Implications of methicillin-resistant Staphylococcus aureus on nursing home practice.

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is being isolated with increasingly frequency from nursing home patients. There is a limited choice of antibiotics available to treat infections caused by the organism. Control measures for nursing homes have not been well established. METHODS Using the key words "methicillin," "homes for the aged," and "long-term care," and also using the text term "MRSA," the MEDLINE files were searched from 1966 to 1989 using a CD ROM system. Articles occurring subsequent to this search, until the manuscript was submitted, were accessed using a monthly update from the MEDLINE database using the same key words. RESULTS MRSA prevalence rates as high as 34 percent have been reported from long-term care settings. Risk factors for developing MRSA include being sick, debilitated, and functionally impaired. Frequent use of antibiotics and invasive devices, such as catheters, are also identified risk factors. The implication of MRSA colonization on patient outcomes is not clear. Vancomycin remains the drug of choice for treating MRSA infections. Control measures include surveillance of new and established cases and the introduction of isolation procedures. Patients colonized with MRSA should not be refused admission to a nursing home because of their MRSA status. CONCLUSIONS MRSA in nursing homes will continue to increase. There are resulting implications for patient care, health care costs, and admission and discharge policies. Research should first establish what effect MRSA colonization has on clinical outcomes in this setting and, if necessary, go on to develop clinical and cost effective methods of prevention and control.