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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)

Published online by Cambridge University Press:  21 June 2016

Elisabeth Meyer ,
Frank Schwab ,
Petra Gastmeier ,
Daniel Jonas ,
Henning Rueden  and
Franz D. Daschner
Elisabeth Meyer*
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiberg, Germany
Frank Schwab
Affiliation:
Institute of Hygiene and Environmental Medicine, University Hospital Benjamin Franklin, Free University of Berlin, and the Department of Hospital Epidemiology, University Hospital Charité, Humboldt University Berlin, Berlin, Germany
Petra Gastmeier
Affiliation:
Institute of Medical Microbiology and Hospital Epidemiology, Hannover School of Medicine, Hannover, Germany National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
Daniel Jonas
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiberg, Germany
Henning Rueden
Affiliation:
Institute of Hygiene and Environmental Medicine, University Hospital Benjamin Franklin, Free University of Berlin, and the Department of Hospital Epidemiology, University Hospital Charité, Humboldt University Berlin, Berlin, Germany National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
Franz D. Daschner
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Freiberg, Germany National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
*
Institute of Environmental Medicine and Hospital Epidemiology, Freiburg University Hospital, Hugstetter Str. 55, 79106 Freiburg, Germany (smeyer@iuk3.ukl.uni-freiburg.de)
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Abstract

Objectives.

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).

Methods.

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.

Results.

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.

Conclusion.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 2 , February 2006 , pp. 146 - 154
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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