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Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002–2009

  • Clinical and Epidemiological Study
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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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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Acknowledgments

We gratefully acknowledge the Center on Systems, Outcomes and Quality in Chronic Disease and Rehabilitation, a Research Enhancement Award Program of the Health Services Research and Development Service, and Providence Veterans Affairs Medical Center Research Service for the data storage and software assistance. The views expressed are those of the authors and do not necessarily reflect the position or policy of the United States Department of Veterans Affairs. A.R.C. is supported by a Department of Veterans Affairs Career Development Award.

Conflict of interest

A.R. Caffrey: Pfizer research funding; K.L. LaPlante: Astellas, Cubist, Forest, Ortho-McNeil, and Pfizer research funding, advisory board, speakers bureau, and/or consultancy.

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Authors and Affiliations

  1. Infectious Diseases Research Program, Veterans Affairs Medical Center (151), Research Building #35; 830 Chalkstone Avenue, Providence, RI, 02908, USA

    A. R. Caffrey & K. L. LaPlante

  2. Department of Pharmacy Practice, University of Rhode Island, Kingston, RI, 02881, USA

    A. R. Caffrey & K. L. LaPlante

  3. Division of Infectious Diseases, Alpert Medical School of Brown University, Providence, RI, 02912, USA

    K. L. LaPlante

Authors
  1. A. R. Caffrey
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Correspondence to K. L. LaPlante.

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Caffrey, A.R., LaPlante, K.L. Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002–2009. Infection 40, 291–297 (2012). https://doi.org/10.1007/s15010-011-0232-3

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  • DOI: https://doi.org/10.1007/s15010-011-0232-3

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