A longitudinal survey of methicillin-resistant Staphylococcus aureus carriage in nursing homes and the long-term care facility in Taiwan

Abstract

Background: We conducted a longitudinal survey for methicillin-resistant Staphylococcus aureus (MRSA) carriage in nursing homes and long-term care facilities (LTCFs) in northern Taiwan.

Methods: From July 2016 to February 2017, healthcare workers and residents in four institutions were enrolled. One swab sample from nares and another swab sample from umbilicus were obtained from each participant for detection of MRSA at enrolment and then follow-up samples were collected every two months for additional three times if feasible.

Results: We enrolled a total of 194 participants, including 127 residents and 67 healthcare workers. MRSA colonization rates were 23.2%, 22.8%, 20.7% and 18.6% at enrolment, the 2-, 4-, and 6-month follow-up survey, respectively, and the cumulative colonization rate was 40.2%. The MRSA detection rate was significantly higher at Institution 2 (70.7%) than that at other three institutions (25.7% ∼ 35%) (p < 0.001). Among 78 MRSA carriers, 45 were found to be colonized at enrolment, and other 33 were newly identified as MRSA colonization during follow-up. Of 172 MRSA isolates identified, there were two major clones, sequence types (ST) 45 (49.4%), and ST30 (25%). ST45 prevailed in three institutions and ST30 prevailed in two institutions.

Conclusions: Nearly one in five residents or healthcare workers in nursing homes and LTCFs harbored MRSA, mostly ST45 or ST30 strains, at any given time point in the study. The prevalence and molecular epidemiology of MRSA could vary in different institutions and molecular evidence for intra- and inter-institutional spread of MRSA was provided.

Keywords: Carriage; Long term care facility; Methicillin-resistant Staphylococcus aureus; Nursing homes; Sequence type 30; Sequence type 45.