title: Methicillin-resistant Staphylococcus aureus: Prevalence, incidence, risk factors, and effects on survival of patients in a specialist palliative care unit: A prospective observational study.
abstract: BACKGROUND
  Little is known about the impact of methicillin-resistant Staphylococcus aureus in palliative care settings. To date, the clinical impact of methicillin-resistant Staphylococcus aureus in palliative care is unknown.
  
  
  OBJECTIVE
  To determine prevalence and incidence of methicillin-resistant Staphylococcus aureus colonisation in a specialist palliative care setting, to identify risk factors for methicillin-resistant Staphylococcus aureus colonisation, to determine the eradication success rate and to determine the impact of methicillin-resistant Staphylococcus aureus on survival.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Data were collected for consecutive admissions to an inpatient palliative care service. Patients were screened for methicillin-resistant Staphylococcus aureus colonisation on admission and 1 week post admission. Methicillin-resistant Staphylococcus aureus eradication was attempted in methicillin-resistant Staphylococcus aureus positive patients.
  
  
  RESULTS
  Data were collected from 609 admissions for 466 individual patients. Admission screening data were available in 95.5%. Prevalence of methicillin-resistant Staphylococcus aureus colonisation was 11.59% (54 patients). One week incidence of methicillin-resistant Staphylococcus aureus colonisation was 1.2%. Risk factors for methicillin-resistant Staphylococcus aureus colonisation were determined using Chi-Squared test and included high Waterlow score (p < 0.01), high palliative performance scale score (p < 0.01), methicillin-resistant Staphylococcus aureus status prior to admission (p < 0.01), admission from hospital (p < 0.05), presence of urinary catheter or percutaneous endoscopic gastrostomy tube (p < 0.05) and poor dietary intake (p < 0.05). Regression analysis did not identify independent risk factors. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of admissions, while 46 patients commenced on the protocol (62.2%) died before completing it. Methicillin-resistant Staphylococcus aureus did not significantly impact survival but was significantly associated with having infection episodes and longer length of stay.
  
  
  CONCLUSIONS
  This study identified risk factors for methicillin-resistant Staphylococcus aureus colonisation in palliative care patients. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of patients. Hence, restricting methicillin-resistant Staphylococcus aureus screening to high-risk palliative care patients may be prudent.
authors.affiliation: Ysbyty Ystrad Fawr, Ystrad Mynach, UK Aoife.gleeson@wales.nhs.uk.
authors.forename: Aoife
authors.initials: A
authors.lastname: Gleeson
authors.affiliation: School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
authors.forename: Philip
authors.initials: P
authors.lastname: Larkin
authors.affiliation: Department of Statistics, Trinity College Dublin, Dublin, Ireland.
authors.forename: Cathal
authors.initials: C
authors.lastname: Walsh
authors.affiliation: Department of Microbiology, Our Lady's Children's Hospital, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: O'Sullivan
mesh_terms: D000368:Aged; D005260:Female; D006738:Hospices / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods* / Q000706:statistics & numerical data; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D050296:Microbial Viability; D009010:Monte Carlo Method; D010166:Palliative Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D016019:Survival Analysis
keywords: Palliative care; hospices; infection control; methicillin-resistant Staphylococcus aureus; risk factors; terminal care