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Open Access Research article

Transmission of methicillin-resistant staphylococcus aureus in the long term care facilities in Hong Kong

Vincent CC Cheng12, Josepha WM Tai2, Zoie SY Wong3, Jonathan HK Chen1, Kris BQ Pan3, Yizhen Hai3, Wing-Chun Ng4, Denise MK Chow5, Miranda CY Yau1, Jasper FW Chan12, Sally CY Wong12, Herman Tse16, Sophia SC Chan5, Kwok-Leung Tsui3, Felix HW Chan4, Pak-Leung Ho16 and Kwok-Yung Yuen16*

Author Affiliations

1 Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China

2 Infection Control Team, Queen Mary Hospital, Hong Kong Special Administrative Region, China

3 Department of Systems Engineering and Engineering Management, City University of Hong Kong, Hong Kong Special Administrative Region, China

4 Community Geriatric Assessment Team, Fung Yiu King Hospital, Hong Kong Special Administrative Region, China

5 School of Nursing, The University of Hong Kong, Hong Kong Special Administrative Region, China

6 Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong Special Administrative Region, China

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BMC Infectious Diseases 2013, 13:205  doi:10.1186/1471-2334-13-205

Published: 6 May 2013

Abstract

Background

The relative contribution of long term care facilities (LTCFs) and hospitals in the transmission of methicillin-resistant Staphylococcus aureus (MRSA) is unknown.

Methods

Concurrent MRSA screening and spa type analysis was performed in LTCFs and their network hospitals to estimate the rate of MRSA acquisition among residents during their stay in LTCFs and hospitals, by colonization pressure and MRSA transmission calculations.

Results

In 40 LTCFs, 436 (21.6%) of 2020 residents were identified as ‘MRSA-positive’. The incidence of MRSA transmission per 1000-colonization-days among the residents during their stay in LTCFs and hospitals were 309 and 113 respectively, while the colonization pressure in LTCFs and hospitals were 210 and 185 per 1000-patient-days respectively. MRSA spa type t1081 was the most commonly isolated linage in both LTCF residents (76/121, 62.8%) and hospitalized patients (51/87, 58.6%), while type t4677 was significantly associated with LTCF residents (24/121, 19.8%) compared with hospitalized patients (3/87, 3.4%) (p < 0.001). This suggested continuous transmission of MRSA t4677 among LTCF residents. Also, an inverse linear relationship between MRSA prevalence in LTCFs and the average living area per LTCF resident was observed (Pearson correlation −0.443, p = 0.004), with the odds of patients acquiring MRSA reduced by a factor of 0.90 for each 10 square feet increase in living area.

Conclusions

Our data suggest that MRSA transmission was more serious in LTCFs than in hospitals. Infection control should be focused on LTCFs in order to reduce the burden of MRSA carriers in healthcare settings.