The community prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in older people living in their own homes: implications for treatment, screening and surveillance in the UK
Introduction
There is concern in the UK about the appearance of methicillin-resistant Staphylococcus aureus (MRSA) in the community,1., 2. especially in the light of reports from elsewhere.3., 4., 5., 6. MRSA is thought to be predominantly nosocomial, occurring mainly in people aged 65 or older.7 Most patients with MRSA are discharged back to the community and, with decreasing length of stay, more ‘after care’ is performed in primary care. Early discharge of patients with MRSA forms part of most national guidelines.8 There may be a substantial pool of older people with MRSA in the community. In the UK, the prevalence and acquisition of MRSA in older people in nursing and residential homes can be high,9 but its prevalence and the factors associated with its carriage has been little studied in those living at home. Knowledge of prevalence and risk factors would guide rational screening programmes for older people admitted to high-risk areas of the hospital, such as orthopaedic units.8 It would also guide screening practice in primary care, allow early identification of MRSA, and implementation of infection control practices to minimize community spread. We report the findings of a study intended to help in the design of these processes.
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Methods
The study was approved by local ethical committees and carried out in a general practice in North London with 820 people over 65 years of age registered. There were no local residential or nursing homes. The practice referred patients to one district general and two teaching hospitals, all of which had a high endemic prevalence of MRSA. After exclusion of 152 subjects who had either died, left the practice, or not been seen in the last five years, and exclusion of 12 who were either dying, in
Results
Methicillin-sensitive S. aureus (MSSA) was isolated from 60 (23%) patients and MRSA from two (0.8%, 95% CI 0.09, 2.8), both of whom had a past history of MRSA. In both cases typing identified the isolate as an EMRSA 15 strain common in local hospitals. Table I lists the frequency of risk factors. Seven patients (2.7%) had a past history of MRSA carriage, and 43 (16.7%) had been admitted to hospital in the last year. The only risk factor significantly associated with carriage of MRSA was a past
Discussion
The community prevalence of MRSA in older people living in their own homes appears to be low (0.8%) in this sample of participants in London. This is in keeping with the two recent studies performed around the same time in the UK, in Nottingham,10 which also focussed on the elderly, reporting a prevalence of 0.8% (95% CI 0.3–1.4%), and in Birmingham,11 where all ages were studied and prevalence was 1.5% (0.03, 2.9). This is the first study of community prevalence in London, where the prevalence
Acknowledgements
The authors thank Sheila Ainscough and Claire Taylor Royal Free Microbiology Department for processing the samples, Yvonne Carter (ICN, Royal Free NHS Trust), Lynn Leaver (ICN, Central Middlesex), Drs Scott (UCH), Mepham (St Mary's NHS Trust) and Shafi (Central Middlesex) for liaison and permission to use MRSA databases, Roger Bailey (Practice Manager) and Val Gedge, (Assistant Practice Manager), and all nursing and administrative staff at Lonsdale Road Medical Centre; all participants
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