Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002–2009
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The epidemiology of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) is changing. Temporal trends and differences between healthcare settings must be described in order to better predict future risk factors associated with this dangerous bacterial infection.
A national MRSA-infected cohort was identified from 2002 to 2009 in the Veterans Affairs Healthcare System of the United States: hospital (HOS), long-term care (LTC), and outpatient (OPT). We analyzed within-setting time trends using generalized linear mixed models and between-setting differences with χ2 and Wilcoxon rank-sum tests.
The incidence of S. aureus, methicillin-susceptible S. aureus (MSSA), and MRSA infections increased significantly over time in all three settings based on modeled annual percentage changes (P < 0.001). MRSA incidence rates rose by 14, 10, and 37% per year in the HOS, LTC, and OPT settings, respectively. Among 56,345 MRSA-infected patients, the comorbidity burden was highest among LTC inpatients (n = 4,427) and lowest among outpatients (n = 7,250), with an average absolute difference in specific comorbidities of +2 and −7%, respectively, compared to HOS inpatients (n = 44,668). Over time, there was a significant (P ≤ 0.02) decrease in previous inpatient admissions and surgeries (all settings); diabetes with complications and surgical site infections (HOS, OPT); and median length of stay and inpatient mortality (HOS, LTC). Alternatively, obesity, chronic renal disease, and depression were more common between 2002 and 2009 (P ≤ 0.02).
Over the past 8 years, we observed significant changes in the epidemiology of MRSA infections, including decreases in traditional MRSA risk factors, improvements in clinical outcomes, and increases in other patient characteristics that may affect risk.
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About this Article
- Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002–2009
Volume 40, Issue 3 , pp 291-297
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- Methicillin-resistant Staphylococcus aureus
- Veterans Affairs Healthcare System
- Temporal trends
- Industry Sectors
- Author Affiliations
- 1. Infectious Diseases Research Program, Veterans Affairs Medical Center (151), Research Building #35; 830 Chalkstone Avenue, Providence, RI, 02908, USA
- 2. Department of Pharmacy Practice, University of Rhode Island, Kingston, RI, 02881, USA
- 3. Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, 02912, USA