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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

Published online by Cambridge University Press:  21 July 2021

Diego Schaps Open the ORCID record for Diego Schaps [Opens in a new window] ,
Andrew W. Godfrey  and
Deverick J. Anderson
Diego Schaps
Affiliation:
School of Medicine, Duke University, Durham, North Carolina
Andrew W. Godfrey
Affiliation:
Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina
Deverick J. Anderson*
Affiliation:
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
*
Author for correspondence: Deverick J. Anderson, E-mail: deverick.anderson@duke.edu
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Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 4 , April 2022 , pp. 442 - 447
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: This study was accepted in abstract form for a poster presentation at The Society for Healthcare Epidemiology of America (SHEA) Spring Conference, which took place virtually April 13–16, 2021.

References

Schaps, D, Joiner, AP, Anderson, DJ. Medical transport-associated infection: review and commentary making a case for its legitimacy. Infect Control Hosp Epidemiol 2020. doi: 10.1017/ice.2020.1354.CrossRefGoogle Scholar
Bledsoe, BE, Sweeney, RJ, Berkeley, RP, Cole, KT, Forred, WJ, Johnson, LD. EMS provider compliance with infection control recommendations is suboptimal. Prehosp Emerg Care 2014;18:290–294.CrossRefGoogle ScholarPubMed
Gibson, CV. Emergency medical services oxygen equipment: a fomite for transmission of MRSA? Emerg Med J 2019;36:89–91.Google ScholarPubMed
O’Hara, NB, Reed, HJ, Afshinnekoo, E, et al. Metagenomic characterization of ambulances across the USA. Microbiome 2017;5:125.CrossRefGoogle ScholarPubMed
Teter, J, Millin, MG, Bissell, R. Hand hygiene in emergency medical services. Prehosp Emerg Care 2015;19:313–319.CrossRefGoogle ScholarPubMed
Vikke, HS, Giebner, M, Kolmos, HJ. Prehospital infection control and prevention in Denmark: a cross-sectional study on guideline adherence and microbial contamination of surfaces. Scand J Trauma Resusc Emerg Med 2018;26:71.CrossRefGoogle ScholarPubMed
Vikke, HS, Vittinghus, S, Giebner, M, et al. Compliance with hand hygiene in emergency medical services: an international observational study. Emerg Med J 2019;36:171–175.CrossRefGoogle Scholar
Emanuelsson, L, Karlsson, L, Castrèn, M, Lindström, V. Ambulance personnel adherence to hygiene routines: still protecting ourselves but not the patient. Eur J Emerg Med 2013;20:281–285.CrossRefGoogle Scholar
Khan, AA. Emergency medical services providers’ experiences and attitudes toward infection prevention and control measures in Saudi Arabia: a qualitative study. Disaster Med Public Health Prep 2020;14:713–718.CrossRefGoogle ScholarPubMed
Rui, P, Kang, K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables, in National Center for Health Statistics Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/data/nhamcs/web_tables/2017_ed_web_tables-508.pdf. Published 2017. Accessed June 16, 2021.Google Scholar
Bland, M. An Introduction to Medical Statistics, Fourth ed. Oxford, UK: Oxford University Press; 2015.Google Scholar
Hosmer, DW. Applied Logistic Regression. Third ed. Hoboken, NJ: Wiley; 2013.CrossRefGoogle Scholar
Haukoos, JS, Lewis, RJ. The propensity score. JAMA 2015;314:1637–1638.CrossRefGoogle ScholarPubMed
Stuart, EA. Matching methods for causal inference: a review and a look forward. Stat Sci 2010;25:1–21.CrossRefGoogle Scholar
Alter, SM, Merlin, MA. Nosocomial and community-acquired infection rates of patients treated by prehospital advanced life support compared with other admitted patients. Am J Emerg Med 2011;29:57–64.CrossRefGoogle ScholarPubMed
Orellana, RC, Hoet, AE, Bell, C, et al. Methicillin-resistant Staphylococcus aureus in Ohio EMS providers: a statewide cross-sectional study. Prehosp Emerg Care 2016;20:184–190.CrossRefGoogle Scholar
Al Amiry, A, Bissell, RA, Maguire, BJ, Alves, DW. Methicillin-resistant Staphylococcus aureus nasal colonization prevalence among emergency medical services personnel. Prehosp Disaster Med 2013;28:348–352.CrossRefGoogle ScholarPubMed
Miramonti, C, Rinkle, JA, Iden, S, et al. The prevalence of methicillin-resistant staphylococcus aureus among out-of-hospital care providers and emergency medical technician students. Prehosp Emerg Care 2013;17:73–77.CrossRefGoogle ScholarPubMed
Ro, YS, Shin, SD, Noh, H, Cho, SI. Prevalence of positive carriage of tuberculosis, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci in patients transported by ambulance: a single center observational study. J Prev Med Public Health 2012;45:174–180.CrossRefGoogle ScholarPubMed