Clinical question: What factors are associated with methicillin-resistant Staphylococcus aureus (MRSA) carriage at hospital discharge to home health care, prolonged MRSA colonization, and MRSA transmission to household contacts?
Background: Previous studies have reported prolonged colonization with hospital-acquired MRSA after discharge, as well as transmission of MRSA to household contacts. However, the rates and risk factors for MRSA carriage and transmission are unknown.
Study design: Multicenter prospective cohort.
Setting: Home-health-care system associated with 47 public teaching hospitals in France.
Synopsis: More than 1,500 hospitalized adult patients with planned discharge to home health care were screened for MRSA colonization, and 12.7% were MRSA-positive by nasal or skin lesion swab.
Factors independently associated with MRSA carriage at hospital discharge were chronic skin lesions, older age, longer duration of hospitalization, and neurologic and cardiovascular primary diagnoses.
Surveillance sampling for up to one year showed that approximately half of these patients had clearance of MRSA, with a median time to clearance of 282 days. Lack of self-sufficiency in daily activities was associated with persistent MRSA carriage.
Nineteen percent of household contacts acquired MRSA during the study period. Risks included older age and providing healthcare to the index patient.
Bottom line: Hospital-acquired MRSA colonization is prevalent at discharge to home health settings, is frequently prolonged, and commonly results in transmission to household contacts, particularly those providing healthcare to the index patient.
Citation: Lucet JC, Paoletti X, Demontpion C, et al. Carriage of methicillin-resistant Staphylococcus aureus in home care settings: prevalence, duration, and transmission to household members. Arch Intern Med. 2009;169(15):1372-1378.
—Reviewed for TH eWire by Kelly Cunningham, MD, Elizabeth Rice, MD, Eduard Vasilevskis, MD, Joshua LaBrin, MD, Kelly Sopko, MD, Shelley Ellis, MD, MPH, and Sunil Kripalani, MD, MSc, Section of Hospital Medicine, Vanderbilt University, Nashville, Tenn.