Endemic Methicillin-resistant Staphylococcus Aureus Research Articles

Molecular fingerprinting of fusidic acid- and rifampicin-resistant strains of methicillin-resistant Staphylococcus aureus (MRSA) from Malaysian hospitals.

The emergence and spread of multiresistant methicillin-resistant Staphylococcus aureus (MRSA) strains, especially those resistant to fusidic acid and rifampicin, in Malaysian hospitals is of concern. In this study DNA fingerprinting by PFGE was performed on fusidic acid- and rifampicin-resistant isolates from Malaysian hospitals to determine the genetic relatedness of these isolates and their relationship with the endemic MRSA strains. In all, 32 of 640 MRSA isolates from 9 Malaysian hospitals were resistant to fusidic acid and rifampicin. Seven PFGE types (A, ZC, ZI, ZJ, ZK, ZL and ZM) were observed. The commonest type was type ZC, seen in 72% of isolates followed by type A, seen in 13%. Each of the other types (ZI, ZJ, ZK, ZL and ZM) was observed in a single isolate. Each type, even the commonest, was found in only one hospital. This suggests that the resistant strains had arisen from individual MRSA strains in each hospital and not as a result of the transmission of a common clone.

Strain relatedness of endemic MRSA isolates in a burns unit in South India—a five year study

Methicillin-resistant Staphylococcus aureus (MRSA) is an important hospital-acquired pathogen in healthcare centres worldwide. The strain characteristics vary widely from country to country, although some strains have the propensity to spread globally. E-MRSA 15 and 16 have been established as epidemic strains in the UK and Europe. MRSA is widely prevalent in the Indian sub-continent and is endemic in the Burns Unit of St Johns Medical College Hospital, Bangalore, India. The purpose of the study was to investigate the predominance of one or more epidemic strains within an endemic situation. A representative selection of 65 isolates of MRSA over a period spanning five years (1994–1998) was subjected to antibiogram comparison, phage-typing and pulsed field gel electrophoresis (PFGE) using SmaI. The antibiogram comparison was not a discerning method of strain discrimination. At least 11 different phage-types were seen among these 65 isolates; 35.4% belonged to phage-types A and SM-A. PFGE studies showed 12 distinct patterns, with a single pattern accounting for over half of the isolates. The study showed that the isolates from India were diverse and distinct from strains of MRSA such as E-MRSA reported from many studies in the UK. Molecular characterization of isolates is a source of valuable information that could enhance global surveillance; more work is needed across the Indian sub-continent to establish the nature of MRSA strain diversity.

Occurrence of methicillin-resistant Staphylococcus aureus infections in German intensive care units.

This study aims to describe the occurrence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections and the relation between endemic and epidemic nosocomial MRSA infections in intensive care units (ICUs) in Germany. The ICU component within the German national nosocomial infections surveillance system (KISS) was established in January 1997. The number of participating ICUs increased from 25 in 1997 to 178 (June 2000). In every case of nosocomial infection (NI), the pathogens identified were referred to the surveillance system. To identify clusters and outbreaks and distinguish them from mere single events, the following simple definitions were applied: a "cluster" was two nosocomial MRSA infections within 3 months; an "outbreak" was three or more nosocomial MRSA infections within 3 months; all other MRSA infections were classed as "single events." A total of 10,261 NIs were identified during the observation period in the 139 ICUs which had been participating for at least 6 months. Among the 1,535 nosocomial S. aureus infections, 219 MRSA infections were identified (14.3%). Only 51 (36.7%) of the 139 KISS ICUs identified nosocomial MRSA infections. In 12 ICUs (8.6%) however, more than 50% of all nosocomial S. aureus infections were caused by MRSA. The mean incidence density was 0.31 nosocomial MRSA infections/1,000 patient days (range 0-3.6). Outbreaks were registered in 13 ICUs, clusters in 12 further ICUs and only single events in the remaining 26. 64.0% of all MRSA infections were registered during outbreaks and 12.8% in cluster situations. Thus, only 23.2% of MRSA infections were single events. These definitions of clusters and outbreaks can only provide an estimate of the real number of cases. However, through the targeted identification of ICUs with endemic and epidemic MRSA problems and subsequent strict measures to prevent the spread of MRSA within these ICUs, it may be possible to retain, or even reduce, the present level of MRSA infections in Germany.

Epidemiology of methicillin-resistant Staphylococcus aureus: results of a nation-wide survey in Switzerland.

To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Switzerland. One-year national survey of all MRSA cases detected in a large sample of Swiss healthcare institutions (HCI). Analysis of epidemiological and molecular typing data (PFGE) of MRSA strains. During 1997, 385 cases of MRSA were recorded in the 5 university hospitals, in 33 acute care community hospitals, and 14 rehabilitation or long-term care institutions. Half of the cases were found at the University of Geneva Hospitals where MRSA was already known to be endemic (41.1 cases/10,000 admissions). The remaining cases (200) were distributed throughout Switzerland. The highest rates (>100 cases/10,000 admissions) were reported from non-acute care institutions. Rates ranged from 3.3 to 41.1 cases/10,000 admissions for university hospitals (mean 15.5); 0.67 to 90.4 for community hospitals (mean 4.8), and 28.2 to 315 for non-acute care institutions reporting MRSA (mean 85.7). Forty percent of MRSA patients were infected, while 60% were only colonised. The leading infection sites were skin and soft tissue (21%), surgical site (15%), and the urinary tract (26%). Whereas in Eastern Swiss HCI most MRSA cases occurred in acute care hospitals (n = 47, 98%), rehabilitation and long-term care institutions accounted for an important number of the identified cases (n = 107, 38%) in Western Switzerland. Low rates of MRSA were still observed in Swiss HCI, despite one outlying acute care centre with endemic MRSA and some nonacute care institutions with epidemic MRSA. Rehabilitation and long-term care institutions contributed to a substantial proportion of cases in Western Switzerland and may constitute a significant reservoir. Overall, a national approach to surveillance and control of MRSA is mandatory in order to preserve a still favourable situation, and to decrease the risk of epidemic MRSA dissemination.

Epidemiology of methicillin-resistant Staphylococcus aureus: results of a nation-wide survey in Switzerland.

To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Switzerland. One-year national survey of all MRSA cases detected in a large sample of Swiss healthcare institutions (HCI). Analysis of epidemiological and molecular typing data (PFGE) of MRSA strains. During 1997, 385 cases of MRSA were recorded in the 5 university hospitals, in 33 acute care community hospitals, and 14 rehabilitation or long-term care institutions. Half of the cases were found at the University of Geneva Hospitals where MRSA was already known to be endemic (41.1 cases/10,000 admissions). The remaining cases (200) were distributed throughout Switzerland. The highest rates (>100 cases/10,000 admissions) were reported from non-acute care institutions. Rates ranged from 3.3 to 41.1 cases/10,000 admissions for university hospitals (mean 15.5); 0.67 to 90.4 for community hospitals (mean 4.8), and 28.2 to 315 for non-acute care institutions reporting MRSA (mean 85.7). Forty percent of MRSA patients were infected, while 60% were only colonised. The leading infection sites were skin and soft tissue (21%), surgical site (15%), and the urinary tract (26%). Whereas in Eastern Swiss HCI most MRSA cases occurred in acute care hospitals (n = 47, 98%), rehabilitation and long-term care institutions accounted for an important number of the identified cases (n = 107, 38%) in Western Switzerland. Low rates of MRSA were still observed in Swiss HCI, despite one outlying acute care centre with endemic MRSA and some nonacute care institutions with epidemic MRSA. Rehabilitation and long-term care institutions contributed to a substantial proportion of cases in Western Switzerland and may constitute a significant reservoir. Overall, a national approach to surveillance and control of MRSA is mandatory in order to preserve a still favourable situation, and to decrease the risk of epidemic MRSA dissemination.

Prevalence of methicillin-resistant Staphylococcus aureus carriage at the time of admission in two acute geriatric wards

Studies on methicillin-resistant Staphylococcus aureus (MRSA) in the elderly have been concerned with patients hospitalized in nursing homes or long-term care facilities. Our objective was to estimate the prevalence of MRSA at the time of admission in two acute geriatric wards with high endemic MRSA incidence in a French teaching hospital. A prospective screening of MRSA carriers was conducted by swabbing nares and wounds during five weeks for all patients on the day of admission. For each patient demographic, administrative, clinical and therapeutic data were recorded. Their associations with MRSA carriage were studied by logistic regression analysis. On the day of admission, 35 patients (14.6%) were MRSA carriers. Variables independently associated with carriage were hospitalization within the six last months (OR = 4.64; P < 0.001) and the existence of wounds or bedsores (OR = 2.864; P = 0.02). The high prevalence of MRSA carriage at the time of admission could explain in part the high incidence of MRSA in these wards. A systematic selective screening targeted on patients with high risk of carriage should be helpful to implement barrier precautions and reduce cross-transmission.

Characterization of the Brazilian endemic clone of methicillin-resistant Staphylococcus aureus (MRSA) from hospitals throughout Brazil.

The objective of this study was to characterize patterns of the Brazilian endemic clone of methicillin-resistant Staphylococcus aureus (MRSA) from hospitals throughout Brazil. We studied 83 MRSA strains isolated from patients hospitalized in 27 public and private hospitals in 19 cities located in 14 Brazilian states from September, 1995, to June, 1997. The MRSA strains were typed using antibiograms, bacteriophage typing and pulsed field gel electrophoresis (PFGE). The analysis of genomic DNA by PFGE showed that 65 isolates presented the same PFGE pattern. This pattern was present in all of the hospitals studied indicating the presence of an endemic MRSA clone widely disseminated throughout Brazilian hospitals (BEC). All isolates belonging to the BEC proved to be resistant to ciprofloxacin, erythromycin, lincomycin, trimethoprim-sulphamethoxazole, and tetracycline. Variable susceptibility to these drugs was found only in isolates belonging to clones other than the BEC. The results show that, among MRSA, the BEC is common in Brazil. The best method for mapping changes in the frequency of this clone among MRSA is pulsed field gel electrophoresis. Use of molecular mapping is an important tool for monitoring the spread of potentially dangerous microbes.

Appearance of methicillin-resistant Staphylococcus aureus (MRSA) sensitive to gentamicin in a hospital with a previous endemic distinct MRSA.

Since 1990 a clone of gentamicin and methicillin-resistant Staphylococcus aureus (MRSA) has remained endemic in our hospital, but since January 1996 a gentamicin-sensitive strain has progressively replaced the previous clone. We characterized the phenotypic and molecular pattern of the MRSA strains isolated in our hospital in 1996 and compared prospectively the epidemiological, clinical and evolutionary characteristics of ninety patients infected or colonized by gentamicin-sensitive MRSA (GS-MRSA) (49) and by gentamicin-resistant MRSA (GR-MRSA) (41). Finally we studied the variation of aminoglycoside consumption in our hospital from 1989 to 1996. We observed two antibiotypes (GS-MRSA and GR-MRSA) corresponding to two major chromosomal patterns. Patients with GS-MRSA usually acquired the infection 72 hours after hospital admission. No significant differences were observed in epidemiological characteristics, clinical presentation and evolution between patients with GS-MRSA and GR-MRSA. Since 1989 aminoglycoside intake in our hospital has decreased by 46%.

The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a Veterans' Affairs hospital.

To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistant Staphylococcus aureus (MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA. All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA. The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used. Inpatients and outpatients at the facility. MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] > or = 4 to 256 microg/mL), and 42% showed high-level mupirocin resistance (MIC > or = 512 microg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA CONCLUSIONS: Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA. We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.

Staphylococcus aureus résistant à la méticilline: facteurs responsables de l'endémie

How can we explain that the proportion of methicillin-resistant Staphylococcus aureus (MRSA) varies between the European countries, ranging from < 1% in Scandinavia to > 30% in Spain, France and Italy? This paper is aimed at attempting to determine factors at the origin of the spreading of endemic MRSA strains as of the early 1980s. Those strains are characterized by their ability to develop resistance to current antibiotics and make treatment of severe and deep infections more complex. Differences in the virulence of MRSA strains and that of susceptible strains appear unlikely. MRSA prevalence seems to be a growing problem, especially in Southern Europe where rates of resistance to other anti-staphylococcal antibiotics are high. General policies for antibiotic therapy as well as the implementation of strategies for prevention and control of MRSA might be responsible for such rates. Indeed, once MRSA is introduced into a facility without control program, this multiresistant bacteria rapidly spreads within the hospital and becomes endemic, expanding its reservoir. FUTURE PROSPECTS ET PROJECTS: Due to the introduction of new methods in microbiology and communication, infection control measures including procedures for isolation and identification of MRSA reservoirs are still feasible; however, their implementation requires human and material resources. Areas requiring improvement in the detection of MRSA outbreaks are identified in this paper, with particular emphasis on the need for national surveillance of MRSA prevalence and reappraisal of MRSA control strategies in French hospitals.

Keeping MRSA out of a district general hospital

This study describes a three-year audit of methicillin-resistant Staphylococcus aureus (MRSA) in a district general hospital and surrounding community. Despite a continuing increase in new cases of MRSA both nationally and locally, and the transfer of patients with MRSA from outside, the hospital remains free from endemic MRSA, albeit with occasional sporadic cases. This is attributed to the presence of a Control of Infection team who have introduced and implemented various policies to control MRSA. These include prompt screening of hospital transfers, an effective topical regimen, attention to environmental cleaning, treatment for established infection, tailored protocol for colonized urinary catheters and an educational programme for staff. Some of these policies have been extended into the community. This report also presents data from 172 cases of MRSA, including carriage rate, infection site, antibiogram, phage-typing, treatment and/or clearance outcome and preliminary evaluation of pathogenicity. A questionnaire has been formulated to assess colonization vs infection. Future strategies will be required if the Status quo is to be maintained.

Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit.

Despite the success of some countries in controlling endemic methicillin-resistant Staphylococcus aureus (MRSA), such programs have not been implemented for some hospitals with endemic infection because of concerns that these programs would be costly and of limited benefit. To compare the costs and benefits of an MRSA control program in an endemic setting. Case-control study conducted at a medical intensive care unit (ICU) of a French university hospital with a 4% prevalence of MRSA carriage at ICU admission. Twenty-seven randomly selected patients who had ICU-acquired MRSA infection between January 1993 and June 1997, matched to 27 controls hospitalized during the same period without MRSA infection. Intensive care unit costs attributable to MRSA infection, computed from excess therapeutic intensity in cases using estimates from a cost model derived in the same ICU, were compared with costs of the control program, derived from time-motion study of nurses and physicians. The threshold for MRSA carriage that would make the control strategy dominant was determined; sensitivity analyses varied rates of MRSA transmission and ratio of infection to transmission, length of ICU stay, and costs of isolation precautions. The mean cost attributable to MRSA infection was US $9275 (median, $5885; interquartile range, $1400-$16,720). Total costs of the control program ranged from $340 to $1480 per patient. A 14% reduction in MRSA infection rate resulted in the control program being beneficial. In sensitivity analyses, the control strategy was dominant for a prevalence of MRSA carriage on ICU admission ranging from 1% to 7%, depending on costs of control measures and MRSA transmission, for infection rates greater than 50% following transmission. In this example of a hospital with endemic MRSA infection, selective screening and isolation of carriers on ICU admission are beneficial compared with no isolation.

Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA.

Screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage in patients at risk was evaluated as part of a control program in a 26-bed medical intensive care unit (ICU) of a university hospital with a high level of endemic MRSA. Control measures included isolation and barrier precautions, skin decolonization with chlorhexidine of patients from whom MRSA was recovered, and mupirocin treatment of nasal carriers of MRSA. Of 3,686 patients admitted during a 4-year period, 44% were screened, which occurred during admission for 38%; MRSA was recovered from 293 patients (8%). There were 150 imported cases and 143 ICU-acquired cases, of which 51% and 45%, respectively, were first identified through screening. Nasal swab cultures identified 84% of MRSA carriers. The incidence of all ICU-acquired cases and of acquired colonization or infection decreased from 5.8% and 5.6% to 2.6% and 1.4% (P = .002 and P < .001), respectively, whereas that of imported cases remained unchanged (range, 3.8% to 4.3%; P = .8). Selective screening for nasal carriage during admission to high-risk areas may contribute to identification of a substantial proportion of cases of MRSA and to early implementation of effective control measures.

Epidemiology of methicillin-resistant Staphylococcus aureus in three Canadian tertiary-care centers.

To describe the epidemiology and spread of methicillin-resistant Staphylococcus aureus (MRSA) in three tertiary-care centers in Ottawa, Ontario, Canada, where MRSA is encountered infrequently. Retrospective review over a 6-year period, from January 1, 1990, through December 31, 1995. Three tertiary-care teaching hospitals in Ottawa. Patients and healthcare workers (HCWs) with MRSA isolated from any body site. Patients and HCWs were identified retrospectively through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiological data, including age, gender, previous hospital admissions (where noted), and current and recent antibiotic use. MRSA isolates that were available were typed using pulsed-field gel electrophoresis (PFGE). Methicillin resistance was confirmed by standard methods and by polymerase chain reaction using mecA-specific primers. MRSA was identified in 53 patients and 2 HCWs. Three patients were excluded from further analysis because medical records were incomplete. Epidemiological data were collected on the remaining 52 individuals. Thirty-nine isolates from 31 patients and 2 HCWs were available for PFGE typing. Five epidemiologically linked nosocomial clusters involving 10 patients and 2 HCWs were identified and were confirmed by PFGE. MRSA isolates from a sixth cluster were not available for PFGE. In each cluster, nosocomial spread was minimized by standard infection control practices, including strict isolation of patients and screening of contacts. There was no evidence of secondary spread of MRSA involving the remaining 36 patients. Recent antibiotic use, surgery, admission to an intensive-care unit, and previous hospitalization were common among patients. There was no evidence of spread of MRSA among the three hospitals, and no endemic strains were apparent in any of these centers. MRSA remains an infrequent isolate in our centers, with no apparent interhospital spread. In institutions with little or no endemic MRSA, rigorous application of standard infection control practices is effective in limiting nosocomial transmission of this organism.

Living with methicillin-resistant Staphylococcus aureus: a 7-year experience with endemic MRSA in a university hospital.

A review of our infection control records revealed 3,159 new isolations of methicillin-resistant Staphylococcus aureus (MRSA) from 1988 to 1994. Prior to this period, our approach to MRSA had changed from eradication to containment measures. We found a decline in MRSA rates from 11.4 to 5.2 first isolations per 1,000 deaths and discharges over the study period.

Environmental Contamination Due to Methicillin-Resistant Staphylococcus aureus: Possible Infection Control Implications

To study the possible role of contaminated environmental surfaces as a reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. A prospective culture survey of inanimate objects in the rooms of patients with MRSA. A 200-bed university-affiliated teaching hospital. Thirty-eight consecutive patients colonized or infected with MRSA. Patients represented endemic MRSA cases. Ninety-six (27%) of 350 surfaces sampled in the rooms of affected patients were contaminated with MRSA. When patients had MRSA in a wound or urine, 36% of surfaces were contaminated. In contrast, when MRSA was isolated from other body sites, only 6% of surfaces were contaminated (odds ratio, 8.8; 95% confidence interval, 3.7-25.5; P < .0001). Environmental contamination occurred in the rooms of 73% of infected patients and 69% of colonized patients. Frequently contaminated objects included the floor, bed linens, the patient's gown, overbed tables, and blood pressure cuffs. Sixty-five percent of nurses who had performed morning patient-care activities on patients with MRSA in a wound or urine contaminated their nursing uniforms or gowns with MRSA. Forty-two percent of personnel who had no direct contact with such patients, but had touched contaminated surfaces, contaminated their gloves with MRSA. We concluded that inanimate surfaces near affected patients commonly become contaminated with MRSA and that the frequency of contamination is affected by the body site at which patients are colonized or infected. That personnel may contaminate their gloves (or possibly their hands) by touching such surfaces suggests that contaminated environmental surfaces may serve as a reservoir of MRSA in hospitals.

Blanket use of intranasal mupirocin for outbreak control and long-term prophylaxis of endemic methicillin-resistant Staphylococcus aureus in an open ward

In December 1992, a thoracic ward in a Melbourne teaching hospital experienced an increase in patients infected with methicillin-resistant Staphylococcus aureus (MRSA). It was decided to attempt to control the outbreak by cohorting positive patients (infected and colonized), as well as nurse cohorting, emphasis on handwashing, and use of intranasal mupirocin initially three times a day for three days, then thrice weekly, for all patients in the ward (with or without MRSA). The campaign comprised four phases of 53, 45, 92 and 365 days, respectively. Patient and nurse cohorting stopped at the end of phase I. In phases I and II, surveillance nose swabs were taken on admission, then twice weekly; in phase III, on admission and weekly and in phase IV, on admission until the end of 1993. In phases I and II (98 days), only one patient acquired MRSA. When the frequency of mupirocin prophylaxis was decreased to once weekly (phase III), two patients acquired MRSA in 92 days (no significant difference): thrice weekly administration resumed (phase IV), during which there were three acquisitions in 365 days. The rates of nose colonization of admissions were 6·4%, 6·3%, 9·7% and 3·1% in phases I–IV, respectively. Only three patients were treated with vancomycin between July 1993 and June 1994 (significantly lower than historical rates, P = 0·0086). No mupirocin resistance was seen in MRSA isolates from this ward during phases I, II and III. In areas of low-level endemic MRSA, the blanket use of thrice-weekly intranasal mupirocin may be effective in decreasing serious infections with MRSA, and does not necessarily elicit mupirocin resistance.

Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit.

To control infections with endemic methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU), triple dye was applied to the umbilical cords of infants in the intermediate-care but not the intensive-care area. The rate of MRSA infection, adjusted for time and intensity of care, decreased in the intermediate-care area (rate ratio, 0.35; 95% confidence interval [CI], 0.14-0.87; P < .01) but not in the intensive-care area (rate ratio, 0.92; 95% CI, 0.41-2.24; P = .48). After 22 months, the rate increased in both areas (Mantel-Haenszel rate ratio, 1.7; 95% CI, 1.0-2.8; P < .05) after overcrowding and understaffing increased. After temporary reduction of overcrowding and understaffing, extension of triple dye use to the intensive-care area and dedication of an infection control nurse to the NICU, MRSA colonization and infection rates decreased to near zero in both areas (infection rate ratios, 0.09 and 0.11, respectively; P < .005). The endemic MRSA strain, identified by pulsed-field gel electrophoresis, was eradicated.

Control of Methicillin-Resistant Staphylococcus aureus: The Ambivalence Persists

The ambivalence regarding methods of dealing with methicillin-resistant Staphylococcus aureus (MRSA) among hospitals and nursing facilities is highlighted in this issue of Infection Control and Hospital Epidemiology. On the one hand, the American Hospital Association (AHA) special report on MRSA1 is a rational but somewhat inconsistent evaluation of various measures to deal with MRSA. The overall tone of the special report is one of moderation in handling this problem. In contrast, a letter by Simor al2 reports an intense epidemiologic effort (culturing all residents and staff) after finding two residents with MRSA infection or colonization in a long-term care facility in Toronto, Ontario, Canada. These two reports are sending two different messages regarding MRSA to hospitals and nursing facilities trying to deal with this organism. The AHA report implies that hospitals and nursing facilities should be concerned about endemic MRSA and provides opinions as to which approaches may be useful. The Task Force suggests that each hospital and nursing facility adopt a plan that is based on surveillance data and resources available. The message by Simor et al2 is that MRSA needs to be sought out and eliminated at all cost to prevent it from becoming an increasing problem in an institution. This editorial will try to put these reports into perspective and to highlight issues that are not addressed. AHA SPECIAL REPORT

Elimination of methicillin‐resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan

Evaluating hand wash products in terms of user acceptability and effectiveness against methicillin-resistant Staphylococcus aureus (MRSA) has been part of a long-term strategy to eliminate endemic MRSA from the neonatal intensive care unit at the Royal Women's Hospital (Brisbane). Following the introduction of a new hand wash disinfectant (triclosan 1% wt/vol), new cases of MRSA colonization were monitored for 12 months. In addition, the use of antibiotics, the incidence of multi-resistant Gram-negative cultures and neonatal infections were noted. No changes were made to any procedures or protocols during the trial. All babies colonized with MRSA had been discharged from the nursery within 7 months of the introduction of triclosan and in the subsequent 9 months no new MRSA isolates had been reported. Reduction in the use of vancomycin has resulted in a cost saving of approximately $A17,000. The total number of Gram-negative isolates has not increased, although Pseudomonas aeruginosa is now reported more often. Compared with the previous 12 months, fewer antibiotics were prescribed and fewer nosocomial infections recorded (P < 0.05).