Article Figures & Data
Figures
- Fig 1
Distribution of chlorhexidine MICs of 829 MRSA isolates from residents of 25 nursing homes.
- Fig 2
MRSA resistant to mupirocin (HLMR, LLMR, and all resistant [MR]) at each of 25 nursing homes in Orange County.
Tables
- Table 1
Characteristics of 26 nursing homes in Orange County, 2009
Characteristic Median value (range) Nursing home characteristics No. of beds 99 (24–255) Annual no. of admissionsa 262 (18–1,526) Median length of stay (days) 101 (17–753) MRSA point prevalence (% MRSA+ residents) 26 (0–52) Demographics (as % of all facility residents) Age over 85 yrsa 25 (2–72) Male 42 (21–67) Non-Caucasian race 16 (1–88) Less than high school education 24 (0–64) Admitted from acute hospital 82 (15–98) Comorbidities (as % of all facility residents) Diabetes 27 (11–59) Skin lesions 72 (4–100) Indwelling devices 2 (0–46) History of MRSA 11 (0–69) Multidrug-resistant MRSA isolate 68 (0–100) Functional status (avg score among all facility residents) RUG scoreb 0.92 (0.81–1.43) ADL score 19.82 (10.77–26.90) ↵a After excluding the 4 psychiatric facilities, the median annual admissions was 300 and the percentage of facility residents over 85 years old was 39%. The medians for the other variables did not differ substantially after excluding the 4 psychiatric nursing homes.
↵b The RUG score is a facility-level score that reflects the average level of care required by residents, based upon residents' comorbidities, ability to perform activities of daily living, and the required amount of physical and occupational therapy.
- Table 2
Susceptibility of Orange County nursing home MRSA isolates (n = 829) to 13 antimicrobial agents
Antimicrobial agent MIC data (μg/ml) % resistant Range MIC50 MIC90 Chlorhexidine 0.5–4 2 4 NAa Clindamycin ≤0.12 to >16 >16 >16 55 Erythromycin ≤0.25 to >32 >32 >32 90 Tetracycline ≤0.5 to >64 ≤0.5 ≤0.5 4 Trimethoprim-sulfamethoxazole ≤0.25 to >32 ≤0.25 ≤0.25 2 Gentamicin ≤0.5 to >64 ≤0.5 64 12 Levofloxacin ≤0.25 to >32 32 >32 98 Vancomycin 0.5–2 1 1 0 Daptomycin ≤0.5–4 ≤0.5 ≤0.5 NA Quinupristin-dalfopristin ≤0.5–4 ≤0.5 ≤0.5 <1 Linezolid ≤1–8 2 2 <1 Rifampin ≤0.5 to >4 ≤0.5 ≤0.5 1 Mupirocinb Low-level resistance isolates 3 High-level resistance isolates 9 - Table 4
Bivariate analysis of nursing home characteristics and partner hospital characteristics associated with high-level mupirocin-resistant MRSAa
Variable Odds ratio P value Nursing home characteristics Annual no. of admissions 0.99 0.58 Length of stay (median no. of days) 1.00 0.83 MRSA point prevalence 1.02 0.43 Demographics (as % of all facility residents) Less than high school education 1.03 0.88 Admitted from acute hospital 1.01 0.42 Comorbidities (as % of all facility residents) Diabetes 1.01 0.59 Skin lesions 1.15 0.40 Indwelling device 1.30 0.006 History of MRSAb 2.99 <0.001 Multidrug-resistant MRSA isolateb 2.55 0.004 Functional status (avg score among all facility residents) High RUG scorec 2.97 0.04 Avg ADL score 1.28 0.001 Partner hospital characteristicd % physicians who routinely decolonize patients who have MDROe 1.04 0.78 % MRSA+ patients who are decolonized 0.79 0.13 % that use mupirocin to decolonize MRSA+ patients 0.54 0.26 ↵a Note that four psychiatric facilities were removed from the bivariate analyses.
↵b Analyzed as a resident-level or isolate-level variable, not as a facility-level variable.
↵c RUG is a facility-level score that reflects the average level of care required by residents, based upon residents' comorbidities, ability to perform activities of daily living, and the required amount of physical and occupational therapy. The RUG score was dichotomized into high and low values around the median.
↵d A nursing home's partner hospital was the hospital that transferred the most patients to that nursing home in a year.
↵e MDRO, multidrug-resistant organisms.
- Table 5
Multivariate analysisa of factors associated with high-level mupirocin-resistant MRSA
Variable Odds ratio (95% CI) P value Multidrug-resistant MRSA isolateb 2.69 (1.37, 5.28) 0.004 History of MRSAb 2.34 (1.75, 3.12) <0.001 Avg ADL scorec 1.25 (1.07, 1.45) 0.004 ↵a Note that four psychiatric facilities were removed from the multivariate analysis.
↵b Analyzed as a resident-level or isolate-level variable, not as a facility-level variable.
↵c The ADL score ranges from 0 (completely independent) to 28 (completely dependent) and is expressed per 1 point increase. The reported average ADL score is the average score among all residents of one facility. The ADL score was colinear with the presence of indwelling devices.
