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Community-acquired Methicillin-resistant Staphylococcus aureus: role of home nursing care in a French prospective study

Abstract number: 10.1111/j.1198-743X.2004.902_o093.x

Lescure F.-X.

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Background:

Until recently, Methicillin resistant Staphylococcus aureus (MRSA) was regarded as a multi-resistant pathogen associated exclusively with nosocomial infections. For 10 years, authors have evoked an epidemiological ‘drift’ of MRSA towards the community. The question is where exactly MRSA acquisition takes place. The aim of the survey was to research the risk factors in relation to community acquisition of MRSA, concentrating primarily on medical or paramedical care in community.

Methods:

A case-control study with prospective recruitment included consecutively 198 cases and 198 controls between the 1st of April 2002 and the 31st of July 2003 in a french teaching hospital. All patients were, at the time of admission, infected with Staphylococcus aureus. Cases were infected with MRSA, controls were infected with MSSA.

Findings:

Multivariate analysis showed a strong and highly significant independent association between MRSA infection at admission and prior home nursing care (OR = 3.7, P < 0.0001). The other independent risk factors were prior hospitalisation in a surgical ward (OR = 3.8, P = 0.0003), transfer from another institution (OR = 2.3, P = 0.008) and age >65 years (OR = 1.6, P = 0.04). In addition, there was a dose-effect relation for prior home nursing care and a positive interaction-effect with prior hospitalisation in a surgical ward (OR = 3.1, P = 0.02).

Implications:

These results evoke the possibility of true community MRSA acquisitions by home nursing care. The MRSA reservoir are probably MRSA carriers discharged from hospital. A potential vector are domiciliary nurses who, not daily confronted with nosocomial infections and often ignoring the patient status in relation to MRSA, do not apply appropriate hygiene measures.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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