Infection with methicillin-resistant Staphylococcus aureus (MRSA) appears relatively common among patients discharged from the hospital into home health care, according to a report in the August 10/24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, about one-fifth of infected patients may transmit the organism to other people in their households.
MRSA is common in hospitals in most countries, and as the incidence of infection increases new patterns of spread are emerging, according to background information in the article. "Thus, in the last decade, community-acquired MRSA strains have caused hospital outbreaks and sometimes replaced older strains previously responsible for hospital-acquired MRSA infections," the authors write. "Conversely, hospital-acquired MRSA strains can spread outside the health care system."
Jean-Christophe Lucet, M.D., Ph.D., of Bichat-Claude Bernard Hospital, Assistance Publique-Hτpitaux de Paris, France, and colleagues studied 1,501 adult inpatients in French hospitals who in 2003 and 2004 were screened for MRSA before discharge to home health care. Patients were followed up and screened for clearance of MRSA every three months for one year, and household contacts were also screened for presence of the organism.
MRSA was identified in a total of 191 of the 1,501 patients (12.7 percent) before discharge from the hospital to home health care. Of the 148 who were followed up, 75 were found to have cleared the organism within one year. Patients who were more self-sufficient in daily activities appeared more likely to experience clearance of MRSA.
The 191 patients with MRSA had 188 household contacts who participated in the study. Of these, 36 (19.1 percent) acquired MRSA, although none developed an infection. Household contacts who were older and who played a role in providing health care for the patient appeared more likely to be colonized with MRSA. "Sharing the same bed or bedroom, in contrast, was not associated with MRSA transmission," the authors write. "Thus, MRSA may be preferentially transmitted to contacts who are at high risk for hand contamination during care procedures."
Because none of the household contacts who acquired MRSA developed an infection, it is unclear whether this transmission represents a serious public health problem, the authors note. However, to prevent spread of the organism, "household contacts should apply infection control measures similar to those recommended in the hospital setting."
This study was supported by grants from the Programme Rιgional de Recherche Clinique, Direction de la Recherche Clinique, AP-HP, Paris (a publicly funded non-profit organization).
- Jean-Christophe Lucet; Xavier Paoletti; Christine Demontpion; Marie Degrave; Dominique Vanjak; Corinne Vincent; Antoine Andremont; Vincent Jarlier; France Mentre; Marie-Helene Nicolas-Chanoine; for the Staphylococcus aureus Resistant a la Meticilline en Hospitalisation A Domicile (SARM HAD) Study Group. 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 [link]
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