title: Occupational determinants of methicillin-resistant Staphylococcus aureus colonization among healthcare workers: a longitudinal study in a rehabilitation center.
abstract: BACKGROUND Staphylococcus aureus carriage among healthcare workers (HCWs) is a concern in hospital settings, where it may provide a reservoir for later infections in both patients and staff. Earlier studies have shown that the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in HCWs is highly variable, depending notably on location, hospital department type, MRSA prevalence among patients, and type of contacts with patients. However, MRSA incidence in HCWs and its occupational determinants have seldom been studied. METHODS A prospective, observational cohort study was conducted between May and October 2009 in a French rehabilitation center hospital. HCWs and patients were screened weekly for S. aureus nasal carriage. Methicillin-susceptible S. aureus and MRSA prevalence and incidence were estimated and factors associated with MRSA acquisition were identified using generalized estimating equation regression methods. RESULTS Among 343 HCWs included in the analysis, the average prevalence was 27% (95% CI, 24%-29%) for methicillin-susceptible S. aureus and 10% (8%-11%) for MRSA. We observed 129 MRSA colonization events. According to the multivariable analysis, high MRSA prevalence level among patients and HCW occupation were significantly associated with MRSA acquisition in HCWs, with assistant nurses being more at risk than nurses (odds ratio, 2.2; 95% CI, 1.4-3.6). CONCLUSIONS Our findings may help further our understanding of the transmission dynamics of MRSA carriage acquisition in HCWs, suggesting that it is notably driven by carriage among patients and by the type of contact with patients.
authors.affiliation: 1Univ Paris-Sud,UMR 0320/UMR8120 Génétique Quantitative et Evolution-Le Moulon,F-91190 Gif-sur-Yvette,France.
authors.forename: J
authors.initials: J
authors.lastname: Legrand
authors.affiliation: 2Laboratoire MESuRS,Conservatoire national des Arts et Métiers,F-75003 Paris,France.
authors.forename: L
authors.initials: L
authors.lastname: Temime
authors.affiliation: 3Service de Microbiologie,Hôpital Raymond Poincaré,Assistance Publique-Hôpitaux de Paris,F-92380,Garches,France.
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: 3Service de Microbiologie,Hôpital Raymond Poincaré,Assistance Publique-Hôpitaux de Paris,F-92380,Garches,France.
authors.forename: J L
authors.initials: JL
authors.lastname: Herrmann
authors.affiliation: 5INSERM,U1136,Paris,France.
authors.forename: P Y
authors.initials: PY
authors.lastname: Boelle
authors.affiliation: 7Inserm UMR 1181 "Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases" (B2PHI),F-75015 Paris,France.
authors.forename: D
authors.initials: D
authors.lastname: Guillemot
mesh_terms: D000328:Adult; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D009666:Nose / Q000382:microbiology; D009726:Nurses / Q000706:statistics & numerical data; D009728:Nursing Assistants / Q000706:statistics & numerical data; D016273:Occupational Exposure; D015995:Prevalence; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*