006761:Hospitals; D006801:Humans; D008297:Male; D008484:Medicaid; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D014481:United States; D055815:Young Adult
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