A hidden reservoir of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in patients newly admitted to an acute rehabilitation hospital.

OBJECTIVE: To 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.

DESIGN: A prospective, cohort, screening study. The period of surveillance was 3 months in the winter of 2006-2007.

SETTING: A freestanding academic and community rehabilitation hospital.

PARTICIPANTS: A total of 540 consecutive patients admitted to a freestanding rehabilitation hospital.

METHODS: All of the patients were screened for MRSA and VRE upon admission to the hospital.

MAIN OUTCOME MEASURE: The number of new patients identified with either MRSA or VRE colonization.

RESULTS: A 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.

CONCLUSION: We 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.