Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2

Table 4. Factors associated with health care–associated methicillin-resistant Staphylococcus aureus infection Category Variable Odds ratio 95% CI P value (0.63, 0.85) <.001 In all patients Cohort Before After Surgery — 0.73 No (referent) — Yes 1.3 (1.12, 1.51) <.001 1 (1.00, 1.01) 0.07 Male (referent) — Age Sex HA-MRSA-I remains a serious problem in the modern health care environment. Our study suggests that surveillance programs are eﬀective in decreasing these infections, both hospitalwide and among surgical patients. We also conﬁrm the increased mortality associated with HA-MRSA-I. Further studies are needed to aid in the reduction of the transmission of this disease among hospitalized patients, with particular focus on African American patients and those with increased lengths of stay. 1. Shorr AF. Epidemiology of staphylococcal resistance. Clin Infect Dis 2007;45(Suppl 3):S171–S176. 2. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber Race White (referent) — MJ, Karchmer AW, Carmeli Y. Comparison of morAfrican American 1.31 (1.1, 1.55) 0.002 tality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: Hispanic 0.99 (0.77, 1.28) 0.15 a meta-analysis. Clin Infect Dis 2003;36(1):53–59. Asian 0.29 (0.07, 1.18) 0.10 3. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Other 0.65 (0.31, 1.38) 0.65 Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susLength of stay 1.05 (1.05, 1.06) <.001 ceptible and methicillin-resistant Staphylococcus auIn the after cohort reus. Arch Intern Med 2002;162(19):2229–2235. 4. Anderson DJ, Sexton DJ, Kanafani ZA, Auten G, Surgery No (referent) — Kaye KS. Severe surgical site infection in commuYes 1.33 (1.05, 1.70) <.0167 nity hospitals: epidemiology, key procedures, and Age 1.00 (1.0, 1.01) 0.3334 the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol Sex Male (referent) — 2007;28(9):1047–1053. F emale 0.49 (0.39, 0.62) <.0001 5. Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, Fridkin SK; National HealthRace White (referent) — care Safety Network Team; Participating National African American 1.48 (1.45, 1.91) 0.0212 Healthcare Safety Network Facilities. NHSN annual Hispanic 1.00 (0.69, 1.47) 0.7821 update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual sumAsian 0.69 (0.17, 2.79) 0.5864 mary of data reported to the National Healthcare Other 0.73 (0.27, 1.98) 0.5479 Safety Network at the Centers for Disease Control Length of stay 1.05 (1.03, 1.04) <.0001 and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29(11):996–1011. 6. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM, Farr BM; SHEA. SHEA prophylaxis for patients who screen positive, and adminguideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epiistering mupirocin calcium nasal ointment for all patients demiol 2003;24(5):362–386. regardless of screening status (16). MRSA infections at per7. Kallen AJ, Mu Y, Bulens S, Reingold A, Petit S, Gershman K, Ray SM, cutaneous gastrostomy sites decreased from 12% to 29% over Harrison LH, Lynﬁeld R, Dumyati G, Townes JM, Schaﬀner W, Patel PR, a 33-month period to 2% after a screening and decontaminaFridkin SK; Active Bacterial Core surveillance (ABCs) MRSA Investigation program was initiated. The protocol involved screening tors of the Emerging Infections Program. Health care-associated invasive MRSA infections, 2005–2008. JAMA 2010;304(6):641–648. for MRSA from multiple sites, nasal treatment with mupiro8. Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial cin, and daily skin decontamination prior to the procedure infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern (17). MRSA infection rates among ICU patients decreased Med 1982;97(3):309–317. from 3.0% to 1.5% when enhanced cleaning procedures were 9. Parvez N, Jinadatha C, Fader R, Huber TW, Robertson A, Kjar D, Corneused in rooms previously occupied by patients with MRSA. A lius LK. Universal MRSA nasal surveillance: characterization of outcomes at a tertiary care center and implications for infection control. South Med similar reduction in vancomycin-resistant enterococci infecJ 2010;103(11):1084–1091. tion rates from 3.0% to 2.2% was also demonstrated (18). 10. Harbarth S, Fankhauser C, Schrenzel J, Christenson J, Gervaz P, However, Camus and colleagues did not show a reduction in Bandiera-Clerc C, Renzi G, Vernaz N, Sax H, Pittet D. Universal screening MRSA acquisition in the ICU setting with more aggressive for methicillin-resistant Staphylococcus aureus at hospital admission and nosointervention protocols, including repeated MRSA screening, comial infection in surgical patients. JAMA 2008;299(10):1149–1157. 11. Mera RM, Suaya JA, Amrine-Madsen H, Hogea CS, Miller LA, Lu EP, contact and droplet isolation precautions, and decontaminaSahm DF, O’Hara P, Acosta CJ. Increasing role of Staphylococcus aureus and tion with nasal mupirocin and chlorhexidine body wash for community-acquired methicillin-resistant Staphylococcus aureus infections MRSA-positive patients (19). Female 86 0.56 (0.48, 0.65) <.001 Baylor University Medical Center Proceedings Volume 27, Number 2

Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 12