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Risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition during ambulance transport: A retrospective propensity-score-matched cohort analysis.
OBJECTIVE: To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport. METHODS: We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome. RESULTS: In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09-12.71; P = .04). CONCLUSIONS: Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport-associated infection burden to eventually develop interventions to address it.
Duke Scholars
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Related Subject Headings
- Vancomycin-Resistant Enterococci
- Vancomycin Resistance
- Vancomycin
- Staphylococcal Infections
- Retrospective Studies
- Propensity Score
- Methicillin-Resistant Staphylococcus aureus
- Humans
- Gram-Positive Bacterial Infections
- Epidemiology
Citation
![Journal cover image](https://secure.syndetics.com/index.aspx?isbn=/lc.gif&issn=1559-6834&client=dukeuniv)
Published In
DOI
EISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Vancomycin-Resistant Enterococci
- Vancomycin Resistance
- Vancomycin
- Staphylococcal Infections
- Retrospective Studies
- Propensity Score
- Methicillin-Resistant Staphylococcus aureus
- Humans
- Gram-Positive Bacterial Infections
- Epidemiology