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Methicillin-Resistant Staphylococcus aureus Colonization or Infection in Canada: National Surveillance and Changing Epidemiology, 1995–2007

Published online by Cambridge University Press:  02 January 2015

Andrew E. Simor ,
Nicolas L. Gilbert ,
Denise Gravel ,
Michael R. Mulvey ,
Elizabeth Bryce ,
Mark Loeb ,
Anne Matlow ,
Allison McGeer ,
Lisa Louie  and
Jennifer Campbell
...Show all authors
Andrew E. Simor*
Affiliation:
Sunnybrook Health Sciences Centre, Public Health Agency of Canada, Ottawa
Nicolas L. Gilbert
Affiliation:
Hamilton Health Sciences Corporation, Hamilton
Denise Gravel
Affiliation:
Hamilton Health Sciences Corporation, Hamilton
Michael R. Mulvey
Affiliation:
Vancouver General Hospital, Vancouver, British Columbia, Canada
Elizabeth Bryce
Affiliation:
Vancouver General Hospital, Vancouver, British Columbia, Canada
Mark Loeb
Affiliation:
Ontario, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba
Anne Matlow
Affiliation:
Hospital for Sick Children, Public Health Agency of Canada, Ottawa
Allison McGeer
Affiliation:
Mount Sinai Hospital, Toronto, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa
Lisa Louie
Affiliation:
Sunnybrook Health Sciences Centre, Public Health Agency of Canada, Ottawa
Jennifer Campbell
Affiliation:
Vancouver General Hospital, Vancouver, British Columbia, Canada
*
Department of Microbiology, Sunnybrook Health Sciences Centre, B103-2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada ([email protected])
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Abstract

Objective.

To determine the incidence and describe the changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in Canadian hospitals from 1995–2007.

Setting.

Forty-eight hospitals participating in the Canadian Nosocomial Infection Surveillance Program.

Design.

Prospective, laboratory-based surveillance for incident cases of MRSA colonization or infection among hospitalized patients.

Methods.

Clinical and epidemiologic data were obtained by review of hospital records. Standard criteria were used to determine whether MRSA colonization or infection was present and whether the MRSA strain was healthcare associated or community associated. A representative subset of isolates was characterized by use of pulsed-field gel electrophoresis and staphylococcal cassette chromosome (SCC) mec typing.

Results.

From 1995 to 2007, a total of 37,169 hospitalized patients were newly identified as either infected or colonized with MRSA, and the overall incidence of both MRSA colonization and MRSA infection increased from 0.65 to 11.04 cases per 10,000 patient-days (P < .001). Of these 37,169 patients, 11,828 (32%) had an MRSA infection, and infection rate increased from 0.36 to 3.43 cases per 10,000 patient-days. The proportion of community-associated MRSA strains increased from 6% to 23% (P < .001). The most common genotype (47% of isolates) was CMRSA-2 (USA100/800); in 2007, CMRSA-10 (USA300) was the second most common strain (27% of isolates), associated with SCCmec type IV. Patients with CMRSA-10 were predominantly from western Canada and were more likely to be children (odds ratio [OR], 10.0 [95% confidence interval {CI}, 7.4–13.4]) and to have infection (OR, 2.3 [95% CI, 1.9–2.7]), especially skin and/or soft tissue infection (OR, 5.9 [95% CI, 5.0–6.9]).

Conclusions.

The overall incidence of both MRSA colonization and MRSA infection increased 17-fold in Canadian hospitals from 1995 to 2007. There has also been a dramatic increase in cases of community-associated MRSA infection due to the CMRSA-10 (USA300) clone. Continued surveillance is needed to monitor the ongoing evolution of MRSA colonization or infection in Canada and globally.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 348 - 356
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1. Deresinski, S. Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic Odyssey. Clin Infect Dis 2005;40:562–573.Google Scholar
2. Boucher, HW, Corey, GR. Epidemiology of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2008;46(suppl 5):S344-S349.Google Scholar
3. Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of community-and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976–2984.Google Scholar
4. Li, M, Diep, BA, Villacruz, AE, et al. Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus . Proc Natl Acad Sci USA 2009;106:5883–5888.Google Scholar
5. Grundmann, H, Aires-de-Sousa, M, Boyce, J, Tiemersma, E. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public health threat. Lancet 2006;368:874–885.CrossRefGoogle ScholarPubMed
6. Tiemersma, EW, Bronzwaer, SLAM, Lyytikäinen, O, et al. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004;10:1627–1634.Google Scholar
7. Jarvis, WR, Schlosser, J, Chinn, RY, Tweeten, S, Jackson, M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control 2007;35:631–637.Google Scholar
8. Aires de Sousa, M, Miragala, M, Santos Sanches, I, et al. Three-year assessment of methicillin-resistant Staphylococcus aureus clones in Latin America from 1996 to 1998. J Clin Microbiol 2001;39:2197–2205.CrossRefGoogle ScholarPubMed
9. McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–5130.Google Scholar
10. Ko, KS, Lee, J-Y, Suh, JY, et al. Distribution of major genotypes among methicillin-resistant Staphylococcus aureus clones in Asian countries. J Clin Microbiol 2005;43:421–426.Google Scholar
11. Simor, AE, Ofner-Agostini, M, Bryce, E, et al. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001;165:21–26.Google ScholarPubMed
12. Simor, AE, Ofner-Agostini, M, Bryce, E, et al. Laboratory characterization of methicillin-resistant Staphylococcus aureus in Canadian hospitals: re-suits of 5 years of national surveillance, 1995-1999. J Infect Dis 2002;186: 652–660.CrossRefGoogle ScholarPubMed
13. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care Setting. Am J Infect Control 2008;36:309–332.Google Scholar
14. Fridkin, SK, Hageman, JC, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352: 1436–1444.Google Scholar
15. Louie, L, Matsumura, SO, Choi, E, Louie, M, Simor, AE. Evaluation of three rapid methods for detection of methicillin resistance in Staphylococcus aureus . J Clin Microbiol 2000;38:2170–2173.Google Scholar
16. Mulvey, MR, Chui, L, Ismail, J, et al. Development of a Canadian standardized protocol for subtyping methicillin-resistant Staphylococcus aureus using pulsed-field gel electrophoresis. J Clin Microbiol 2001;39:3481–3485.Google Scholar
17. Christiansen, S, Golding, GR, Campbell, J, Canadian Nosocomial Infection Surveillance Program, Mulvey, MR. Comparative genomics of Canadian epidemic lineages of methicillin-resistant Staphylococcus aureus . J Clin Microbiol 2007;45:1904–1911.Google Scholar
18. Oliveira, DC, de Lencastre, H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 2002;46:2155–2161.Google Scholar
19. Lina, G, Piémont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128–1132.CrossRefGoogle ScholarPubMed
20. Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007;13:1840–1846.Google Scholar
21. Ofner-Agostini, M, Varia, M, Johnston, L, et al. Infection control and antimicrobial restriction practices for antimicrobial resistant organisms in Canadian tertiary care hospitals. Am J Infect Control 2007;35:563–568.CrossRefGoogle ScholarPubMed
22. Canadian Institute for Health Information. Number of hospital inpatient days, inpatient admissions, ambulatory care visits, emergency visits, Canada, 2006-2007. Canadian Institute for Health Information, ref. CMDB3.1.Google Scholar
23. Rubin, RJ, Harrington, CA, Poon, A, et al. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis 1999;5:9–17,CrossRefGoogle ScholarPubMed
24. Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.Google Scholar
25. Kurbis, CA, Wylie, JL. Community-based cluster of methicillin-resistant Staphylococcus aureus in Manitoba. Can J Infect Dis 2001;12:149–152.Google Scholar
26. Mulvey, MR, MacDougall, L, Cholin, B, et al. Community-associated methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis 2005;11:844–850.CrossRefGoogle ScholarPubMed
27. Gilbert, M, MacDonald, J, Gregson, D, et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006;175:149–154.Google Scholar
28. Dalloo, A, Soboi, I, Palacios, C, Mulvey, M, Gravel, D, Panaro, L. Investigation of community-associated methicillin-resistant Staphylococcus aureus in a remote northern community, Nunavut, Canada. Can Commun Dis Rep 2008;34:1–7.Google Scholar
29. Seybold, U, Kourbatova, EV, Johnson, JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42:647–656.Google Scholar
30. Otter, JA, French, GL. Nosocomial transmission of community-associated meticillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2006;6:753–755.CrossRefGoogle Scholar
31. Patel, M, Kumar, RA, Stamm, AM, Hoesley, CJ, Moser, SA, Waites, KB. USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. J Clin Microbiol 2007;45:3431–3433.CrossRefGoogle ScholarPubMed
32. Liu, C, Graber, CJ, Karr, M, et al. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-2005. Clin Infect Dis 2008;46: 1637–1646.Google Scholar
33. Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46:787–794.CrossRefGoogle ScholarPubMed
34. David, MZ, Glikman, D, Crawford, SE, et al. What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 2008;197: 1235–1243.Google Scholar
35. McGeer, A, Fleming, CA, Willey, BM, Green, KA, Low, DE. Antimicrobial resistance in common hospital pathogens in Ontario. QMP-LS News. October 2008; No. 131:4-14. http://www.qmpls.org/pub_resources/publications/qmpls_news/pdf/qmplsnews131.pdf. Accessed July 25, 2009.Google Scholar