Adverse events associated with methicillin-resistant Staphylococcus aureusin a nursing home

Background: Methicillin-resistant Staphylococcus aureus (MRSA) generates co ncern in nursing homes. Restrictive isolation precautions may be applied fo r indefinite periods. Adverse events driving these concerns include transmi ssion and infection. Methods: The 721-bed Wisconsin Veterans Home in King performs approximately 645 cultures annually. The site, severity, and number of MRSA infections w ere determined for 69 months. Pulsed-field gel electrophoresis was performe d on all initial isolates, followed by a statistical cluster analysis looki ng for evidence of transmission. Results: Sixty-seven MRSA infections were identified (1.6 per 100 residents per year); many were polymicrobial, and it was difficult to determine the proportionate role of MRSA in morbidity or mortality. There was an episode of rapidly fatal MRSA septicemia in which empiric antibiotic therapy was in effective. Twenty-one genetic 13 clusters of genetically identical strains clustered in time and space (P < .05). Conclusions: Infections with MRSA were identified at relatively low rates; however, the etiology of many serious nursing home infections is not determ ined, especially pneumonia. Statistical analysis revealed clustering and ev idence of transmission. Nursing home practitioners should consider MPRSA wh en applying empiric treatment to serious Infections. We recommend a program including (1) judicious use of antibiotics, including topical agents, to r educe selection of resistant organisms; (2) obtaining and tracking cultures of infectious secretions to diagnose MRSA infections and focus antibiotic therapy; (3) universal standard secretion precautions because any resident could be a carrier; and (4) a detailed assessment and care plan for the car rier that maximizes containment of secretions and independence in activitie s. However, basic hygiene cannot be maintained in communal areas by some re sidents without restriction of activities of daily living.