2. Department of Internal Medicine, Hospital da Barbanza, Riviera (A Coruña), Spain.
3. Department of Internal Medicine, University Hospital Complex of Vigo, Vigo (Pontevedra), Spain.
4. Department of Internal Medicine, Complex University Hospital of A Coruña, (A Coruña), Spain.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a very important multidrug-resistant pathogen with increase morbidity, mortality and related medical costs. MRSA infection has been described not also in hospitals but in long term care facilities such as nursing homes. MRSA strains can spread from hospitals to nursing homes and vice versa. Our objective is to study the incidence of MRSA infection in a community hospital, the prevalence of MRSA carriers in a nursing home and the impact of a program to control MRSA carriers at the nursing home on MRSA related hospital admissions.
Material and methods: The study has three parts. First part includes a retrospective study conducted to investigate patients hospitalized because of MRSA infection from 1998 to 2005. A nursing home was opened in 2002. In 2006, a cohort study among residents and caregivers at the nursing home to assess the prevalence of MRSA carriage was performed. When nasal culture was positive, intranasal mupirocin was administered. The retrospective part of the study and the intervention procedure at the nursing home were carried out simultaneously. The third part of the study was prospective. It was performed from 2006 to 2009 to evaluate the occurrence of new MRSA related hospital admissions. The study was finished in 2009.
Results: 74 patients were hospitalized because of MRSA related infections, mostly old men. MRSA was isolated from the sputum, blood and skin. The incidence of MRSA infection ranged from 3.03/100000 (2000, 2007, 2008) to 30.30/100000 habitants (2005). Eighteen patients (24.32%) died during hospitalization. A total of 104 residents undergo nasal culture. MRSA was isolated in 9 (8.65%). Among caregivers, 54 were examined. MRSA was present in 2 (3.70%).
Conclusions: Following the opening of the hospital there was a progressive increase in MRSA infections with a peak in 2005. Mortality rate was near to 25% during hospitalization in MRSA infected patients. After the opening of the nursing home there was an increase in the incidence that dropped dramatically after performing the intervention study at the nursing home. Elderly, the high rate of MRSA carriers, the probable previous admission to hospital, including ICU stay of some patients, point to the need of eradicating MRSA carriers in order to reduce hospital infections. Nursing homes seem to be a suitable place to perform MRSA eradication.
Keywords: MRSA infection, MRSA spread, nursing home, elderly, caregiver