MRSA is a dominant hospital pathogen because of its increasing incidence, the cost of treatment, antibiotic resistance, limited antimicrobial armamentarium, and associated increased mortality. Determining risk factors for MRSA acquisition in hospital settings has important public health relevance for defining targets for infection control, reduction in mortality from hospital-acquired infections, and decreasing hospitalization costs. A retrospective matched case-control study was initiated to determine patient-associated risk factors for MRSA acquisition at the Presbyterian University Hospital. It was hypothesized that risk factors for MRSA acquisition could be identified and used to enhance or tailor infection control strategies. Cases and two matched controls were selected among patients admitted to high risk units where MRSA screening was routinely done from January 2001 to December 2008. Cases were subjects who acquired MRSA during hospitalization. Variables collected were potential patient-associated risk factors associated with MRSA acquisition among cases versus controls. The odds of exposure to potential risk factors for MRSA acquisition were compared between cases and controls, using matched univariate conditional logistic regression. A single multivariate conditional logistic regression model identifying patient-specific risk factors significantly associated with MRSA acquisition was generated.
The final model included 15 independently significant variables. Seven factors were positively associated with MRSA acquisition: primary diagnosis of respiratory disease, digestive tract disease, or injury/trauma, any diagnosis of pneumonia, cerebrovascular/peripheral vascular disease, intracranial ventricular shunt procedure, and a high risk unit stay prior to index culture. Eight variables were protective and included two beta lactam antibiotic classes (penicillin and cephalosporin), rifamycin, daptomycin/linezolid, proton pump inhibitors, history of transplant, extracorporeal membrane oxygenation, and intravascular stenting/catheterization. As 3 of the 7 factors positively associated with MRSA acquisition were conditions present on admission, they were not modifiable. Of the remaining 4, pneumonia could potentially be reduced by maintaining high compliance with pneumococcal vaccine. Admission to a high risk unit in itself is not modifiable. Although ventricular shunting was a factor, the lack of association with many common bedside or interventional procedures performed in these high risk areas argues for intensified environmental control and strict sterile technique for all procedures performed on patients.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07302009-063130 |
| Date | 29 September 2009 |
| Creators | Salangsang, Jo-anne M |
| Contributors | Maria Mori Brooks, Lee H. Harrison, Carlene A. Muto |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07302009-063130/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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