Skip to main content Accessibility help

Methicillin-Resistant Staphylococcus aureus in German Intensive Care Units During 2000-2003: Data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units)

  • Elisabeth Meyer (a1), Frank Schwab (a2), Petra Gastmeier (a3) (a4), Daniel Jonas (a1), Henning Rueden (a2) (a4) and Franz D. Daschner (a1) (a4)...



The objective of this study was to analyze methicillin-resistant Staphylococcus aureus (MRSA) percentages (defined as the percentage of S. aureus isolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003).


This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days.


From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552 S. aureus isolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use (P<.05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%]). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage (P<.05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days.


The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.


Corresponding author

Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Hugstetter Str. 55, 79106 Freiburg, Germany (


Hide All
1.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003. Am J Infect Control 2003;31:481498.
2.Gastmeier, P, Sohr, D, Geffers, C, Nassauer, A, Dettenkofer, M, Ruden, H. Occurrence of methicillin-resistant Staphylococcus aureus infections in German intensive care units. Infection 2002; 30:198202.
3.Herr, CE, Heckrodt, TH, Hofmann, FA, Schnettler, R, Eikmann, TF. Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 2003; 24:673678.
4.Kresken, M, Hafner, D, Schmitz, FJ, Wichelhaus, TA. Resistenzsituation bei klinisch wichtigen Infektionserregern gegenüber Antibiotika in Deutschland und im mitteleuropäischen Raum. Bonn, Germany: Antiinfectives Intellegence; 2003.
5.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97:309317.
6.Fridkin, SK, Steward, CD, Edwards, JR, et al. Surveillance of antimicrobial use and antimicrobial resistance in United States hospitals: project ICARE phase 2. Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE) hospitals. Clin Infect Dis 1999; 29:245252.
7.Wertheim, HF, Vos, MC, Boelens, HA, et al. Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in The Netherlands: the value of search and destroy and restrictive antibiotic use. J Hosp Infect 2004; 56:321325.
8.Monnet, DL, Frimodt-Moller, N. Antimicrobial-drug use and methicillin-resistant Staphylococcus aureus. Emerg Infect Dis 2001; 7:161163.
9.Monnet, DL. Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use: possible implications for control. Infect Control Hosp Epidemiol 1998; 19:552559.
10.Weber, SG, Gold, HS, Hooper, DC, Karchmer, AW, Carmeli, Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 2003; 9:14151422.
11.Archibald, L, Phillips, L, Monnet, D, McGowan, JE Jr, Tenover, F, Gaynes, R. Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211215.
12.Gastmeier, P, Geffers, C, Sohr, D, Dettenkofer, M, Daschner, F, Ruden, H. Five years working with the German nosocomial infection surveillance system (Krankenhaus Infektions Surveillance System). Am J Infect Control 2003;31:316321.
13.German Industrial Standard (DIN). Methods for the Determination of Susceptibility of Pathogens (Except Mycobacteria) to Antimicrobial Agents. Part 4. Evaluation Classes of the Minimum Inhibitory Concentration. Berlin: Beuth Verlag; 1998:111. DIN number 58940-4.
14.NCCLS. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA; 1999. NCCLS document M100-S9.
15.Meyer, E, Jonas, D, Schwab, F, Rueden, H, Gastmeier, P, Daschner, FD. Design of a surveillance system of antibiotic use and bacterial resistance in German intensive Care units (SARI). Infection 2003; 31:208215.
16.Meyer, E, Schwab, F, Jonas, D, Rueden, H, Gastmeier, P, Daschner, FD. Surveillance of antimicrobial use and antimicrobial resistance in intensive care units (SARI): 1. Antimicrobial use in German intensive care units. Intensive Care Med 2004; 30:10891096.
17.Zuschneid, I, Geffers, C, Sohr, D, Kohlhase, C, Schumacher, M, Gastmeier, P, Ruden, H. Accuracy of diagnosing nosocomial infections (NI) within the intensive care unit component of the German Surveillance System and correlations between findings and structural or process variables. In: Program and abstracts of the 13th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 2003; Arlington, VA. Abstract 18.
18.Crowcroft, NS, Ronveaux, O, Monnet, DL, Mertens, R. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol 1999; 20:3136.
19.Loeffler, JM, Garbino, J, Lew, D, Harbarth, S, Rohner, P. Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units. Scand J Infect Dis 2003; 35: 843850.
20.European Antimicrobial Resistance Surveillance System (EARSS). EARSS Annual Report 2002. Bilthoven, The Netherlands: National Institute of Public Health and the Environment; 2004.
21.Fridkin, SK, Hill, HA, Volkova, NV, et al. Temporal changes in prevalence of antimicrobial resistance in 23 US Hospitals. Emerg Infect Dis 2002; 8:697701.
22.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 to June 2002, issued August 2002. Am J Infect Control 2002; 30:458475.
23.Bisognano, C, Vaudaux, P, Rohner, P, Lew, DP, Hooper, DC. Induction of fibronectin-binding proteins and increased adhesion of quinolone-resistant Staphylococcus aureus by subinhibitory levels of ciprofloxacin. Antimicrob Agents Chemother 2000; 44:14281437.
24.Westh, H, Zinn, CS, Rosdahl, VT. An international multicenter study of antimicrobial consumption and resistance in Staphylococcus aureus isolates from 15 hospitals in 14 countries. Microb Drug Resist 2004; 10: 169176.
25.Lopez-Lozano, JM, Monnet, DL, Yague, A, et al. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000; 14:2131.
26.Monnet, D, MacKenzie, F, López-Lozano, JM, et al. Antimicrobial drug use and methicillin-resistant Staphylococcus aureus, Aberdeen, 1996-2000. Emerg Infect Dis 2004; 10:14321441.
27.Monnet, DL, Lopez-Lozano, JM, Campillos, P, Burgos, A, Yague, A, Gonzalo, N. Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models. Clin Microbiol Infect 2001; 7(Suppl 5):2936.
28.Talon, D, Muller, A, Thouverez, M, Bertrand, X. MRSA incidence as an indicator of infection control practices: do the results reflect the reality? J Hosp Infect 2004; 57:265266.
29.Leegaard, TM, Caugant, DA, Froholm, LO, Hoiby, EA. Apparent differences in antimicrobial susceptibility as a consequence of national guidelines. Clin Microbiol Infect 2000; 6:290293.


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed