Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is still recognized as one of the most important nosocomial pathogens. These isolates are usually resistant to all currently available β-lactam antibiotics (penicillins, cephalosporins and carbapenems). Vancomycin has historically been the drug of choice and sometimes the last resort for the treatment of serious MRSA infections, providing empirical coverage and definitive therapy. However, its increased use has now become questionable. Moreover, its increased use has already led to emergence of vancomycin-intermediate S. aureus (VISA) as well as vancomycin-resistant S. aureus (VRSA) in certain parts of the world. In the early 1990s, MRSA was reported to account for 20 – 25 % of S. aureus isolates in hospitalized, worldwide. By the middle of the current decade, many hospitals experienced MRSA percentages in the range of 50-70% of total S. aureus isolates from clinical cultures. Recent studies have found that an increasing proportion of hospital-onset invasive MRSA infections are caused by community strains. The clinical scenario has been more dramatic by MRSA colonization which increases the risk of infection, and infecting strains match colonizing strains in as many as 50–80% of cases. Methicillin-resistant Staphylococcus aureus may persist within the hospital environment for a long time, complicating attempts of eradication. Besides, colonization is not static, as strains have been found to evolve and even to be replaced within the same host. Poor infection control measures as well as continues and indiscriminate use of antibiotics have resulted in this huge problem of acquisition and dissemination of MRSA.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is still recognized as one of the most important nosocomial pathogens
By the middle of the current decade, many hospitals experienced MRSA percentages in the range of 50-70% of total S. aureus isolates from clinical cultures
Recent studies have found that an increasing proportion of hospital-onset invasive MRSA infections are caused by community strains
Summary
To answer adequately the questions which have been raised in the Continuous medical education activities, Case No 5 [4], these data would be useful: Factors related to the increase in MRSA infection rate: Risk factors for MRSA colonization and transmission include severe underlying illness or comorbid conditions, prolonged hospital stay, exposure to broad-spectrum antimicrobials, presence of invasive devices (such as central venous catheters), and frequent contact with the health care system or healthcare personnel. Colonization pressure (the ratio of MRSA carrier–days to total patient-days) has been identified as an independent risk factor for hospital-associated acquisition of MRSA [1]. Identify any patient with a current or prior history of MRSA to ensure application of infection prevention strategies for these patients according to hospital policy (e.g., contact precautions). 7-Implement a laboratory-based alert system that notifies HCP of new MRSA-colonized or MRSA-infected patients in a timely manner. A. Timely notification of new MRSA-positive test results to clinical caregivers and/or infection preventionists facilitates rapid implementation of contact precautions and other interventions as appropriate per facility policy, assessment of risk, and timely surveillance for HAIs. 8-Implement an alert system that identifies readmitted or transferred MRSA-colonized or MRSA-infected patients.
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