A Hidden Reservoir of Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus in Patients Newly Admitted to an Acute Rehabilitation Hospital

ObjectiveTo find hidden reservoirs of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) via active surveillance cultures for MRSA and VRE in newly admitted patients.DesignA prospective, cohort, screening study. The period of surveillance was 3 months in the winter of 2006-2007.SettingA freestanding academic and community rehabilitation hospital.ParticipantsA total of 540 consecutive patients admitted to a freestanding rehabilitation hospital.MethodsAll of the patients were screened for MRSA and VRE upon admission to the hospital.Main Outcome MeasureThe number of new patients identified with either MRSA or VRE colonization.ResultsA total of 540 patients were screened, of whom 42 (7.8%) had pre-existing MRSA status, 8 (1.5%) had pre-existing VRE status, and 10 (1.9%) had a history of positive results for both MRSA and VRE. Of the 480 patients without pre-existing positive cultures, admission swabs were positive for MRSA in 37 patients (7.7%), swabs were positive for VRE in 33 patients (6.9%), and swabs for both MRSA and VRE were newly positive for 7 patients (1.5%). Therefore 16% of the patients without a history of MRSA or VRE had a new finding of MRSA or VRE. Regression analysis revealed that prior bacteremia was a risk factor for MRSA; diabetes mellitus and a history of pneumonia and trimethoprim-sulfamethoxazole use were risk factors for VRE.ConclusionWe found a 16% incidence of a hidden reservoir of multiple drug-resistant organisms in patients admitted to rehabilitation hospitals. We believe that all patients admitted to a rehabilitation facility should be screened for MRSA and VRE.