Some good news on MRSA: Hospital efforts working
HAIs drop, community acquired hold steady
Hospital infection prevention efforts aimed at methicillin-resistant Staphylococcus aureus (MRSA) appear to having some effect in preventing nosocomial transmission. Between 2005 and 2006, population-based surveillance for invasive MRSA infections in a diverse group of hospitals across the U.S. revealed a 11% decrease in the incidence of nosocomial infections, the Centers for Disease Control and Prevention reports.1 Infections classified as health care-associated with community-onset (HACO) dropped as well, but community- acquired cases held at a similar rate over the period.
National, regional, and local efforts to reduce nosocomial MRSA infections have begun in many U.S. hospitals over the past several years with some documented success at individual institutions. A systematic measure of the larger impact of these efforts in the United States is lacking. Thus the investigators used a national surveillance system reporting invasive MRSA to describe the change in incidence between 2005 and 2006 among nosocomial MRSA infections in comparison to non-nosocomial MRSA infections.
In nine metropolitan areas across the United States, which include 162 hospitals participating in the Active Bacterial Core surveillance (ABCs) from January 2005 through December 2006, all people with invasive MRSA infection (MRSA isolated from a normally sterile body site) were identified through active laboratory-based surveillance with supplemental data obtained through hospital record review.
Infections were categorized into nosocomial (MRSA isolated > 48 hours after admission); HACO (MRSA isolated < 48 hours since admission and any established MRSA risk factor [past hospital admission, surgery, dialysis, or long-term care stay in past year, current invasive device, or any history of MRSA]); and community-associated (CA, MRSA isolated < 48 hours since admission and no established MRSA risk factors).
Overall, 9,875 incident invasive MRSA infections were identified; nonmutually exclusive presenting syndromes included bacteremia (75%), pneumonia (13%), skin infection (10%), osteomyelitis (7%), and endocarditis (6%). Age- and race-adjusted incidence were similar in the two years; 31.8 per 100,000 in 2005 to 29.6 per 100,000 in 2006, a 5.8% decrease. The largest relative decrease was among nosocomial cases (9.1 vs. 8.1 per 100,000; 11.3% decrease), followed by HACO cases (17.9 vs. 16.6 per 100,000; 7.9% decrease, while there was no change in incidence of CA cases (4.8 vs. 4.6;). Incidence of nosocomial cases decreased in seven of the nine reporting sites (median difference of -8.7%, range -24% to +24%).
Reference
- Fridkin S, Bulens S, Zell E, et al. Decreased incidence of nosocomial invasive Methicillin-resistant Staphylococcus aureus (MRSA) infections reported through population-based surveillance in 9 metropolitan areas in the U.S., 2005-2006. Presented at the Society for Health Care Epidemiology of America. Orlando, FL; April 5-8, 2008.
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