2181. Impact of Methicillin-Resistant Staphyloccus aureus Colonization on Transfer to a Nursing Home
Session: Poster Abstract Session: HAI: MRSA, MSSA, and Other Gram Positives
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Studies on the spread of antibiotic-resistant organisms across a network of facilities often rely on measures of infection rates, however, little is known about the impact that colonization may have on whether patients require additional care after discharge. To understand the impact of MRSA colonization on transfers to nursing homes (NH), we used surveillance tests for methicillin-resistant Staphylococcus aureus (MRSA) which have been performed for patients admitted to US Veterans Affairs (VA) hospitals since October 1, 2007.

Methods: We identified first admissions into a VA facility from January 1 2000 to July 1 2011, restricting our analysis to patients first admitted into a hospital after MRSA surveillance was initiated on October 1, 2007. Patients were included if they had an admission test and at least one additional test during their stay. Importation was defined by a positive MRSA surveillance test within 12 hours of admission, and acquisition was defined as a negative test within 12 hours of admission followed by a positive test. Primary outcome was NH transfer, with all other events censored. We classified MRSA colonization as either importation or acquisition, and ran a cox proportional hazard model, treating acquisition as a time-varying covariate. Because the time of first positive test is unlikely to coincide with the time of acquisition, we estimated acquisition time as the midpoint between the negative and positive test times. Baseline covariates included importation, gender and age.

Results: Included were 243,553 admissions with a total of 5,548 (2.3 %) transfers to NH, 12,399 (5.1 %) importations and 3,064 (1.3 %) acquisitions. Gender was not associated with NH transfer, but age was associated with increased risk of NH transfer (HR 1.36, 95% CI 1.25-1.49 for 55 age 70, and HR 1.84, 95% CI 1.68-2.01 for age 70). Additionally, importation (HR 1.19, 95% CI 1.09-1.31) and acquisition (HR 1.28, 95% CI 1.09-1.49) were associated with increased rate of NH transfer.

Conclusion: MRSA colonization is associated with increased risk of NH transfer following hospital admission. Additionally, acquisition of MRSA seems to result in a slightly elevated risk of NH transfer compared with those who are colonized at the time of hospital admission.

Karim Khader, PhD1, Damon Toth, PhD1, Makoto Jones, MD, MS2, Michael Rubin, MD, PhD, FIDSA3 and Matthew Samore, MD, FSHEA4, (1)Ideas Center, VA Salt Lake City Health Care System, Salt Lake City, UT, (2)Internal Medicine, VA Salt Lake City Health Care System, Salt Lake City, UT, (3)Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, (4)University of Utah School of Medicine, Division of Epidemiology, Salt Lake City, UT

Disclosures:

K. Khader, None

D. Toth, None

M. Jones, None

M. Rubin, None

M. Samore, None

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