BACKGROUND:Methicillin-resistant Staphylococcus aureus (MRSA), a major cause of healthcare-associated infections, is endemic in hospitals. Despite interventions, hospital-onset (HO)-MRSA bacteraemia rates remain high. Infection prevention and control efforts mainly target colonised patients, yet non-colonised patients also carry distinct risks. Identifying risk differences is essential for prevention.
METHODS:We conducted a case-control study of 253 HO-MRSA cases and 253 controls matched by month, specialty, and status at 2 tertiary hospitals (2016-2022). Multi-nomial regression identified risk factors.
RESULTS:Among colonised patients, risk factors were immunosuppressive therapy (relative risk ratio 3.53, 95% confidence interval [CI]: 1.80-6.91), fluoroquinolone exposure (RRR: 2.29, 95% CI: 1.08-4.84), glycopeptide exposure (RRR: 2.57, 95% CI: 1.23-5.39), thrombophlebitis (RRR: 21.25, 95% CI: 5.67-79.58), and peripherally inserted central catheter (PICC) presence (RRR: 7.68, 95% CI: 1.39-42.54). Among non-colonised patients, risk factors were days at risk 22-28 (RRR: 3.57, 95% CI: 1.05-12.14), immunosuppressive therapy (RRR: 2.37, 95% CI: 1.13-4.97), fluoroquinolone exposure (RRR: 2.19, 95% CI: 1.06-4.53), glycopeptide exposure (RRR: 2.51, 95% CI: 1.18-5.31), thrombophlebitis (RRR: 20.80, 95% CI: 4.35-99.35), and chronic haemodialysis (RRR: 3.08, 95% CI: 1.03-9.16). Most risk factors were similar, but prolonged stay and haemodialysis were unique to non-colonised patients and presence of PICC to colonised patients.
CONCLUSION:These differences challenge assumptions of uniform risk and support tailored prevention efforts. To mitigate bacteraemia risk, hospitals can reinforce PICC care in colonised patients and implement repeat screening for non-colonised patients and haemodialysis patients with prolonged hospitalisation.