Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-23T07:49:06.573Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence of Colonization and Infection with Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus and of Clostridium difficile Infection in Canadian Hospitals

Published online by Cambridge University Press:  02 January 2015

Andrew E. Simor ,
Victoria Williams ,
Allison McGeer ,
Janet Raboud ,
Oscar Larios ,
Karl Weiss ,
Zahir Hirji ,
Felicia Laing ,
Christine Moore  and
Denise Gravel
...Show all authors
Andrew E. Simor*
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada University of Toronto, Toronto, Ontario, Canada
Victoria Williams
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Allison McGeer
Affiliation:
University of Toronto, Toronto, Ontario, Canada Mount Sinai Hospital, Toronto, Ontario, Canada
Janet Raboud
Affiliation:
University of Toronto, Toronto, Ontario, Canada University Health Network, Toronto, Ontario, Canada
Oscar Larios
Affiliation:
University of Saskatchewan and Saskatoon Health Region, Saskatoon, Saskatchewan, Canada
Karl Weiss
Affiliation:
Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
Zahir Hirji
Affiliation:
Bridgepoint Health, Toronto, Ontario, Canada
Felicia Laing
Affiliation:
Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
Christine Moore
Affiliation:
Mount Sinai Hospital, Toronto, Ontario, Canada
Denise Gravel
Affiliation:
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
*
Department of Microbiology, Sunnybrook Health Sciences Centre, B103-2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada (andrew.simor@sunnybrook.ca).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile infection (CDI) in Canadian hospitals.

Design.

National point prevalence survey in November 2010.

Setting.

Canadian acute care hospitals with at least 50 beds.

Patients.

Adult inpatients colonized or infected with MRSA or VRE or with CDI.

Methods.

The prevalence (per 100 inpatients) of MRSA, VRE, and CDI was determined. Associations between prevalence and institutional characteristics and infection control policies were evaluated.

Results.

One hundred seventy-six hospitals (65% of those eligible) participated. The median (range) prevalence rates for MRSA and VRE colonization or infection and CDI were 4.2% (0%–22.1%), 0.5% (0%–13.1%), and 0.9% (0%–8.6%), respectively. Median MRSA and VRE infection rates were low (0.3% and 0%, respectively). MRSA, VRE, and CDI were thought to have been healthcare associated in 79%, 96%, and 84% of cases, respectively. In multivariable analysis, routine use of a private room for colonized/infected patients was associated with lower median MRSA infection rate (prevalence ratio [PR], 0.44 [95% confidence interval (CI), 0.22–0.88]) and VRE prevalence (PR, 0.26 [95% CI, 0.12–0.57]). Lower VRE rates were also associated with enhanced environmental cleaning (PR, 0.52 [95% CI, 0.36–0.75]). Higher bed occupancy rates were associated with higher rates of CDI (PR, 1.02 [95% CI, 1.01–1.03]).

Conclusions.

These data provide the first national prevalence estimates for MRSA, VRE, and CDI in Canadian hospitals. Certain infection prevention and control policies were found to be associated with prevalence and deserve further investigation.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 7 , July 2013 , pp. 687 - 693
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Simor, AE, Gilbert, NL, Gravel, D, et al. Methicillin-resistant Staphylococcus aureus colonization or infection in Canada: national surveillance and changing epidemiology, 1995-2007. Infect Control Hosp Epidemiol 2010;31:348–356.CrossRefGoogle ScholarPubMed
2.Ofner-Agostini, M, Johnston, BL, Simor, AE, et al. Vancomycin-resistant enterococci in Canada: Results from the Canadian Nosocomial Infection Surveillance Program, 1999-2005. Infect Control Hosp Epidemiol 2008;29:271–274.Google Scholar
3.Gravel, D, Miller, M, Simor, A, et al. Health care-associated Clostridium difficile infection in adults admitted to acute care hospitals in Canada: a Canadian Nosocomial Infection Surveillance Program study. Clin Infect Dis 2009;48:568–576.Google Scholar
4.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
5.Llata, E, Gaynes, RP, Fridkin, S. Measuring the scope and magnitude of hospital-associated infection in the United States: the value of prevalence surveys. Clin Infect Dis 2009;48:1434–1440.Google Scholar
6.French Prevalence Survey Study Group. Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. J Hosp Infect 2000;46:186–193.Google Scholar
7.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
8.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.Google Scholar
9.Arnold, MS, Dempsey, JM, Fishman, M, McAuley, PJ, Tibert, C, Vallande, NC. The best hospital practices for controlling meth-icillin-resistant Staphylococcus aureus: on the cutting edge. Infect Control Hosp Epidemiol 2002;23:69–76.CrossRefGoogle Scholar
10.Gravel, D, Gardam, M, Taylor, G, et al. Infection control practices related to Clostridium difficile infection in acute care hospitals in Canada. Am J Infect Control 2009;37:9–14.Google Scholar
11.Dulon, M, Haamann, F, Peters, C, Schablon, A, Nienhaus, A. MRSA prevalence in European healthcare settings: a review. BMC Infect Dis 2011;11:138.CrossRefGoogle ScholarPubMed
12.Jarvis, WR, Schlosser, J, Chinn, RY, Tweeten, S, Jackson, M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control 2007;35:631–637.Google Scholar
13.Jarvis, WR, Jarvis, AA, Chinn, RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012;40: 194–200.CrossRefGoogle ScholarPubMed
14.Ostrowsky, BE, Venkataraman, L, D'Agata, EM, Gold, HS, De-Girolami, PC, Samore, MH. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med 1999;159:1467–1472.Google Scholar
15.Warren, DK, Kollef, MH, Seiler, SM, Fridkin, SK, Fraser, VJ. The epidemiology of vancomycin-resistant Enterococcus colonization in a medical intensive care unit. Infect Control Hosp Epidemiol 2003;24:257–263.Google Scholar
16.Calderwood, MS, Mauer, A, Tolentino, J, et al. Epidemiology of vancomycin-resistant enterococci among patients on an adult stem cell transplant unit: observations from an active surveillance program. Infect Control Hosp Epidemiol 2008:29:1019–1025.Google Scholar
17.Gerding, DN. Global epidemiology of Clostridium difficile infection in 2010. Infect Control Hosp Epidemiol 2010;31(suppl 1): S32–S34.Google Scholar
18.Bauer, MP, Notermans, DW, van Benthem, BHB, et al. Clostridium difficile infection in Europe: a hospital-based survey. Lancet 2011;377:63–73.Google Scholar
19.Health Protection Agency. Annual Counts and Rates of C. difficile. London: Health Protection Agency, 2007. http://www.hpa.org.uk.Google Scholar
20.Jarvis, WR, Schlosser, J, Jarvis, AA, Chinn, RY. National point-prevalence of Clostridium difficile in US health care facility inpatients, 2008. Am J Infect Control 2009;37:263–270.Google Scholar
21.Clements, A, Halton, K, Graves, N, et al. Overcrowding and un-derstaffing in modern health-care systems: key determinants in meticillin-resistant Staphylococcus aureus transmission. Lancet Infect Dis 2008;8:427–434.Google Scholar
22.Borg, MA, Cookson, BD, Rasslan, O, et al. Correlation between meticillin-resistant Staphylococcus aureus prevalence and infection control initiatives within southern and eastern Mediterranean hospitals. J Hosp Infect 2009;71:36–42.Google Scholar
23.Kaier, K, Luft, D, Dettenkoffer, M, Kist, M, Frank, U. Correlations between bed occupancy rates and Clostridium difficile infections: a time-series analysis. Epidemiol Infect 2011;139:482–485.Google Scholar
24.Gurieva, T, Bootsma, MCJ, Bonten, MJM. Successful Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections revisited. Clin Infect Dis 2012;54:1618–1620.Google Scholar
25.Grammatico-Gaillon, L, Thiolet, J-M, Bernillon, P, Coignard, B, Khoshnood, B, Desenclos, J-C. Relationship between the prevalence of methicillin-resistant Staphylococcus aureus infection and indicators of nosocomial infection control measures: a population-based study in French hospitals. Infect Control Hosp Epidemiol 2009;30:861–869.Google Scholar
26.MacKenzie, FM, Bruce, J, Streulens, MJ, et al. Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals. Clin Microbiol Infect 2007;13:269–276.Google Scholar
27.Hansen, S, Schwab, F, Asensio, A, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken? Infection 2010;38:159–164.Google Scholar
28.Bracco, D, Dubois, M-J, Bouali, R, Eggimann, P. Single rooms may help to prevent nosocomial bloodstream infection and cross-transmission of methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2007;33:836–840.Google Scholar
29.Cooper, BS, Stone, SP, Kibbler, CC, et al. Isolation measures in the hospital management of methicillin-resistant Staphylococcus aureus (MRSA): a systematic review of the literature. BMJ 2004;329:533–537.Google Scholar
30.Cookson, BD, Macrae, MB, Barrett, SP, et al. Guidelines for the control of glycopeptide-resistant enterococci in hospitals. J Hosp Infect 2006;62:6–21.Google Scholar
31.Batra, R, Cooper, BS, Whiteley, C, Patel, AK, Wyncoll, D, Edge-worth, JD. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010;50:210–217.Google Scholar
32.Bonten, MJM, Hayden, MK, Nathan, C, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615–1619.CrossRefGoogle ScholarPubMed
33.Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46:678–85.Google Scholar
34.Robicsek, A, Beaumont, JL, Peterson, LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2009:910–913.Google Scholar