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15 July 2005

Volume 41, Number 2
Clinical Infectious Diseases 2005;41:159–166
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4102-0003$15.00
DOI: 10.1086/430910
MAJOR ARTICLE

Risk Factors for Colonization with Methicillin‐Resistant Staphylococcus aureus (MRSA) in Patients Admitted to an Urban Hospital: Emergence of Community‐Associated MRSA Nasal Carriage

Alicia I. Hidron,1

Ekaterina V. Kourbatova,1

J. Sue Halvosa,2

Bianca J. Terrell,1

Linda K. McDougal,3

Fred C. Tenover,3

Henry M. Blumberg,1,2 and

Mark D. King1,2

1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 2Epidemiology Department, Grady Memorial Hospital, and 3Centers for Disease Control and Prevention, Atlanta, Georgia

Background.Surveillance cultures performed at hospital admission have been recommended to identify patients colonized with methicillin‐resistant Staphylococcus aureus (MRSA) but require substantial resources. We determined the prevalence of and risk factors for MRSA colonization at the time of hospital admission among patients cared for at a public urban hospital.

Methods.Anterior nares cultures were obtained within 48 h after admission during a 1‐month period. A case‐control study and molecular typing studies were performed.

Results.A total of 53 (7.3%) of 726 patients had a nares culture positive for MRSA, and 119 (16.4%) had a nares culture that was positive for methicillin‐susceptible S. aureus. In multivariate analysis, risk factors for MRSA colonization included antibiotic use within 3 months before admission (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.2–5.0), hospitalization during the past 12 months (OR, 4.0; 95% CI, 2.0–8.2), diagnosis of skin or soft‐tissue infection at admission (OR, 3.4; 95% CI, 1.5–7.9), and HIV infection. A total of 47 (89%) of 53 case patients colonized with MRSA had at least 1 of these independent risk factors, in contrast to 343 (51%) of 673 control patients (OR, 7.5; 95% CI, 3.2 –17.9). Molecular typing demonstrated that 16 (30%) of 53 MRSA nares isolates (2.2% of the 726 isolates) belonged to the USA300 community‐associated MRSA (CA‐MRSA) genotype.

Conclusion.The prevalence of MRSA colonization at the time of patient admission was high (>7%). Limiting surveillance cultures to patients with 1 of the identified risk factors may allow for targeted screening. The emergence of CA‐MRSA colonization represents a new, unrecognized reservoir of MRSA within hospitals, potentially increasing the risk for horizontal transmission.

Received 11 November 2004; accepted 23 February 2005; electronically published 8 June 2005.

  • (See the editorial commentary by Karchmer on pages 167–9)

Reprints or correspondence: Dr. Henry M. Blumberg, Div. of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Dr., Atlanta, GA 30303 ().

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