Hostname: page-component-77c89778f8-swr86 Total loading time: 0 Render date: 2024-07-17T07:05:51.002Z Has data issue: false hasContentIssue false
  • English
  • Français

Reduction of Methicillin-Resistant Staphylococcus aureus Infection among Veterans in Atlanta

Published online by Cambridge University Press:  02 January 2015

Edward Stenehjem ,
Cortney Stafford  and
David Rimland
Edward Stenehjem*
Affiliation:
Atlanta Veterans Affairs Medical Center, Decatur, Georgia Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
Cortney Stafford
Affiliation:
Atlanta Veterans Affairs Medical Center, Decatur, Georgia
David Rimland
Affiliation:
Atlanta Veterans Affairs Medical Center, Decatur, Georgia Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
*
5121 South Cottonwood Street, Gardner Women and Newborn Center, LL2, Murray, UT 84157 (eddie.stenehjem@imail.org)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Describe local changes in the incidence of community-onset and hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) infection and evaluate the impact of MRSA active surveillance on hospital-onset infection.

Design.

Observational study using prospectively collected data.

Setting.

Atlanta Veterans Affairs Medical Center (AVAMC).

Patients.

All patients seen at the AVAMC over an 8-year period with clinically and microbiologically proven MRSA infection.

Methods.

All clinical cultures positive for MRSA were prospectively identified, and corresponding clinical data were reviewed. MRSA infections were classified into standard clinical and epidemiologic categories. The Veterans Health Administration implemented the MRSA directive in October 2007, which required active surveillance cultures in acute care settings.

Results.

The incidence of community-onset MRSA infection peaked in 2007 at 5.45 MRSA infections per 1,000 veterans and decreased to 3.14 infections per 1,000 veterans in 2011 (P < .001 for trend). Clinical and epidemiologic categories of MRSA infections did not change throughout the study period. The prevalence of nasal MRSA colonization among veterans admitted to AVAMC decreased from 15.8% in 2007 to 11.2% in 2011 (P <.001 for trend). The rate of intensive care unit (ICU)-related hospital-onset MRSA infection decreased from October 2005 through March 2007, before the MRSA directive. Rates of ICU-related hospital-onset MRSA infection remained stable after the implementation of active surveillance cultures. No change was observed in rates of non-ICU-related hospital-onset MRSA infection.

Conclusions.

Our study of the AVAMC population over an 8-year period shows a consistent trend of reduction in the incidence of MRSA infection in both the community and healthcare settings. The etiology of this reduction is most likely multifactorial.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 1 , January 2013 , pp. 62 - 68
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. Jevons, MP, AW, Coe, Parker, MT. Methicillin resistance in staphylococci. Lancet 1963;1(7287):904–907.10.1016/S0140-6736(63)91687-8Google Scholar
2. Panlilio, AL, Culver, DH, Gaynes, RP, et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13(10):582–586.Google Scholar
3. Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389–391.10.1086/499367Google Scholar
4. Burton, DC, Edwards, JR, Horan, TC, Jernigan, JA, Fridkin, SK. Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA 2009;301(7):727–736.10.1001/jama.2009.153Google Scholar
5. Kallen, AJ, Mu, Y, Bulens, S, et al. Health care-associated invasive MRSA infections, 2005-2008. JAMA 2010;304(6):641–648.10.1001/jama.2010.1115Google Scholar
6. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus: Minnesota and North Dakota, 1997-1999. MMWR Morb Mortal Wkly Rep 1999;48(32): 707–710.Google Scholar
7. BC, Herold, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279(8): 593–598.Google Scholar
8. Johnson, JK, Khoie, T, Shurland, S, Kreisel, S, Stine, OC, Roghmann, MC. Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus USA300 clone. Emerg Infect Dis 2007;13(8):1195–1200.10.3201/eid1308.061575Google Scholar
9. McCaig, LF, McDonald, LC, Mandai, S, Jernigan, DB. Staphylococcus aureus-associated skin and soft tissue infections in ambulatory care. Emerg Infect Dis 2006;12(11):1715–1723.10.3201/eid1211.060190Google Scholar
10. David, MZ, Daum, RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010;23(3): 616–687.10.1128/CMR.00081-09Google Scholar
11. Talan, DA, Krishnadasan, A, Gorwitz, RJ, et al. Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008. Clin Infect Dis 2011;53(2):144–149.10.1093/cid/cir308Google Scholar
12. Miller, LG, Perdreau-Remington, F, Rieg, G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352(14): 1445–1453.10.1056/NEJMoa042683Google Scholar
13. Moellering, RC Jr, Abbott, GF, Ferraro, MJ. Case records of the Massachusetts General Hospital. Case 2-2011. A 30-year-old woman with shock after treatment of a furuncle. N Engl J Med 2011;364(3):266–275.10.1056/NEJMcpc1003886Google Scholar
14. Hota, B, Ellenbogen, C, Hayden, MK, Aroutcheva, A, Rice, TW, Weinstein, RA. Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med 2007;167(10):1026–1033.10.1001/archinte.167.10.1026Google Scholar
15. Hota, B, Lyles, R, Rim, J, et al. Predictors of clinical virulence in community-onset methicillin-resistant Staphylococcus aureus infections: the importance of USA300 and pneumonia. Clin Infect Dis 2011;53(8):757–765.10.1093/cid/cir472Google Scholar
16. Tracy, LA, Furano, JP, Harris, AD, Singer, M, Langenberg, P, Roghmann, MC. Staphylococcus aureus infections in US veterans, Maryland, USA, 1999-2008. Emerg Infect Dis 2011;17(3): 441–448.10.3201/eid1707.100502Google Scholar
17. 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(5):309–332.10.1016/j.ajic.2008.03.002Google Scholar
18. Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):1763–1771.10.1001/jama.298.15.1763Google Scholar
19. Landrum, ML, Neumann, C, Cook, C, et al. Epidemiology of Staphylococcus aureus blood and skin and soft tissue infections in the US military health system, 2005-2010. JAMA 2012;308(1): 50–59.10.1001/jama.2012.7139Google Scholar
20. Caffrey, AR, Laplante, KL. Changing epidemiology of methicillin-resistant Staphylococcus aureus in the Veterans Affairs Healthcare System, 2002-2009. Infection 2012;40(3):291–297.10.1007/s15010-011-0232-3Google Scholar
21. Schaefer, MK, Ellingson, K, Conover, C, et al. Evaluation of international classification of diseases, ninth revision, clinical modification codes for reporting methicillin-resistant Staphylococcus aureus infections at a hospital in Illinois. Infect Control Hosp Epidemiol 2010;31(5):463–468.10.1086/651665Google Scholar
22. Tracy, LA, Furano, JP, Harris, AD, Singer, M, Langenberg, P, Roghmann, MC. Predictive ability of positive clinical culture results and international classification of diseases, ninth revision, to identify and classify noninvasive Staphylococcus aureus infections: a validation study. Infect Control Hosp Epidemiol 2010; 31(7):694–700.10.1086/653206Google Scholar
23. Miller, LG, Diep, BA. Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46(5):752–760.10.1086/526773Google Scholar
24. Begier, EM, Frenette, K, Barrett, NL, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39(10): 1446–1453.10.1086/425313Google Scholar
25. Kazakova, SV, Hageman, JC, Matava, M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005;352(5):468–475.10.1056/NEJMoa042859Google Scholar
26. 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(5):362–386.10.1086/502213Google Scholar
27. Weber, SG, Huang, SS, Oriola, S, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2007;28(3):249–260.10.1086/512261Google Scholar
28. McGinigle, KL, Gourlay, ML, Buchanan, IB. The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus-rehled morbidity, mortality, and costs: a systematic review. Clin Infect Dis 2008; 46(11):1717–1725.Google Scholar
29. Huskins, WC, Huckabee, CM, O'Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364(15):1407–1418.Google Scholar
30. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364(15):1419–1430.10.1056/NEJMoa1007474Google Scholar
31. Gurieva, T, Bootsma, MC, Bonten, MJ. Successful Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections revisited. Clin Infect Dis 2012;54(11):1618–1620.10.1093/cid/cis272Google Scholar
32. Hudson, LO, Murphy, CR, Spratt, BG, et al. Differences in methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from pediatric and adult patients from hospitals in a large California county. J Clin Microbiol 2012;50(3):573–579.10.1128/JCM.05336-11Google Scholar
33. Liu, C, Graber, CJ, Karr, M, et al. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-2005. Clin Infect Dis 2008;46(11):1637–1646.10.1086/587893Google Scholar
34. Laupland, KB, Church, DL, Mucenski, M, Sutherland, LR, Davies, HD. Population-based study of the epidemiology of and the risk factors for invasive Staphylococcus aureus infections. J Infect Dis 2003;187(9):1452–1459.Google Scholar