BETHESDA, MD. — Community-acquired methicillin-resistant Staphylococcus aureus was three times more prevalent than nosocomial MRSA in a small, nonteaching community hospital, reported Ananthakrishnan Ramini, M.D., at the annual conference on antimicrobial resistance sponsored by the National Foundation for Infectious Diseases.
MRSA was once limited to tertiary care centers and large hospitals but is rapidly becoming a dominant community pathogen, said Dr. Ramini, a physician at Columbia Memorial Hospital, a 192-bed facility in Hudson, N.Y.
Dr. Ramini and his colleagues conducted a prospective study of all MRSA infections in the hospital from January to December 2004. The investigators identified 78 cases of MRSA, of which 58 (74%) were community acquired.
The definition of community-acquired infection was an infection that surfaced within 48 hours of hospital admission.
Among the 51 patients older than 70 years, 47 had MRSA resistant to both clindamycin and erythromycin, which suggests more comorbidities in older patients, Dr. Ramini said. None of the organisms was resistant to oxacillin.
In addition, more of the MRSA cases (both community acquired and nosocomial) occurred outside than inside the ICU (56 vs. 22).
“There was a very high mortality among these patients,” Dr. Ramini noted.
Of the infected patients, 21 died, 39 were discharged to a nursing home, 15 went home, and 3 entered a tertiary care facility. “What was surprising was that community MRSA was so much more prevalent than nosocomial MRSA,” Dr. Ramini said.
“We need to be aware that treatment with a β-lactam alone is no longer a reliable empiric therapy,” he added.
He had no conflicts of interest to report.