Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-25T07:21:09.568Z Has data issue: false hasContentIssue false
  • English
  • Français

Active Surveillance for Methicillin-Resistant Staphylococcus aureus(MRSA) Decreases the Incidence of MRSA Bacteremia

Part of: WILLIAM JARVIS AWARD RECIPIENTS

Published online by Cambridge University Press:  21 June 2016

Pnina Shitrit ,
Bat-Sheva Gottesman ,
Michal Katzir ,
Avi Kilman ,
Yona Ben-Nissan  and
Michal Chowers
Pnina Shitrit
Affiliation:
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
Bat-Sheva Gottesman
Affiliation:
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
Michal Katzir
Affiliation:
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
Avi Kilman
Affiliation:
Microbiology Laboratory, Meir Medical Center, Kfar Saba, Israel
Yona Ben-Nissan
Affiliation:
Microbiology Laboratory, Meir Medical Center, Kfar Saba, Israel
Michal Chowers*
Affiliation:
Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel Sakler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
*
Infectious Diseases Unit, Meir Medical Center, 59 Tsharnichovski, Kfar Saba, Israel44281, (chowersm@post. tau.ac.il)
Get access Rights & Permissions [Opens in a new window]

Extract

Objectives.

To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital.

Design.

Before-after trial.

Setting.

A 700-bed hospital.

Patients.

All patients admitted to the hospital who were at high risk for MRSA bacteremia.

Intervention.

Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004).

Results.

The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (P<.001). The mean number of MRSA bacteremia cases per month decreased from 3.6 cases before the intervention to 1.8 cases after the intervention (P< 0.001).

Conclusions.

Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1004 - 1008
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003; 36:592–598.CrossRefGoogle ScholarPubMed
2. Merrer, J, Santoli, F, Appere de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000; 21:718–723.Google Scholar
3. Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004; 39:776–782.CrossRefGoogle ScholarPubMed
4. von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001; 344:11–16.Google Scholar
5. Corbella, X, Dominguez, MA, Pujol, M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997; 16:351–357.CrossRefGoogle ScholarPubMed
6. Pujol, M, Pena, C, Pallares, R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996; 100:509–516.CrossRefGoogle ScholarPubMed
7. Wertheim, HF, Vos, MC, Ott, A, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004; 364:703–705.CrossRefGoogle ScholarPubMed
8. Garner, JS, Simmons, BP. Guideline for isolation precautions in hospitals. Infect Control 1983; 4:245–325.Google Scholar
9. Panlilio, AL, Culver, DH, Gaynes, RP, et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992; 13:582–586.Google Scholar
10. Marshall, C, Wesselingh, S, McDonald, M, Spelman, D. Control of endemic MRSA-what is the evidence? A personal view. J Hosp Infect 2004; 56:253–268.Google Scholar
11. Cooper, BS, Stone, SP, Kibbler, CC, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004; 329:533.Google Scholar
12. LeDell, K, Muto, CA, Jarvis, WR, Farr, BM. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003; 24:639–641.Google Scholar
13. National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Test for Bacteria That Grow Aerobically. 5th ed. Villanova, PA: NCCLS; 2000. Approved standard M7-A5.Google Scholar
14. Girou, E, Azar, J, Wolkenstein, P, Cizeau, F, Brun-Buisson, C, Roujeau, JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 2000; 21:583–587.CrossRefGoogle Scholar
15. Papia, G, Louie, M, Tralla, A, Johnson, C, Collins, V and Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999; 20:473–477.Google Scholar
16. Rubinovitch, B, Pittet, D. Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned? J Hosp Infect 2001;47:9–18.Google Scholar
17. Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003; 36:281–285.CrossRefGoogle ScholarPubMed
18. Pan, A, Carnevale, G, Catenazzi, P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA “search and isolate” strategy in a hospital in Italy with hyperendemic MRSA. Infect Control Hosp Epidemiol 2005; 26:127–133.Google Scholar
19. Crossley, K. Long-term care facilities as sources of antibiotic-resistant nosocomial pathogens. Curr Opin Infect Dis 2001; 14:455–459.CrossRefGoogle ScholarPubMed
20. McNeil, SA, Mody, L, Bradley, SF. Methicillin-resistant Staphylococcus aureus: management of asymptomatic colonization and outbreaks of infection in long-term care. Geriatrics 2002; 57:16-18,21-24,27.Google Scholar
21. Lucet, JC, Grenet, K, Armand-Lefevre, L, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005; 26:121–126.CrossRefGoogle ScholarPubMed
22. Kotilainen, P, Routamaa, M, Peltonen, R, et al. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001; 161:859–863.Google Scholar
23. Kotilainen, P, Routamaa, M, Peltonen, R, et al. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003; 9:169–175.Google Scholar
24. Tomic, V, Svetina Sorli, P, Trinkaus, D, Sorli, J, Widmer, AF, Trampuz, A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004; 164:2038–2043.CrossRefGoogle Scholar
25. Verhoef, J, Beaujean, D, Blok, H, et al. A Dutch approach to methicillin-resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1999; 18:461–466.Google Scholar
26. Vriens, M, Blok, H, Fluit, A, Troelstra, A, Van Der Werken, C, Verhoef, J. Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 2002; 21:782–786.CrossRefGoogle Scholar