A multilevel model of methicillin-resistant Staphylococcus aureus acquisition within the hierarchy of an Australian tertiary hospital

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• 作者：Fiona Kong ; MPubHealth^a ; ^b ; ^{fiona.kong@uqconnect.edu.au} ; David L. Paterson ; MBBS ; PhD^b ; ^c ; Michael Coory ; MBBS ; PhD^d ; Archie C.A. Clements ; PhD^a
• 关键词：Hospital infection ; Nosocomial transmission ; Spatio-temporal ; Bayesian hierarchical model
• 刊名：American Journal of Infection Control
• 出版年：2012
• 出版时间：November, 2012
• 年：2012
• 卷：40
• 期：9
• 页码：787-793
• 全文大小：380 K

文摘

Hospitals without universal single room accommodations typically contain multibed cubicles within wards. In this study, we examined whether the variation in a patient¡¯s risk for acquiring methicillin-resistant Staphylococcus aureus (MRSA) in a major tertiary hospital was greatest at the bed, cubicle, or ward level, and quantified the risk of MRSA acquisition associated with exposure to MRSA-colonized/infected patients within the same bed, cubicle, and ward at differently distributed lag times. Nested tri-level hierarchical logistic regression models with random effects were used for non-multiresistant MRSA (nmMRSA) and multiresistant MRSA (mMRSA). The models were internally validated. Receiver operating characteristic curves were used to compare the models¡¯ predictive capability The odds of new nmMRSA acquisition were 6.06-fold (95 % credible intervals [CrI], 3.93- to 9.34-fold) greater in bed-weeks when a nmMRSA-colonized/infected patient was in the same cubicle 2 weeks earlier. The odds of mMRSA acquisition were 5.12-fold (95 % CrI, 4.02- to 6.51-fold) greater in bed-weeks when a colonized/infected patient was in the same ward 2 weeks earlier. The between-cluster variance was highest at the ward level. Patients were at greater risk if there was a colonized/infected patient in the same cubicle or ward 2 weeks earlier. Our findings indicate that focusing on the relevant cubicles and wards during this high-risk period can help target infection control resources more efficiently.