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Journal of Clinical Microbiology, September 2007, p. 3031-3038, Vol. 45, No. 9
0095-1137/07/$08.00+0     doi:10.1128/JCM.00315-07
Copyright © 2007, American Society for Microbiology. All Rights Reserved.

Methicillin-Resistant Staphylococcus aureus Infection or Colonization Present at Hospital Admission: Multivariable Risk Factor Screening To Increase Efficiency of Surveillance Culturing

Department of Internal Medicine, Austin Medical Education Programs, Brackenridge Hospital, 601 E. 15th Street, Austin, Texas 78701,¹ Division of Epidemiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390-8874²

Received 8 February 2007/ Returned for modification 22 April 2007/ Accepted 30 June 2007

Identifying methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection present at admission has become important in reducing subsequent nosocomial transmission, but the most efficient surveillance methods remain to be defined. We performed anterior nares surveillance cultures of all patients upon admission to and discharge from the general internal medicine floor in our community hospital over a 7-week period, and patients completed a questionnaire on MRSA risk factors. Of the 401 patients, 41 (10.2%) had MRSA upon admission. Of the 48 risk measures analyzed, 10 were significantly associated with admission MRSA, and 7 of these were independently associated in stepwise logistic regression analysis. Factor analysis identified eight latent variables that contained most of the predictive information in the 48 risk measures. Repeat logistic regression analysis including the latent variables revealed three independent risk measures for admission MRSA: a nursing home stay (relative risk [RR], 6.18; 95% confidence interval [95% CI], 3.56 to 10.72; P < 0.0001), prior MRSA infection (RR, 3.97; 95% CI, 1.94 to 8.12; P = 0.0002), and the third latent variable (factor 3; RR, 3.14; 95% CI, 1.56 to 6.31; P = 0.0013), representing the combined effects of homelessness, jail stay, promiscuity, intravenous drug use, and other drug use. Multivariable models had greater sensitivity at detecting admission MRSA than any single risk measure and allowed detection of 78% to 90% of admission MRSA from admission surveillance cultures on 46% to 58% of admissions. If confirmed in additional studies, multivariable questionnaire screening at admission might identify a subset of admissions for surveillance cultures that would more efficiently identify most admission MRSA.

Published ahead of print on 11 July 2007.

Present address: Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention, Portland, Oregon.

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