1962. Invasive Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Residents of Long-Term Care Facilities: Targeted Prevention Efforts Needed
Session: Oral Abstract Session: Controlling Resistant Gram Positive Infections
Saturday, October 10, 2015: 2:45 PM
Room: 5--AB
Background: Long-term care facility (LTCF) residence is a well-described risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization, with prevalence as high as 58%.  Studies examining MRSA in LTCFs have focused on risk factors for carriage but less is known about MRSA infections in this setting. We describe characteristics and healthcare exposures of LTCF residents with invasive MRSA infections, and compare LTCF-onset and hospital-onset (HO) infections.


We analyzed data on invasive MRSA infections (i.e., cultured from sterile body sites) from surveillance areas in 9 states reported to CDC’s Emerging Infections Program (EIP) from 2009–2013. Onset location was defined as the facility where patients resided 3 days prior to infection.  We described characteristics of LTCF-onset MRSA infections from all 9 sites.  Using nursing home utilization data from California (CA), we estimated pooled mean MRSA bloodstream infection (BSI) incidence (per 100,000 patient-days) from LTCFs within the CA EIP catchment area and compared to HO MRSA BSI incidence from general acute-care hospitals within the same area (obtained from publicly reported data).


Of invasive MRSA infections reported from 9 sites, 4,607 were LTCF-onset compared to 4,344 HO infections.  Most LTCF-onset infections were BSI (91%), with an in-hospital case-fatality rate of 19%.  Among LTCF residents with invasive MRSA infections, known risk factors for infection were common: 1014 (22%) had decubitus ulcers, 1455 (32%) had previous MRSA infection or colonization, 1098 (24%) had a central venous catheter in the 2 days before initial culture, and 1101 (24%) were chronic dialysis patients; 958 (30%) were discharged from an acute-care hospital in the prior 30 days.  In 2013 the pooled mean incidence of LTCF-onset MRSA BSI in the CA EIP catchment area was 3.3 per 100,000 patient days, compared to 4.3 HO infections per 100,000 patient days (P=0.10) (median facility HO rate: 3.4 per 100,000 patient-days).


These data suggest the burden of LTCF-onset invasive MRSA infections may now be comparable to HO infections.   While infection control measures have shown success in preventing invasive MRSA infections in hospitals, future strategies to reduce the burden of invasive MRSA infections should address the LTCF population.

Cheri Grigg, DVM, MPH1, Nimalie Stone, MD2, Nicole Gualandi, RN, MS/MPH1, Wendy Bamberg, MD3, Ghinwa Dumyati, MD, FSHEA4, Lee Harrison, MD5, Ruth Lynfield, MD, FIDSA6, Joelle Nadle, MPH7, Susan Petit, MPH8, Susan M. Ray, MD, FIDSA9, William Schaffner, MD, FIDSA, FSHEA10, John M. Townes, MD11 and Isaac See, MD1, (1)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention (CDC), Atlanta, GA, (3)Colorado Dept. of Public Health and Environment, Denver, CO, (4)University of Rochester Medical Center, Rochester, NY, (5)University of Pittsburgh, Pittsburgh, PA, (6)Minnesota Department of Health, St. Paul, MN, (7)California Emerging Infections Program, Oakland, CA, (8)Connecticut Department of Public Health, Hartford, CT, (9)Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, (10)Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, (11)Oregon Health and Science University, Portland, OR


C. Grigg, None

N. Stone, None

N. Gualandi, None

W. Bamberg, None

G. Dumyati, None

L. Harrison, None

R. Lynfield, None

J. Nadle, None

S. Petit, None

S. M. Ray, None

W. Schaffner, None

J. M. Townes, None

I. See, None

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