752 Invasive Methicillin-Resistant Staphylococcus aureus Infections Occurring in Long-Term Care Facility (LTCF) Residents in a Metropolitan Community

Sunday, March 21, 2010: 11:45 AM
International North (Hyatt Regency Atlanta)
Melissa Viray, MD , Centers for Disease Control and Prevention, Atlanta, GA
Ghinwa Dumyati, MD , University of Rochester, Rochester, NY
Nimalie Stone, MD, MS , Centers for Disease Control and Prevention, Atlanta, GA
Ruth Belflower, MPH , University of Rochester, Rochester, NY
Scott K. Fridkin , Centers for Disease Control and Prevention, Atlanta, GA
Fernanda Lessa, MD, MPH , Centers for Disease Control and Prevention, Atlanta, GA

Background: The number of U.S. residents in long-term care facilities (LTCFs) has increased dramatically in the past decade; recent data suggest residence in a LTCF is a risk factor for patients presenting to hospitals with invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Little is known about the preventability of infections in these patients.

Objective: Describe patients who developed invasive MRSA infections while in a LTCF within one metropolitan area and identify possible risk factors for infection.

Methods: We used data collected as part of CDC's Emerging Infections Program/Active Bacterial Core Surveillance (ABCs) for invasive MRSA infections to identify patients residing in any of six LTCFs in Rochester, NY, with MRSA cultured during January 2008 - June 2009 from a normally sterile site within 3 days of hospital admission, if admitted (community-onset). Medical records were reviewed for LTCF and prior acute-care admissions, including data on prior MRSA infections and colonization, underlying conditions, functional status, precedent device use and antimicrobial exposures.

Results: Thirty-eight patients met the inclusion criteria. The median age was 72 years (range 35 91); 37% (14/38) were female. Sources of the invasive isolate included blood, 66% (25/38), and bone, joint or lumbar spine (32%). Recent (prior 90 days) hospitalization in an acute-care facility was documented for 74% (28/38), with 18 (47%) hospitalized in the prior 30 days. The median length of stay in the LTCF before infection was 30 days (range 4-90). Preceding illness or condition in the 90 days prior to infection most often included any wound, 84% (32/38); 13/38 (34%) had decubitus ulcers and 12/38 (32%) had wounds related to surgery or other procedures. A prior MRSA-positive culture was documented in 12 patients (32%); only 26% (10/38) of patients had a central venous catheter (CVC) at any point during the 90 days preceding infection.

Conclusions: Invasive MRSA infections in LTCF residents most often occurred in patients receiving care for wounds, including procedural wounds and decubiti. Hospitalization and MRSA infection or colonization in the recent past were also common, while CVC use was less frequently seen. Evaluations aimed at preventing invasive MRSA infections in LTCF patients should include aspects of wound management.