Iowa City, IA—Hospital pharmacists and other healthcare professionals who battle daily against antibiotic-resistant infections might be surprised by new research indicating that patients can take superbugs home with them and infect family members.

The report in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), noted that family members of patients who were  recently discharged from the hospital appear to have a higher risk of getting a superbug even if the patient was not diagnosed with the same infection.

University of Iowa–led researchers say their findings suggest that hospitals play a role in the community spread of resistant bacteria. The study focused on MRSA infection and found that the longer the relative’s hospital stay, even without a MRSA diagnosis, the higher the risk to family members.

“Patients can become colonized with MRSA during their hospital stay and transmit MRSA to their household members,” explained lead researcher Aaron Miller, PhD, of the University of Iowa. “This suggests hospitals contribute to the spread of MRSA into the community through discharged patients who are asymptomatic carriers.”

The solution, according to Dr. Miller, is enhanced infection control practices, including testing for MRSA colonization, especially at discharge, even with there are no symptoms of infection. Dr. Miller suggested that MRSA colonization and infections could be tracked among hospital patients and their household contacts to identify and mitigate transmission more effectively.

MRSA infections—considered superbugs because they do not respond to common antibiotics—usually occur in patients who have been in a hospital or another healthcare setting, such as a nursing home but can spread in communities outside the hospital, usually through skin-to-skin contact. While most patients with MRSA have no obvious symptoms, the bacteria can cause painful swelling if it gets under the skin and can be deadly if it spreads to other parts of the body, such as the blood system or lungs.

For the study, the researchers used a large database of insurance claims that included 158 million enrollees with two or more family members on the same plan to learn about how MRSA spread to family members after someone in a household had been in the hospital.

With 424,512 MRSA cases reviewed among 343,524 insured people, the study found 4,724 cases of MRSA being potentially transmitted to a family member from a relative who had recently been in the hospital and had a diagnosis of MRSA. They also found 8,064 potential transmissions of MRSA after the hospitalization of a family member who did not have a MRSA infection.

“It is important not over-emphasize the hospital stay risk,” Dr. Miller said. “While we identified a significant risk factor for transmission in the household and community the absolute risk remains relatively low.”

Across all included enrollees, exposure to a family member with MRSA in the prior 30 days was associated with significantly increased risk of infection (IRR: 71.03 [95% CI, 67.73–74.50]). Even after setting aside enrollees who were hospitalized or exposed to a family member with MRSA, exposure to a family member who was recently discharged from the hospital was associated with an elevated risk of infection (incidence rate ratio [IRR]: 1.44; 95% CI, 1.39-1.49) and the risk of infection increased with the duration of the family member’s hospital stay (P value <.001).

That means that people exposed to a recently hospitalized family member with MRSA were more than 71 times (or 7,000%) more likely to get a MRSA infection compared with enrollees who did not have a family member who had been in the hospitalized or exposed to MRSA in the previous 30 days, according to a SHEA press release.

Having a family member in the household who was hospitalized but did not have MRSA increased the chances of a relative getting MRSA in the month after discharge by 44%, the association added.

Length of hospitalization influenced the risk:
• If the patient was in the hospital 1 to 3 days in the previous month, the chance of a relative getting MRSA increased by 34% compared with people with no recent hospitalizations in their household
• If the length of stay increased to 4 to 10 days, the chances of MRSA infection in a relative were 49% higher
• With hospitalizations longer than 10 days, the odds of relatives in the same household getting an infection rose by 70% to 80%.

The study advised that other factors associated with MRSA infections among household members included number of other illnesses, prior antibiotic usage, and the presence of young children in the family.

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