Age and Ageing Advance Access originally published online on July 11, 2005
Age and Ageing 2005 34(5):456-462; doi:10.1093/ageing/afi135
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Research Paper |
Prevalence and prediction of previously unknown MRSA carriage on admission to a geriatric hospital
1 Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
2 Department of Geriatrics, Geneva University Hospitals, Geneva, Switzerland
3 Microbiology Laboratory, Geneva University Hospitals, Geneva, Switzerland
Address correspondence to: S. Harbarth, Infection Control Program, Geneva University Hospitals, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland. Fax: (+41) 22 372 3987. Email: stephan.harbarth{at}hcuge.ch
Abstract
Objectives: to determine the prevalence and characteristics of previously unknown methicillin-resistant Staphylococcus aureus (MRSA) carriers at admission.
Design: two prospective case–control studies.
Subjects: 1,621 elderly patients were screened for MRSA carriage within 24 hours after admission to a geriatric hospital in Geneva, Switzerland.
Methods: risk factors associated with previously unknown MRSA carriage were determined in the derivation group, and the resulting risk score was evaluated in the validation cohort using logistic regression analysis.
Results: prevalence of MRSA carriage at admission increased from 7.3% (53/724 patients) in 2001 to 8.7% (78/897 patients) in 2003, with a corresponding prevalence of unknown MRSA carriers of 4.6 and 5.8%, respectively. Three variables were independently associated with previously unknown MRSA carriage: recent antibiotic treatment (adjusted OR (aOR) 2.3; 95% CI 1.0–5.1), intra-hospital transfer (aOR 2.5; 95% CI 1.2–5.3), and hospitalization in the past 2 years (aOR 2.7; 95% CI 1.1–6.7). In the validation cohort, the probability of MRSA carriage increased across risk scores: 0 point, 4% prevalence (6/146); 1 point, 15% (21/136); and $2 points, 31% (21/68; P<0.001). The risk score showed good discrimination and calibration in both groups.
Conclusions: our risk score, which used a simple additive point system to estimate the likelihood of unknown MRSA carriage, had good accuracy and generalised well in an independent sample of patients. Once validated in a clinical trial, our risk score may be used as a tool to optimise MRSA control.
Keywords: MRSA, prevalence, infection control, carriage, prediction, aged, elderly
Received December 3, 2004; accepted in revised form May 24, 2005.
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