One in 20 patients in a Boston emergency department tested positive for methicillin resistant Staphylococcus aureus, and of these more than half carried MRSA on multiple sites, according to a study published in the Annals of Emergency Medicine.
"Ours is one of the first studies to test patients in the ER for MRSA regardless of their reason for being there," said principal author Kalpana Gupta, MD, of the Boston Veterans Affairs Health Care System.
While it's too costly to test all patients for MRSA who present in the emergency room, or to make it a standard practice, a better way to prevent transmission within the hospitalis to make sure patients and providers wash their hands, his team advised.
"The ED is frequently used by patients with complaints of skin and soft tissue infections," and MRSA is the most common recovered causative pathogen in these patients, the authors wrote. What's also of concern is the asymptomatic patient, who can have a reserve of bacteria that's easily transmitted.
It's expensive to test every patient, and even those facilities that do only take nasal swabs. Gupta's team wrote that "it is increasingly recognized that a significant number of people may be colonized only extranasally."
For nine of 20 patients found with MRSA, the bacteria were found on the patients in sites other than the nose. Gupta's team recommends that hospitals with large numbers of patients at high risk for MRSA consider testing other body sites in addition to taking nasal swabs.
The study sample was small, only 400 patients, because many of the 2,197 approached to be tested were ineligible or refused, because they were too tired, too ill, had too much pain or lacked interest.
The survey did discover a three-fold higher risk for MRSA infection for patients with a history of diabetes, HIV infection, those who were brought from a nursing home or long-term care facility, had been hospitalized in the last year, were in jail or played contact sports. Of these, HIV infection was the strongest, with a 14-fold higher risk factor for MRSA colonization, compared with patients not infected with HIV.
Patients who complained of skin or soft tissue infection "were almost five times more likely to be colonized with MRSA in one or more sites" than those who had other complaints.
The authors advise that emergency departments pay closer attention to prevention measures in the ED, especially in regions of the country with higher rates of USA 300 MRSA, a particularly troublesome type found in community settings, are found.
"Further study of the prevalence and patterns of silent MRSA carriage in ED patients and the dynamics of transmission between patients and healthcare workers in this unique clinical environment may be helpful for devising optimal infection control policies specific to ED settings," they wrote.
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