1814. Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) Infection after Discharge from Acute-Care Hospitals
Session: Oral Abstract Session: Addressing Healthcare-Associated MRSA Outside of the Inpatient Setting
Saturday, October 5, 2013: 2:15 PM
Room: The Moscone Center: 200-212
Background:

Great strides have been made in reducing invasive MRSA infections in U.S. hospitals; however, prevention of MRSA infections among recently discharged patients remains a challenge. We conducted a matched case-control study to identify risk factors for invasive MRSA infections within 12 weeks post-acute care discharge.

Methods:

We used population-based surveillance for invasive MRSA in 6 U.S. metropolitan areas to identify eligible case-patients defined as adults 18 years of age or older who had MRSA cultured from a normally sterile body site collected as an outpatient (or ≤ 3 days after admission) and who were hospitalized ≤12 weeks before positive culture.  For each case-patient identified , two control-patients were randomly chosen from discharge databases at 15 participating hospitals after matching on age, hospital, and month of discharge of the case-patient’s latest hospitalization prior to invasive MRSA culture (i.e., “hospitalization of interest”). Data were abstracted from medical records and obtained from telephone interviews for both case- and control-patients to assess exposures during the hospitalization of interest and post-discharge period.  Conditional logistic regression was used to identify independent predictors of post-discharge invasive MRSA infection.

Results:

From March 2011–February 2013, 167 case- and 334 matched control-patients were enrolled. Case-patients were more likely to be male (62% vs. 40%, P<.001), have more comorbidities (Charlson Index >1: 72% vs. 45%, P<.001), or be on chronic dialysis (21% vs.3%, P<.001). After controlling for gender, comorbidities, and recent history of MRSA colonization, discharge with a central venous catheter (CVC) (32% of cases) ( aOR:2.9, P<.001) or other invasive devices  (26% of cases) (aOR:2.4, P=.008), insertion of a new CVC during the outpatient period (8% of cases) ( aOR:5.1, P=.01), and discharge to a long term-care facility (47% of cases) (aOR:3.6, P<.001 ) were independently associated with post-discharge invasive MRSA infections.

Conclusion:

Prevention of post-discharge invasive MRSA infection should include improved outpatient CVC insertion and maintenance practices and implementing effective infection control strategies in long-term care settings.

Fernanda Lessa, MD1, Ruth Belflower, RN, MPH1, Yi Mu, PhD1, Susan M. Ray, MD2,3, Janine Scott, MPH3,4,5, Ghinwa Dumyati, MD, FSHEA6, Christina Felsen, MPH6, Susan Petit, MPH7, Kimberly Yousey-Hines, MPH8, Joelle Nadle, MPH9, Lauren Pasutti, MPH9, Ruth Lynfield, MD10, Linn Warnke, RN, MPH10, William Schaffner, MD11, Karen Leib, RN12,13, Alexander Kallen, MD, MPH14 and Scott Fridkin, MD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Emory University School of Medicine and Georgia Emerging Infections Program, Atlanta, GA, (3)Atlanta Veterans Affairs Medical Center, Decatur, GA, (4)Georgia Emerging Infections Program, Decatur, GA, (5)Atlanta Research and Education Foundation, Decatur, GA, (6)University of Rochester, Rochester, NY, (7)Connecticut Emerging Infections Program, New Haven, CT, (8)Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, CT, (9)California Emerging Infections Program, Oakland, CA, (10)Acute Disease Investigation and Control, Minnesota Department of Health, St. Paul, MN, (11)Vanderbilt University School of Medicine, Nashville, TN, (12)Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN, (13)TN Emerging Infections Program, Nashville, TN, (14)Division Of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

F. Lessa, None

R. Belflower, None

Y. Mu, None

S. M. Ray, None

J. Scott, None

G. Dumyati, None

C. Felsen, None

S. Petit, None

K. Yousey-Hines, None

J. Nadle, None

L. Pasutti, None

R. Lynfield, None

L. Warnke, None

W. Schaffner, None

K. Leib, None

A. Kallen, None

S. Fridkin, None

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