A Huttner

B Huttner

C Nielson

K Khader

M Jones

M Rubin

M Samore

Antimicrobial Resistance and Infection Control

PubMed

Springer - Publisher Connector

ORAL PRESENTATION Open Access
O033: Is MRSA inpatient transmission driving
high MRSA hospital importation in the US
veterans affairs?
M Jones1*, K Khader1, B Huttner2, A Huttner2, C Nielson3, M Rubin1, M Samore1
From 2nd International Conference on Prevention and Infection Control (ICPIC 2013)
Geneva, Switzerland. 25-28 June 2013
Introduction
The prevalence of methicillin-resistant Staphylococcus
aureus (MRSA)-carriage among hospital admissions
(importation) is high in United States Veterans Affairs
(VA) hospitals when compared to published studies
from other settings. We investigated whether inpatient
transmission alone could explain this finding.
Methods
We used retrospective clinical data from 112 VA hospitals
to calibrate a stochastic compartmental simulation model.
We modeled a typical VA hospital with 70 beds and its
surrounding community with 38,000 enrolled Veterans.
The model consisted of 6 patient states—susceptible and
colonized individuals who had never been hospitalized,
were currently hospitalized, or had a history of hospitaliza-
tion. Admission, length of stay, inpatient acquisition rates,
and mortality rates were calibrated to observed data for
MRSA-positive and negative populations. The relative rate
of admission of MRSA-positive to negative populations
was set to 1.2, based on the relative rate of readmission.
Importation among first time admissions was 6.8%; overall
it was 10.5%. Readmission rates were calibrated to reflect
15% 30 day readmission[1]. We compared a base-case
scenario assuming 5% assumed MRSA prevalence among
new Veterans entering the population and a scenario with-
out inpatient transmission. Each scenario was run
200 times.
Results
In the base-case scenario, the median importation was
10.2% (IQR 9.7-10.8%), the median outpatient prevalence
was 5.0%, and the median outpatient acquisition rate was
1.5/100,000 person-years. Without inpatient transmis-
sion, the median importation dropped to 3.5% (IQR 3.3-
3.6%).
Conclusion
Dynamic theory predicts that discharge prevalence, out-
patient transmission, and readmission rates influence
importation. This modeling study demonstrated a large
impact of inpatient transmission on MRSA importation
prevalence when other factors were held constant. It
appears plausible that the high importation prevalence
observed in VA hospitals may be attributed to the noso-
comial acquisition and readmission of prevalent patients.
A sensitivity analysis is necessary to assess the robustness
of this finding to our assumptions.
Disclosure of interest
None declared.
Author details
1Epidemiology, VA Salt Lake City HCS, Salt Lake City, USA. 2Infection Control
Program, Geneva University Hospitals and Faculty of Medicine, Geneva,
Switzerland. 3Veterans Affairs Reno Medical Center, Reno, USA.
Published: 20 June 2013
Reference
1. Ann Intern Med 2012, 157(12):837-845.
doi:10.1186/2047-2994-2-S1-O33
Cite this article as: Jones et al.: O033: Is MRSA inpatient transmission
driving high MRSA hospital importation in the US veterans affairs?
Antimicrobial Resistance and Infection Control 2013 2(Suppl 1):O33.
1Epidemiology, VA Salt Lake City HCS, Salt Lake City, USA
Full list of author information is available at the end of the article
Jones et al. Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O33
http://www.aricjournal.com/content/2/S1/O33
© 2013 Jones et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


O033: Is MRSA inpatient transmission driving high MRSA hospital importation in the US veterans affairs?

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O033: Is MRSA inpatient transmission driving high MRSA hospital importation in the US veterans affairs?

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