Hospital- and Community-Based Surveillance of Methicillin-Resistant Staphylococcus aureus: Previous Hospitalization is the Major Risk Factor

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Abstract
Objective: The purpose of the study was to determine the incidence and risk factors for the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in our community.Design: This study used a cross-sectional design to assess patients colonized or infected with MRSA.Patients: The study population consisted of residents of London, Ontario, Canada, who were identified as MRSA-positive for the first time in 1997.Setting: All acute- and chronic-care hospitals, long-term healthcare facilities, and community physicians' offices in the city of London participated in the study.Main Outcome Measure: Incidence of MRSA in the community, risk factors for acquisition, especially previous hospitalization over a defined period, and strain type were evaluated.Results: In 1997, 331 residents of London were newly identified as MRSA-positive, representing an annual incidence of 100/100,000 persons (95% confidence interval, 88.8-110.7). Thirty-one (9.4%) individuals were not healthcare-facility patients in the previous month, and 11 (3.3%), 10 (3.0%), and 6 (1.8%) individuals had no such contact in the previous 3, 6, and 12 months, respectively. One hundred seventy-seven strains, including five of the isolates from patients with no healthcare-facility contact in the previous year, were typed. One hundred sixty (90.3%) of these isolates, including all typed strains from patients with no healthcare facility contact, belonged to a single clone.Conclusion: These findings demonstrate that the incidence of MRSA is higher than previously reported and that hospital contact is the single most important risk factor for the acquisition of MRSA in our community. Screening for MRSA in previously hospitalized patients at the time of hospitalization may reduce nosocomial spread and indirectly reduce the incidence of MRSA in the community.