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Patient-associated risk factors for acquisition of methicillin resistant Staphylococcus aureus(MRSA) in a tertiary hospital setting

Salangsang, Jo-anne M (2009) Patient-associated risk factors for acquisition of methicillin resistant Staphylococcus aureus(MRSA) in a tertiary hospital setting. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

MRSA is a dominant hospital pathogen because of its increasing incidence, the cost of treatment, antibiotic resistance, limited antimicrobial armamentarium, and associated increased mortality. Determining risk factors for MRSA acquisition in hospital settings has important public health relevance for defining targets for infection control, reduction in mortality from hospital-acquired infections, and decreasing hospitalization costs. A retrospective matched case-control study was initiated to determine patient-associated risk factors for MRSA acquisition at the Presbyterian University Hospital. It was hypothesized that risk factors for MRSA acquisition could be identified and used to enhance or tailor infection control strategies. Cases and two matched controls were selected among patients admitted to high risk units where MRSA screening was routinely done from January 2001 to December 2008. Cases were subjects who acquired MRSA during hospitalization. Variables collected were potential patient-associated risk factors associated with MRSA acquisition among cases versus controls. The odds of exposure to potential risk factors for MRSA acquisition were compared between cases and controls, using matched univariate conditional logistic regression. A single multivariate conditional logistic regression model identifying patient-specific risk factors significantly associated with MRSA acquisition was generated. The final model included 15 independently significant variables. Seven factors were positively associated with MRSA acquisition: primary diagnosis of respiratory disease, digestive tract disease, or injury/trauma, any diagnosis of pneumonia, cerebrovascular/peripheral vascular disease, intracranial ventricular shunt procedure, and a high risk unit stay prior to index culture. Eight variables were protective and included two beta lactam antibiotic classes (penicillin and cephalosporin), rifamycin, daptomycin/linezolid, proton pump inhibitors, history of transplant, extracorporeal membrane oxygenation, and intravascular stenting/catheterization. As 3 of the 7 factors positively associated with MRSA acquisition were conditions present on admission, they were not modifiable. Of the remaining 4, pneumonia could potentially be reduced by maintaining high compliance with pneumococcal vaccine. Admission to a high risk unit in itself is not modifiable. Although ventricular shunting was a factor, the lack of association with many common bedside or interventional procedures performed in these high risk areas argues for intensified environmental control and strict sterile technique for all procedures performed on patients.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Salangsang, Jo-anne Msalangsangjs@upmc.edu
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHarrison, Lee Hlharriso@edc.pitt.eduLHARRISO
Committee MemberMuto, Carlene Amutoca@upmc.edu
Committee MemberBrooks, Maria Moribrooks@edc.pitt.eduMBROOKS
Date: 29 September 2009
Date Type: Completion
Defense Date: 29 July 2009
Approval Date: 29 September 2009
Submission Date: 30 July 2009
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: acquisition; colonization; infection control; methicillin-resistant Staphylococcus aureus; MRSA; risk factors
Other ID: http://etd.library.pitt.edu/ETD/available/etd-07302009-063130/, etd-07302009-063130
Date Deposited: 10 Nov 2011 19:55
Last Modified: 15 Nov 2016 13:47
URI: http://d-scholarship.pitt.edu/id/eprint/8745

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