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1 May 2008

Volume 46, Number 9
Clinical Infectious Diseases 2008;46:1368–1373
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4609-0007$15.00
DOI: 10.1086/586751
MAJOR ARTICLE

Epidemiology of Staphylococcus aureus Colonization in Nursing Home Residents

Lona Mody,1,3

Carol A. Kauffman,2

Susan Donabedian,4

Marcus Zervos,4 and

Suzanne F. Bradley1,2,3

Divisions of 1Geriatric Medicine and 2Infectious Diseases and 3Geriatric Research Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, University of Michigan Medical School, Ann Arbor, and 4Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan

Background.We sought to characterize the clinical and molecular epidemiologic characteristics of Staphylococcus aureus colonization (especially extranasal colonization) and to determine the extent to which community‐associated methicillin‐resistant S. aureus (MRSA) has emerged in community nursing homes.

Methods.The study enrolled a total of 213 residents, with or without an indwelling device, from 14 nursing homes in southeastern Michigan. Samples were obtained from the nares, oropharynx, groin, perianal area, wounds, and enteral feeding tube site. Standard microbiologic methods were used to identify methicillin‐susceptible S. aureus and MRSA. Molecular epidemiologic methods included pulsed‐field gel electrophoresis, PCR detection of Panton‐Valentine leukocidin, and SCCmec and agr typing.

Results.One hundred thirty‐one residents (62%) were colonized with S. aureus (MRSA colonization in 86). S. aureus colonization occurred in 80 (76%) of 105 residents with indwelling devices and in 51 (47%) of 108 residents without indwelling devices ( ). Of the 86 residents who were colonized with MRSA, nares culture results were positive for only 56 (65%). Residents with devices in place were more likely to be colonized at multiple sites. Eleven different strains of MRSA were identified by pulsed‐field gel electrophoresis. Seventy‐three residents (85%) were colonized with hospital‐associated SCCmec II strains, and 8 (9%) were colonized with community‐associated SCCmec IV strains, 2 of which carried Panton‐Valentine leukocidin.

Conclusions.Extranasal colonization with MRSA is common among nursing home residents—particularly among residents with an indwelling device. We documented the emergence of community‐associated SCCmec IV MRSA strains in the community nursing home setting in southeastern Michigan.

Received 9 October 2007; accepted 14 December 2007; electronically published 26 March 2008.

Reprints or correspondence: Dr. Lona Mody, 11‐G GRECC, VA Ann Arbor Healthcare System, 2215 Fuller Rd., Ann Arbor, MI 48105 ().

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