See Isaac, Jackson Kelly A, Hatfield Kelly M, Paul Prabasaj, Li Rongxia, Nadle Joelle, Petit Susan, Ray Susan M, Harrison Lee H, Jeffrey Laura, Lynfield Ruth, Bernu Carmen, Dumyati Ghinwa, Gellert Anita, Schaffner William, Markus Tiffanie, Gokhale Runa H, Stone Nimalie D, Jacobs Slifka Kara
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Healthcare-associated Infections, California Emerging Infections Program, Oakland, California, USA.
J Am Geriatr Soc. 2025 Mar;73(3):849-858. doi: 10.1111/jgs.19189. Epub 2025 Jan 20.
Nursing home residents experience a large burden of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Data are limited regarding nursing home characteristics associated with differences in facility-level invasive MRSA rates.
We analyzed 2011-2015 data from CDC's Emerging Infections Program (EIP) active population- and laboratory-based surveillance for invasive MRSA cases within seven states. A nursing home-onset case was defined as MRSA cultured from a normally sterile site in a person living in a nursing home 3 days before culture collection. Facility rates were calculated as nursing home-onset cases per 100,000 resident-days. Nursing home resident-day denominators and facility characteristics were obtained from four Centers for Medicare & Medicaid Services (CMS) datasets. A general estimating equations model with a logit link assessed characteristics of the facilities with highest rates comprising 50% of nursing home MRSA cases ("high rates").
The 626 nursing homes in the surveillance area had 2824 invasive MRSA cases; 82% of facilities had at ≥1 case. The 20% of facilities with highest rates (≥3.84 cases/100,000 resident-days) had 50% of nursing home-onset cases. In multivariable regression, facilities with high rates were more likely to have CMS-derived characteristics of presence of a resident with a multidrug-resistant organism; or greater proportions of residents who were male, were short stay (in the facility <100 days), had a nasogastric or percutaneous gastrostomy tube, or require extensive assistance with bed repositioning; and more likely to be in an EIP area with higher hospital-onset MRSA rates. Higher registered nurses staffing levels (hours/resident/day) and higher proportions of White residents were associated with lower rates.
Facilities with higher invasive MRSA rates served residents with more clinical and functional care needs. Increasing registered nurse staffing in high-risk facilities might assist with reduction of invasive MRSA rates. These findings could help prioritize nursing homes for future MRSA prevention work.
疗养院居民遭受耐甲氧西林金黄色葡萄球菌（MRSA）侵袭性感染的负担沉重。关于与机构层面侵袭性MRSA感染率差异相关的疗养院特征的数据有限。
我们分析了疾病控制与预防中心（CDC）新兴感染项目（EIP）2011 - 2015年期间基于人群和实验室的七个州侵袭性MRSA病例监测数据。疗养院发病病例定义为在培养标本采集前3天居住在疗养院的人员，从正常无菌部位培养出MRSA。机构感染率计算为每10万居民日的疗养院发病病例数。疗养院居民日分母和机构特征来自四个医疗保险与医疗补助服务中心（CMS）数据集。采用具有logit链接的广义估计方程模型评估占疗养院MRSA病例50%的高感染率机构的特征。
监测区域内的626家疗养院有2824例侵袭性MRSA病例；82%的机构至少有1例病例。感染率最高的20%机构（≥3.84例/10万居民日）占疗养院发病病例的50%。在多变量回归分析中，高感染率机构更有可能具有CMS得出的以下特征：存在多重耐药菌感染的居民；或男性居民、短期居住（在机构内<100天）、有鼻胃管或经皮胃造瘘管、或在床位重新定位时需要大量协助的居民比例更高；并且更有可能位于医院发病MRSA感染率较高的EIP区域。较高的注册护士人员配备水平（小时/居民/天）和较高比例的白人居民与较低感染率相关。
侵袭性MRSA感染率较高的机构服务于临床和功能护理需求更多的居民。增加高危机构的注册护士人员配备可能有助于降低侵袭性MRSA感染率。这些发现有助于为未来MRSA预防工作确定疗养院的优先次序。
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