Clinical Risk Factors for Methicillin-Resistant Staphylococcus aureus Bacteriuria in a Skilled-Care Nursing Home
Patrick P. Coll, MB, BCh;
Benjamin F. Crabtree, PhD;
Patrick J. O'Connor, MD, MPH;
Arch Fam Med. 1994;3(4):357-360.
To establish the risk factors for methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria in a nursing home population.
Design, Setting, and Subjects
A case-control study was conducted in a 360-bed skilled-care nursing facility in the northeastern United States that was experiencing an outbreak of MRSA. Fifteen residents were identified as having had MRSA isolated from theirurine over an 18-month period and were compared with 40 controls who were randomly selected from all nursing facility residents.
In bivariate analysis, MRSA bacteriuria was associated with the presence of an indwelling urinary catheter (odds ratio [OR], 36; 95% confidence interval [CI], 7.0 to 184.2), antibiotic use in the prior 6 months (OR, 2.9; 95% CI, 1.5 to 5.5), and impaired physical function (OR, 5.8; 95% CI, 1.3 to 26.6). Urinary catheter use and antibiotic use remained significantly associated with MRSA bacteriuria even when controlling for impaired physical function.
Methicillin-resistant S aureus is being isolated with increasing frequency in nursing homes, and MRSA bacteriuria may prove to be an important reservoir for the spread of organisms in long-term—care settings. Conservative use of indwelling urinary catheters and of broad-spectrum antibiotics should be investigated as potential control measures to reduce the spread of MRSA in nursing homes.
From the Department of Family Medicine, the University of Connecticut, and St Francis Hospital and Medical Center, Hartford, and the Travelers Center on Aging, the University of Connecticut Health Center, Farmington (Drs Coll, Crabtree, and O'Connor). Mr Klenzak is a medical student at the University of North Carolina, Chapel Hill. Dr Crabtree is currently with the Department of Family Medicine, the University of Nebraska, Omaha. Dr O'Connor is currently with Health Partners, St Paul, Minn.
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