Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013.
BACKGROUND
Significant progress has been made in reducing methicillin-resistant Staphylococcus aureus (MRSA) infections among hospitalized patients. However, the decreases in invasive MRSA infections among recently discharged patients have been less substantial. To inform prevention strategies, we assessed risk factors for invasive MRSA infection after acute-care hospitalizations.


METHODS
We conducted a prospective, matched case-control study. A case was defined as MRSA cultured from a normally sterile body site in a patient discharged from a hospital within the prior 12 weeks. Eligible case patients were identified from 15 hospitals across 6 US states. For each case patient, 2 controls were matched for hospital, month of discharge, and age group. Medical record reviews and telephone interviews were performed. Conditional logistic regression was used to identify independent risk factors for postdischarge invasive MRSA.


RESULTS
From 1 February 2011 through 31 March 2013, 194 case patients and 388 matched controls were enrolled. The median time between hospital discharge and positive culture was 23 days (range, 1-83 days). Factors independently associated with postdischarge MRSA infection included MRSA colonization (matched odds ratio [mOR], 7.71; 95% confidence interval [CI], 3.60-16.51), discharge to a nursing home (mOR, 2.65; 95% CI, 1.41-4.99), presence of a chronic wound during the postdischarge period (mOR, 4.41; 95% CI, 2.14-9.09), and discharge with a central venous catheter (mOR, 2.16; 95% CI, 1.13-4.99) or a different invasive device (mOR, 3.03; 95% CI, 1.24-7.39) in place.


CONCLUSIONS
Prevention efforts should target patients with MRSA colonization or those with invasive devices or chronic wounds at hospital discharge. In addition, MRSA prevention efforts in nursing homes are warranted.
Division of Healthcare Quality Promotion Epidemic Intelligence Service, Centers for Disease Control and Prevention.
Lauren
L
Epstein
Division of Healthcare Quality Promotion.
Yi
Y
Mu
Division of Healthcare Quality Promotion.
Ruth
R
Belflower
Georgia Emerging Infections Program, Decatur.
Janine
J
Scott
Emory University School of Medicine, Atlanta Georgia Emerging Infections Program, Decatur.
Susan
S
Ray
University of Rochester Medical Center, New York.
Ghinwa
G
Dumyati
University of Rochester Medical Center, New York.
Christina
C
Felsen
Connecticut Department of Public Health, Hartford.
Susan
S
Petit
Connecticut Emerging Infections Program, Yale School of Public Health, New Haven.
Kimberly
K
Yousey-Hindes
California Emerging Infections Program, Oakland.
Joelle
J
Nadle
California Emerging Infections Program, Oakland.
Lauren
L
Pasutti
Minnesota Department of Health, St Paul.
Ruth
R
Lynfield
Minnesota Department of Health, St Paul.
Linn
L
Warnke
Vanderbilt University School of Medicine Tennessee Emerging Infections Program, Nashville.
William
W
Schaffner
Vanderbilt University School of Medicine Tennessee Emerging Infections Program, Nashville.
Karen
K
Leib
Division of Healthcare Quality Promotion.
Alexander J
AJ
Kallen
Division of Healthcare Quality Promotion.
Scott K
SK
Fridkin
Division of Healthcare Quality Promotion.
Fernanda C
FC
Lessa
D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D010351:Patient Discharge; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology
bacteremia; epidemiology; methicillin-resistant Staphylococcus aureus; risk-factors