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Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

Published online by Cambridge University Press:  02 January 2015

Jesus Jesús Rodríguez-Baño ,
Lola García ,
Encarnación Ramírez ,
Carmen Lupión ,
Miguel A. Muniain ,
Carmen Velasco ,
Juan Gálvez ,
M. Dolores del Toro ,
Antonio B. Millán  and
Lorena López-Cerero
...Show all authors
Jesus Jesús Rodríguez-Baño*
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
Lola García
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain
Encarnación Ramírez
Affiliation:
Servicio de Microbiología, Universidad de Sevilla, Sevilla, Spain
Miguel A. Muniain
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
Carmen Velasco
Affiliation:
Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
Juan Gálvez
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain Hospital Universitario Virgen Macarena, and the Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
M. Dolores del Toro
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain
Antonio B. Millán
Affiliation:
Sección de Enfermedades Infecciosas, Universidad de Sevilla, Sevilla, Spain
Lorena López-Cerero
Affiliation:
Servicio de Microbiología, Universidad de Sevilla, Sevilla, Spain Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
Alvaro Pascual
Affiliation:
Servicio de Microbiología, Universidad de Sevilla, Sevilla, Spain Departamento de Microbiología, Universidad de Sevilla, Sevilla, Spain
*
Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, Sevilla 41009, Spain (jesusrb@us.es)
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Abstract

Objective.

To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation.

Design.

Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis.

Setting.

A 950-bed teaching hospital in Seville, Spain.

Patients.

All patients admitted to the hospital during the period from 1995 through 2008.

Methods.

Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers.

Results.

Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care.

Conclusion.

Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 8 , August 2010 , pp. 786 - 795
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.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 metaanalysis. Clin Infect Dis 2003;36:53–59.CrossRefGoogle ScholarPubMed
2.Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2003;36:1433–1437.Google ScholarPubMed
3.Tiemersma, EW, Bronzwaer, S, Lyytikäinen, O, et al.Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004;10:1627–1634.CrossRefGoogle ScholarPubMed
4.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
5.Cuevas, O, Cercenado, E, Vindel, A, et al.Evolution of the antimicrobial resistance of Staphylococcus spp. in Spain: five nationwide prevalence studies, 1986 to 2002. Antimicrob Agents Chemother 2004;48:4240–4245.CrossRefGoogle ScholarPubMed
6.Tomic, V, Sorli, PS, Trinkaus, D, Sorli, J, Widmer, A, 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
7.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al.Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.CrossRefGoogle ScholarPubMed
8.Chaberny, IF, Schwab, F, Ziesing, S, Suerbaum, S, Gastmeier, P. Impact of routine surgical ward and intensive care unit admission surveillance culture on hospital-wide nosocomial methicillin-resistant Staphylococcus aureus infections in a university hospital: an interrupted time-series analysis. J Antimicrob Chemother 2008;62:1422–1429.CrossRefGoogle Scholar
9.Robicsek, A, Beaumont, JL, Paule, SM, et al.Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409^H8.CrossRefGoogle ScholarPubMed
10.Chowers, MY, Paitan, Y, Sheva Gottesman, B, Gerber, B, Ben-Nissan, Y, Shitrit, P. Hospital-wide methicillin-resistant Staphylococcus aureus control program: a 5 year follow-up. Infect Control Hosp Epidemiol 2009;30:778–781.CrossRefGoogle ScholarPubMed
11.Cuevas, O, Cercenado, E, Goyanes, MJ, et al. Staphylococcus spp. en España: situación actual y evolución de la resistencia a antimicrobianos (19862006). Enferm Infecc Microbiol Clin 2008;26:269–277.CrossRefGoogle Scholar
12.European Antimicrobial Resistance Surveillance System. EARSS Annual Report 2008. http://www.rivm.nl/earss/Images/EARSS%202008_final_tcm61-65020.pdf. Accessed January 15, 2010.Google Scholar
13.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
14.Coia, JE, Duckworth, GJ, Edwards, DI, et al; Joint Working Party of the British Society of Antimicrobial Chemotherapy; Hospital Infection Society; Infection Control Nurses Association. Guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities [published correction appears in J Hosp Infect 2006;64(1):97–98]. J Hosp Infect 2006;63(suppl 1):S1-S44.CrossRefGoogle Scholar
15.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007; 35(10suppl 2):S165–S193.CrossRefGoogle ScholarPubMed
16.Rodriguez-Bano, J, Bischofberger, C, Alvarez-Lerma, F, et al.Vigilancia y el control de Staphylococcus aureus resistente a meticilina en hospitales espanoles. Documento de consenso GEIH-SEIMC y SEMPSPH. Enferm Infecc Microbiol Clin 2008;26:285–298.CrossRefGoogle ScholarPubMed
17.Harbarth, S. Control of endemic methicillin-resistant Staphylococcus aureus—recent advances and future challenges. Clin Microbiol Infect 2006; 12:1154–1162.Google Scholar
18.Preheim, LC, Rimland, D, Bittner, MJ. Methicillin-resistant Staphylococcus aureus in Veterans Administration medical centers. Infect Control 1987;8:191–194.CrossRefGoogle ScholarPubMed
19.Hails, J, Kwaku, F, Wilson, AP, Bellingan, G, Singer, M. Large variation in MRSA policies, procedures and prevalence in English intensive care units: a questionnaire analysis. Intensive Care Med 2003;29:481–483.CrossRefGoogle ScholarPubMed
20.Richet, HM, Benbachir, M, Brown, DE, et al.Are there regional variations in the diagnosis, surveillance, and control of methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2003;24:334–341.CrossRefGoogle ScholarPubMed
21.Rodriguez-Bano, J, Millán, AB, Dommguez, MA, et al.Medidas de control de Staphylococcus aureus resistente a meticilina en hospitales espanoles. Encuesta del proyecto SARM 2003 GEIH/GEMARA/REIPI. Enferm Infect Microbiol Clin 2006;24:149–156.CrossRefGoogle ScholarPubMed
22.Stone, SP, Cooper, BS, Kibbler, CC, et al.The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Lancet Infect Dis 2007;7:282–288.CrossRefGoogle ScholarPubMed
23.Rodriguez-Bano, J, Garcia, L, Ramirez, E, et al.Long-term control of hospital-wide endemic multidrug-resistant (MDR) Acinetobacter bau-mannii through a comprehensive “bundle” approach. Am J Infect Control 2009;37:715–722.CrossRefGoogle ScholarPubMed
24.Garner, JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee [published correction appears in Infect Control Hosp Epidemiol 1996;17(4):214], Infect Control Hosp Epidemiol 1996;17(1):53-80.Google Scholar
25.Sehulster, LM, Chinn, RYW, Arduino, MJ, et al.Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Atlanta, GA: US Department of Health and Human Services and Centers of Disease Control and Prevention, 2003. http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Enviro_guide_03.pdf. Accessed January 15, 2010.Google ScholarPubMed
26.Dominguez, MA, Lencastre, H, Linares, J, Tomasz, A. Spread and maintenance of a dominant methicillin-resistant Staphylococcus aureus (MRSA) disease in a Spanish hospital. J Clin Microbiol 1994;32:2081–2087.CrossRefGoogle Scholar
27.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
28.Cohen, AL, Calfee, D, Fridkin, SK, et al.Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol 2008;29:901–913.CrossRefGoogle ScholarPubMed
29.Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309.CrossRefGoogle ScholarPubMed
30.Shardell, M, Harris, AD, El-Kamary, SS, Furuno, JP, Miller, RM, Perencevich, EN. Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies. Clin Infect Dis 2007;45:901–907.Google Scholar
31.Raineri, E, Crema, L, De Silvestri, A, et al.Meticillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis. J Hosp Infect 2007;67:308–315.CrossRefGoogle Scholar
32.Vaqué, J, Roselló, J, Arribas, JL. Prevalence of nosocomial infections in Spain: EPINE study 1990-1997. EPINE Working Group. J Hosp Infect 1999;43(suppl):S105–S111.CrossRefGoogle ScholarPubMed
33.Rodriguez-Bano, J, Angeles Dominguez, M, Bias Millán, A, et al; GEIH/GEMARA (SEIMC); REIPI. Clinical and molecular epidemiology of community-acquired, healthcare-associated and nosocomial methicillin-resistant Staphylococus aureus in Spain. Clin Microbiol Infect 2009;15(12):1111–1118.CrossRefGoogle ScholarPubMed
34.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
35.Saigado, CD, Farr, BM. What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures? Infect Control Hosp Epidemiol 2006;27:116–121.CrossRefGoogle Scholar
36.Bonten, MJ, Austin, DJ, Lipsitch, M. Understanding the spread of antibiotic resistant pathogens in hospitals: mathematical models as tools for control. Clin Infect Dis 2001;33:1739–1746.CrossRefGoogle ScholarPubMed
37.Vandenbroucke-Grauls, CM. Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 1996;17:512–513.CrossRefGoogle ScholarPubMed
38.Lessing, MPA, Jordens, JZ, Bowler, ICJ. When should healthcare workers be screened for methicillin-resistant Staphylococcus aureus? J Hosp Infect 1996;34:205–210.CrossRefGoogle ScholarPubMed