Association between length of residence and prevalence of MRSA colonization among residents in geriatric long-term care facilities

Abstract

Background A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization has been reported among residents in geriatric long-term care facilities (LTCFs). Some studies indicate that MRSA might be imported from hospitals into LTCFs via resident transfer; however, other studies report that high MRSA prevalence might be caused by cross-transmission inside LTCFs. We aimed to assess which factors have a large impact on the high MRSA prevalence among residents of geriatric LTCFs. Methods We conducted a cohort study among 260 residents of four geriatric LTCFs in Japan. Dividing participants into two cohorts, we separately analyzed (1) the association between prevalence of MRSA carriage and length of LTCF residence (Cohort 1: n = 204), and (2) proportion of residents identified as MRSA negative who were initially tested at admission but subsequently identified as positive in secondary testing performed at ≥2 months after their initial test (Cohort 2: n = 79). Results Among 204 residents in Cohort 1, 20 (9.8%) were identified as positive for MRSA. Compared with residents identified as MRSA negative, a larger proportion of MRSA-positive residents had shorter periods of residence from the initial admission (median length of residence: 5.5 vs. 2.8 months), although this difference was not statistically significant (p = 0.084). Among 79 residents in Cohort 2, 60 (75.9%) were identified as MRSA negative at the initial testing. Of these 60 residents, only one (1.7%) had subsequent positive conversion in secondary MRSA testing. In contrast, among 19 residents identified as MRSA positive in the initial testing, 10 (52.6%) were negative in secondary testing. Conclusions The prevalence of MRSA was lower among residents with longer periods of LTCF residence than among those with shorter periods. Furthermore, few residents were found to become MRSA carrier after their initial admission. These findings highlight that MRSA in LTCFs might be associated with resident transfer rather than spread via cross-transmission inside LTCFs.

Molecular and Source-Specific Profiling of Hospital <i>Staphylococcus Aureus</i> Reveal Dominance of Skin Infection and Age-Specific Selections in Pediatrics and Geriatrics

“…Age-specific infections among different age groups of patients revealed that senior patients over 50 years old had the highest S. aureus infection rates (94.7%); the overwhelming of these were MRSA (81.99%) and 12.7% were caused by MSSA. This finding is consistent with many other studies in geriatric infection and long term care facilities (LTCF) around the world [ [53][54][55][56] ] However, it was surprising to find lower MRSA transmissions in hospitalized seniors compared to new admission screening and shorter-term residents. These novel findings are rare except for a few studies describing similar results in Japan [ 55 ].…”

“…This finding is consistent with many other studies in geriatric infection and long term care facilities (LTCF) around the world [ [53][54][55][56] ] However, it was surprising to find lower MRSA transmissions in hospitalized seniors compared to new admission screening and shorter-term residents. These novel findings are rare except for a few studies describing similar results in Japan [ 55 ]. At present, we do not have clear explanations on these findings other than the stricter MRSA screening protocols in place since the aftermath of MRSA pandemics more than a decade ago [ 6,11 12 ].…”

The global prevalence of methicillin-resistant Staphylococcus aureus colonization in residents of elderly care centers: a systematic review and meta-analysis

“…Furthermore, the estimated colonization rate in our study is higher than those reported from other high-risk groups such as HIV + patients (7.0%, 5.0–9.0%) [ 32 ], hemodialysis patients (6.2%, 4.2–8.5%) [ 33 ], and patients admitted to intensive care units (7.0%, 5.8–8.3%) [ 34 ]. This highlights that elderly residents of ECCs are at very high risk for MRSA colonization, maybe due to cross-transmission between the elderlies in the crowded situation of ECCs or introduction of infection when admitting new elders from outside of ECCs (i.e., hospitals or community) [ 35 ]. Other possible explanations for this high prevalence of MRSA could be frailty, impaired immune system function, frequent hospitalization, and overuse of antibiotics [ 36 , 37 ].…”

Distribution of Extended-Spectrum β-Lactamase Genes and Antimicrobial Susceptibility among Residents in Geriatric Long-Term Care Facilities in Japan

“…All four g-LTCFs were anonymized in accordance with the ethics protocol of this study. Two related studies have been published using the same study settings and participants as the present study [ 50 , 51 ]. The Jichi Medical University Bioethics Committee for Medical Research approved this study and waived the requirement for informed consent from individual participants (Approval ID: 21–106).…”

“…These facilities typically aim to return patients to home-based care, although some residents may require long-term care for years. The latter provide daily life support, including end-of-life care [ 50 , 51 , 52 , 53 ]. This study included three geriatric health service facilities and one geriatric special nursing home.…”