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Patient?s Home Setting and the Prevalence of Methicillin-resistent Staphylococcus aureus (MRSA) on Admission to Acute Geriatric Departments
A.D?HOOGHE, M.VAN DE VYVERE, J.VAN PELLICOM, M.VANDEWOUDE
Background: MRSA screening programs in geriatric patients have focused mostly on long-term care facilities. Few data exist on the prevalence of MRSA in acute geriatric wards. This may constitute a pool of unidentified carriers who spread MRSA in hospitals.
Methods: During a 12-month period [May 2003 ? April 2004] all patients admitted to the geriatric ward were screened with cultures of the nares, perineum, wounds (if present) and urine. Demographic and home setting characteristics were recorded. Length of stay (LOS) and clinical outcome at discharge were determined. Statistical analysis was performed with SPSS 13.01 for Windows. Tests were two-tailed and considered significant at a level of 0.05.
Results: A total of 327 patients (mean age: 82.8 ? 8.6 yr; 69% female) were admitted. Only 10 (3.1%) had no screening cultures. Thirty-five (10.7%) were MRSA positive. One hundred and ninety-four were admitted from home, 111 from a nursing home and 12 from another hospital. Their percentage MRSA-carriage was 8, 16 and 8% respectively. Patients coming from a nursing home were significantly more likely to be MRSA-positive (p=0.033). Overall, MRSA-carriage was not related to patient age. In the subgroup of deceased patients, however, there was a strong correlation between MRSA-positivity and age with older patients being more positive. In-hospital mortality was also significantly related to MRSA-carriage (p<0.001). LOS on the other hand was not significantly higher in the MRSA-positive group (median: 23 versus 21 days in the MRSA-negative group).
Conclusion: There is a high prevalence of MRSA-carriage in patients admitted to acute geri-atric wards. Though the risk of carriage is higher in patients coming from nursing homes, the risk of carriage in patients coming from home is still substantial. Therefore, screening should be extended to all patients. Moreover, MRSA-carriage was significantly related to mortality in this study group
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