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Clinical Incidence of Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization or Infection as a Proxy Measure for MRSA Transmission in Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Pei-Jean I. Feng ,
Alexander J. Kallen ,
Katherine Ellingson ,
Robert Muder ,
Rajiv Jain  and
John A. Jernigan
Pei-Jean I. Feng
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alexander J. Kallen*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Katherine Ellingson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert Muder
Affiliation:
Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Rajiv Jain
Affiliation:
Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
John A. Jernigan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-35, Atlanta, GA 30333 (ffp0@cdc.gov)
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Abstract

Background.

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection has been used as a proxy measure for MRSA transmission, but incidence calculations vary depending on whether active surveillance culture (ASC) data are included.

Objective.

To evaluate the relationship between incidences of MRSA colonization or infection calculated with and without ASCs in intensive care units and non-intensive care units.

Setting.

A Veterans Affairs medical center.

Methods.

From microbiology records, incidences of MRSA colonization or infection were calculated with and without ASC data. Correlation coefficients were calculated for the 2 measures, and Poisson regression was used to model temporal trends. A Poisson interaction model was used to test for differences in incidence trends modeled with and without ASCs.

Results.

The incidence of MRSA colonization or infection calculated with ASCs was 4.9 times higher than that calculated without ASCs. Correlation coefficients for incidences with and without ASCs were 0.42 for intensive care units, 0.59 for non-intensive care units, and 0.48 hospital-wide. Trends over time for the hospital were similar with and without ASCs (incidence rate ratio with ASCs, 0.95 [95% confidence interval, 0.93-0.97]; incidence rate ratio without ASCs, 0.95 [95% confidence interval, 0.92-0.99]; P = .68). Without ASCs, 35% of prevalent cases were falsely classified as incident.

Conclusions.

At 1 Veterans Affairs medical center, the incidence of MRSA colonization or infection calculated solely on the basis of clinical culture results commonly misclassified incident cases and underestimated incidence, compared with measures that included ASCs; however, temporal changes were similar. These findings suggest that incidence measured without ASCs may not accurately reflect the magnitude of MRSA transmission but may be useful for monitoring transmission trends over time, a crucial element for evaluating the impact of prevention activities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 20 - 25
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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