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Community-Acquired Infection With Healthcare-Associated Methicillin-Resistant Staphylococcus aureus: The Role of Home Nursing Care

Published online by Cambridge University Press:  21 June 2016

François-Xavier Lescure ,
Gwenaelle Locher ,
Mathieu Eveillard ,
Maurice Biendo ,
Stéphanie Van Agt ,
Guillaume Le Loup ,
Youcef Douadi ,
Olivier Ganry ,
François Vandenesch  and
François Eb
...Show all authors
François-Xavier Lescure*
Affiliation:
Departments of Tropical and Infectious Diseases, Hospital and University Centre, Amiens, France Service de maladies infectieuses et tropicales, Hôpital Tenon, Paris, France
Gwenaelle Locher
Affiliation:
Bacteriology, Hospital and University Centre, Amiens, France
Mathieu Eveillard
Affiliation:
Bacteriology, Hospital and University Centre, Amiens, France
Maurice Biendo
Affiliation:
Bacteriology, Hospital and University Centre, Amiens, France
Stéphanie Van Agt
Affiliation:
Bacteriology, Hospital and University Centre, Amiens, France
Guillaume Le Loup
Affiliation:
Departments of Tropical and Infectious Diseases, Hospital and University Centre, Amiens, France
Youcef Douadi
Affiliation:
Departments of Tropical and Infectious Diseases, Hospital and University Centre, Amiens, France
Olivier Ganry
Affiliation:
Epidemiology, Hospital and University Centre, Amiens, France
François Vandenesch
Affiliation:
INSERM E0230, IFR62, Centre National de Référence des Staphylocoques, Faculté de Médecine Laennec, Lyon, France
François Eb
Affiliation:
Bacteriology, Hospital and University Centre, Amiens, France
Jean-Luc Schmit
Affiliation:
Departments of Tropical and Infectious Diseases, Hospital and University Centre, Amiens, France
Jerome Etienne
Affiliation:
INSERM E0230, IFR62, Centre National de Référence des Staphylocoques, Faculté de Médecine Laennec, Lyon, France
*
Service de maladies infectieuses et tropicales, Hôpital Tenon, Assistance publique des hôpitaux de Paris (ap-hp), 4 rue de la Chine, 75970 Paris cedex 20, France (xavier.lescure@tnn.aphp.fr)
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Abstract

Objective.

To better understand the role of indirect transmission in community-acquired infection with methicillin-resistant Staphylococcus aureus (MRSA).

Design.

Prospective case-control study.

Setting.

A French teaching hospital.

Patients.

A total of 198 case patients and 198 control patients with MRSA or methicillin-susceptible S. aureus infection diagnosed between April 2002 and July 2003.

Results.

Multivariate analysis showed a highly significant independent link between MRSA infection at admission and prior receipt of home nursing care (odds ratio [OR], 3.7; P<.001). Other independent risk factors were prior hospitalization (OR, 3.8; P<.001), transfer from another institution (OR, 2.3; P = .008), and age older than 65 years (OR, 1.6; P = .04). Prior home nursing care showed a frequency dose-response relationship. Eleven MRSA-infected patients had had home nursing procedures but no hospital stay in the previous 3 years. These patients' MRSA strains were related to the prevalent MRSA clone currently spreading in French hospitals.

Conclusion.

Home nursing care appears to be an independent risk factor for MRSA acquisition in the community. The reservoir probably consists of MRSA carriers discharged from the hospital. Community nurses seem to be a potential vector.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1213 - 1218
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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