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Cited by 41Antimicrobial Resistance in StaphylococcusInfection Control in HealthcareAntibiotic Use and Resistance

Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011–2013

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Epstein, Lauren, Mu, Yi, Belflower, Ruth, Scott, Janine, Ray, Susan, Dumyati, Ghinwa, Felsen, Christina, Petit, Susan +10 more·2016·Clinical Infectious Diseases
DOI 10.1093/cid/civ777PMC PMC6557163
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Abstract

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.

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  • Potential harms of unnecessary antimicrobials include allergic or hypersensitivity reactions, kidney injury, thrombocytopenia, Clostridioides difficile infection, and antimicrobial resistance.

    “These include a range of adverse events such as allergic or hypersensitivity reactions, kidney injury, thrombocytopenia, Clostridioides difficile infection, and antimicrobial resistance (101-106).”

    From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [105]

    The Discussion addresses risk factors for invasive MRSA infection after hospital discharge, not harms of unnecessary antimicrobial use. Searches for allergic reactions, kidney injury, thrombocytopenia, C. difficile infection, and antimicrobial resistance found no passage in the paper linking these harms to unnecessary antimicrobials; the mentions of C. difficile and resistance are in reference titles. (LLM, conf=0.76)

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  • Patient-related risk factors for MRSA include prior MRSA infection or colonisation, recent IV antibiotics, recurrent skin infections or chronic wounds, invasive devices, haemodialysis, recent hospital admissions, and severity of illness.

    “Patient-related risk factors for MRSA include prior history of MRSA infection or colonisation, recent IV antibiotics, history of recurrent skin infections or chronic wounds, presence of invasive devices, haemodialysis, recent hospital admissions and severity of illness [136, 138–142].”

    From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [139]

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Research works printed but not linked: 1

  1. [5]Calfee DP, Salgado CD, Milstone AM, Strategies to prevent methicillinresistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35(suppl 2): S108– 32. 25376072

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Authors
Epstein, L., Mu, Y., Belflower, R., Scott, J., Ray, S., Dumyati, G., Felsen, C., Petit, S., Yousey-Hindes, K., Nadle, J., Pasutti, L., Lynfield, R., Warnke, L., Schaffner, W., Leib, K., Kallen, A. J., Fridkin, S. K., & Lessa, F. C.
Affiliations
  • Centers for Disease Control and Prevention (US)
  • Emory University (US)
  • University of Rochester Medicine (US)
  • Connecticut Department of Public Health (US)
  • Yale University (US)
  • Minnesota Department of Health (US)
  • Vanderbilt University (US)
Corresponding author
Epstein, Lauren
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2015-09-03
Volume
62
Issue
1
Pages
45-52
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/civ777
PMC
PMC6557163
OpenAlex
W2111015920
Cited by
41
References
33
Citations by year
2026: 4 · 2025: 6 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 1 · 2019: 6 · 2018: 6 · 2017: 3 · 2016: 3 · 2015: 2
FWCI
3.64
Type
journal article
Language
en
Open access
Locations
  • Clinical Infectious Diseases (publishedVersion, public-domain)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
National Institutes of Health (CC999999)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Keywords
methicillin-resistant Staphylococcus aureus, invasive MRSA infections, risk factors, MRSA colonization, nursing homes, chronic wounds, central venous catheters, invasive devices, hospital discharge, infection control
MeSH terms
Female, Humans, Male, Middle Aged, Patient Discharge, Prospective Studies, Risk Factors, Staphylococcal Infections, Case-Control Studies, Bacteremia, Methicillin-Resistant Staphylococcus aureus

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