Methicillin-resistant Staphylococcus aureus : Prevalence,incidence,risk factors,and effects on survival of patients in a specialist palliative care unit: A prospective observational study

Abstract

Background:

Little is known about the impact of methicillin-resistant Staphylococcus aureus in palliative care settings. To date, the clinical impact of methicillin-resistant Staphylococcus aureus in palliative care is unknown.

Aim:

To determine prevalence and incidence of methicillin-resistant Staphylococcus aureus colonisation in a specialist palliative care setting, to identify risk factors for methicillin-resistant Staphylococcus aureus colonisation, to determine the eradication success rate and to determine the impact of methicillin-resistant Staphylococcus aureus on survival.

Design:

Prospective cohort study.

Setting/participants:

Data were collected for consecutive admissions to an inpatient palliative care service. Patients were screened for methicillin-resistant Staphylococcus aureus colonisation on admission and 1 week post admission. Methicillin-resistant Staphylococcus aureus eradication was attempted in methicillin-resistant Staphylococcus aureus positive patients.

Results:

Data were collected from 609 admissions for 466 individual patients. Admission screening data were available in 95.5%. Prevalence of methicillin-resistant Staphylococcus aureus colonisation was 11.59% (54 patients). One week incidence of methicillin-resistant Staphylococcus aureus colonisation was 1.2%. Risk factors for methicillin-resistant Staphylococcus aureus colonisation were determined using Chi-Squared test and included high Waterlow score (p < 0.01), high palliative performance scale score (p < 0.01), methicillin-resistant Staphylococcus aureus status prior to admission (p < 0.01), admission from hospital (p < 0.05), presence of urinary catheter or percutaneous endoscopic gastrostomy tube (p < 0.05) and poor dietary intake (p < 0.05). Regression analysis did not identify independent risk factors. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of admissions, while 46 patients commenced on the protocol (62.2%) died before completing it. Methicillin-resistant Staphylococcus aureus did not significantly impact survival but was significantly associated with having infection episodes and longer length of stay.

Conclusion:

This study identified risk factors for methicillin-resistant Staphylococcus aureus colonisation in palliative care patients. Methicillin-resistant Staphylococcus aureus was eradicated in 8.1% of patients. Hence, restricting methicillin-resistant Staphylococcus aureus screening to high-risk palliative care patients may be prudent.

Keywords

Palliative care hospices risk factors infection control terminal care

Get full access to this article

View all access options for this article.

References

Grundmann

Aanensen

van den Wijngaard

. Geographic distribution of Staphylococcus aureus causing invasive infections in Europe: a molecular-epidemiological analysis. PLoS Med 2010; 7(1): e1000215.

Haddadin

Fappiano

Lipsett

. Methicillin resistant Staphylococcus aureus (MRSA) in the intensive care unit. Postgrad Med J 2002; 78(921): 385–392.

Garner

Jarvis

Emori

. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16(3): 128–140.

Sax

Harbarth

Gavazzi

. Prevalence and prediction of previously unknown MRSA carriage on admission to a geriatric hospital. Age Ageing 2005; 34(5): 456–462.

Prentice

Dunlop

Armes

. Methicillin-resistant Staphylococcus aureus infection in palliative care. Palliat Med 1998; 12(6): 443–449.

Ammerlaan

Kluytmans

Wertheim

. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009; 48: 922–930.

Ali

Sykes

Flock

. An investigation of MRSA infection in a hospice. Palliat Med 2005; 19(3): 188–196.

Ghanem

Abou-Alia

Alsirafy

. Prevalence of methicillin-resistant Staphylococcus aureus colonization and infection in hospitalized palliative care patients with cancer. Am J Hosp Palliat Care 2013; 30(4): 377–379.

Bukki

Klein

But

. Methicillin-resistant Staphylococcus aureus (MRSA) management in palliative care units and hospices in Germany: a nationwide survey on patient isolation policies and quality of life. Palliat Med 2013; 27(1): 84–90.

10.

Dand

Fyvie

Yee

. A survey of methicillin-resistant Staphylococcus aureus (MRSA) management in hospices/palliative care units. Palliat Med 2005; 19(3): 185–187.

11.

Buehlmann

Frei

Fenner

. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008; 29(6): 510–516.

12.

Dancer

Crawford

. Keeping MRSA out of a district general hospital. J Hosp Infect 1999; 43(4): 519–527.

13.

Gakuu

. Review of methicillin resistant staphylococcus aureus with special reference to handling of surgical patients. East Afr Med J 1997; 74(3): 198–202.

14.

Bradley

. Methicillin-resistant Staphylococcus aureus in nursing homes: epidemiology, prevention and management. Drugs Aging 1997; 10(3): 185–198.

15.

Bradley

. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999; 106(5A): 2S–10S.

16.

Rahimi

. Prevalence and outcome of methicillin-resistant Staphylococcus aureus colonization in two nursing centers in Georgia. J Am Geriatr Soc 1998; 46(12): 1555–1557.

17.

Strausbaugh

Jacobson

Sewell

. Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans Affairs nursing home care unit. Infect Control Hosp Epidemiol 1992; 13(3): 151–159.

18.

Gammon

. The psychological consequences of source isolation: a review of the literature. J Clin Nurs 1999; 8(1): 13–21.

19.

Morgan

Diekema

Sepkowitz

. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control 2009; 37: 85–93.

20.

Barratt

Shaban

Moyle

. Patient experience of source isolation: lessons for clinical practice. Contemp Nurse 2011; 39(2): 180–193.

21.

European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe. Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net), ECDC, Stockholm, 2011.

22.

European Centre for Disease Prevention and Control (ECDC). Proportion of methicillin resistant Staphylococcus aureus (MRSA) isolates in participating countries in 2011. Stockholm: ECDC, 2013.

23.

Grimes

. Ebola is scary, but antibiotic resistance should scare us more. The Guardian, [http://www.theguardian.com/science/blog/2014/nov/24/ebola-is-scary-but-antibiotic-resistance-should-scare-us-more] 24 November 2014.

24.

Murphy

. One in 20 get infections in hospitals but watchdog is still dragging its feet. Irish Daily Mail, 20 November 2012, p. 2.

25.

Sample

. Rise of superbugs threatens antibiotic crisis. The Guardian, 25 January 2013, p. 14.

26.

Sample

. Antibiotic-resistant diseases pose ‘apocalyptic’ threat, top expert says. The Guardian, 24 January 2013, p. 1.

27.

Sample

Antibiotic-resistant bugs need global response, say health experts. The Guardian, [http://www.theguardian.com/society/2014/may/22/antibiotic-resistant-bugs-health-drug] 28 May 2014.

28.

Gleeson

Larkin

. The impact of an MRSA diagnosis on patients in the specialist palliative care setting. In: Abstracts of the IPOS 12th world congress of psychooncology, Quebec City, QC, Canada, 25–29 May 2010; Psycho Oncol 2010; 19(Suppl. 2): S1–S313.