Background: Methicillin resistance occurs in 66% of nosocomial Staphylococcus aureus while ESBL in 21% Escherichia coli and 51% Klebsiella pneumoniae at our institution. Community-onset MRSA and vancomycin-resistant enterococci (VRE) occur locally. We wish to determine the prevalence and predictors of colonisation by MRSA, VRE and ESBL-positive Gram-negative bacilli (GNB) in patients admitted from our Emergency Department. Methods: All adult patients >16 years of age consenting to participation underwent nasal, axilla, groin and rectal swabs, processed by validated published methods to screen for MRSA, VRE and ESBL-positive GNB. A questionnaire was used to record age, gender, co-morbidity, nursing home residence, contact with healthcare workers; hospitalisation, visit to hospital outpatient, general practitioners or government polyclinics within 3 and 12 months; and oral antibiotic use within 1 and 3 months. Univariate and multivariate analysis were performed to determine independent predictors of colonisation by MRSA, VRE and ESBL-positive GNB. Results: Of 1003 patients recruited, mean age was 47 years; male comprised 65% and nursing home residents 2.2%. Diabetes mellitus occurred in 21%. Hospitalisation within 3 and 12 months was noted in 17% and 27% respectively. Visit to hospital outpatient, government polyclinics and general practitioners within 12 months occurred in 48%, 44% and 48% respectively. Oral antibiotic was taken by 28% within last 3 months. MRSA colonisation occurred in 1.8% and ESBL-positive GNB 12% while none had VRE. The only independent predictor of MRSA colonisation was hospitalisation within 3 months (adjusted odds ratio 3.9, p = 0.04) and of ESBL-positive GNB colonisation was oral antibiotic within 1 month (adjusted odds ratio 1.9, p = 0.02). Conclusions: MRSA and VRE colonisation remain a nosocomial problem while oral antibiotic use in the community has selected for alarmingly high ESBL-positive GNB colonisation rate. Hand hygiene to control nosocomial MRSA transmission and prudent antibiotic prescribing are needed.
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Pada et al. (2008) studied this question.