CONTRASTING METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS COLONIZATION IN VETERANS AFFAIRS AND COMMUNITY NURSING-HOMES

PURPOSE: To compare the prevalence of methicillin-resistant Staphyloco ccus aureus (MRSA) nares colonization, the patterns of MRSA acquisitio n, and the risk for subsequent MRSA infection between a hospital-based , Department of Veterans Affairs (VA) nursing home care unit (NHCU) an d community-based nursing homes.PATIENTS AND METHODS: In this prospect ive study, 148 residents of three community nursing homes and 55 resid ents of a VA NHCU had their anterior nares swabbed; repeat cultures we re obtained from hospitalized patients and/or individuals colonized wi th MRSA. Subjects were followed up prospectively for 1 year to note ho spitalizations and the development of MRSA infections. RESULTS: The pr evalence of MRSA colonization was significantly higher in the VA NHCU than in the community nursing homes (mean +/- SD 30.3% +/- 11% versus 9.9% +/- 4%). The rate of MRSA nares colonization was similar in the t wo settings. Acquisition of MRSA took place in both the long-term care facilities and hospitals, with 23.8% of incident cases occurring duri ng a hospitalization. Only 3 of the 27 individuals colonized at baseli ne developed an MRSA infection. A trend toward an increased rate of in fection was seen in colonized individuals residing in the community nu rsing homes versus those in the VA NHCU (relative risk 4.67; 95% CI 0. 55 to 39.9). Forty-seven percent of the 55 subjects hospitalized were colonized at some point during the study. In contrast to residents of the VA NHCU, MRSA colonization in the community facilities was a marke r for high mortality. CONCLUSIONS: Outcomes from colonization may be d ifferent in the VA NHCU population and the community nursing home popu lation.