title: Methicillin-Resistant Staphylococcus aureus in Saarland, Germany: The Long-Term Care Facility Study.
abstract: BACKGROUND
  Multiresistant organisms pose a threat for patients and care recipients. Control interventions need to be tailored to region, the type of institution considered, and risk factors. The German state of Saarland is ideally suited to study colonisation epidemiology throughout its various health and care institutions. After conclusion of a large admission prevalence study in acute care hospitals, we now performed a methicillin-resistant Staphylococcus aureus (MRSA) point prevalence study in Saarland long term care facilities (LTCF), allowing for a direct comparison with respect of MRSA prevalence and associated risk factors between these two institutional types located within a confined region.
  
  
  RESULTS
  Of all LTCF of the region, 65/136 participated in the study performed between 09/2013 and 07/2014. Overall, complete microbiological specimen and questionnaires of 2,858 of 4,275 (66.8%) LTCF residents were obtained. 136/2,858 (4.8%) screened residents revealed MRSA carrier status. Multivariate risk factor analysis yielded ulcer/deep soft tissue infection, urinary tract catheter, and MRSA history with multiple MRSA decolonisation cycles to be independently associated with MRSA carrier status.
  
  
  CONCLUSIONS
  As already known from previous studies, colonisation with MRSA is common in LTCF residents even in an area with relatively low MRSA prevalence. This found prevalence can now be related to the acute care admission prevalence (2.2%) as well as to the admission prevalence in acute care geriatric departments (7.6%). The common clonal attribution (spa type) of MRSA isolates prevalent in the LTCF population as well as in the acute care admission population points towards a close relationship between both types of institutions. However, the ostensible absence of risk factors such as "previous hospitalisation" in conjunction with newly identified factors such as "multiple decolonisation cycles" refers to MRSA colonisation risks independent of contact with acute care facilities. Overall, this large LTCF point prevalence study allows data-based, region-tailored decisions on MRSA screening policies and provides a basis for additional preventative measures.
authors.affiliation: Institute and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nillius
authors.affiliation: Institute and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: von Müller
authors.affiliation: Institute of Medical Biometry, Epidemiology, and Medical Informatics, Saarland University, Homburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Wagenpfeil
authors.affiliation: Saarland Ministry of Social Affairs, Health, Women, and Family, Saarbrücken, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Klein
authors.affiliation: Institute and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Herrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008134:Long-Term Care; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009735:Nursing Homes; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011795:Surveys and Questionnaires