Skip to main content Accessibility help

Successful Control of Widespread Methicillin-Resistant Staphylococcus aureus Colonization and Infection in a Large Teaching Hospital in The Netherlands

  • M. J. C. A. van Trijp (a1) (a2), D. C. Melles (a2), W. D. H. Hendriks (a1), G. A. Parlevliet (a2), M. Gommans (a1) and A. Ott (a2) (a3)...



The low prevalence of infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) in The Netherlands is ascribed to a national “search-and-destroy” policy. We describe the measures that were implemented to control widespread MRSA colonization and infection in a Dutch hospital.


Descriptive intervention study.


Teaching medical center with a capacity of 679 beds, including 16 intensive care beds.


MRSA colonization and infection were identified using conventional culture with a selective broth. Isolates were typed using pulsed-field gel electrophoresis. Measures to control the epidemic included screening of contacts (patients and hospital staff), screening of patients at readmission or discharge, strict isolation of MRSA-positive patients, decolonization of colonized staff and patients, the development of an electronic signal identifying MRSA-positive patients, and the development of a culture information-system for hospital personnel.


Awareness of uncontrolled dissemination of MRSA began in November 2001. Because the clone involved had a low minimum inhibitory concentration for oxacillin, at first it was not recognized as MRSA. In February 2002, when major screening efforts started, it appeared that MRSA had spread all over the hospital and that many staff members were colonized. By the end of December 2005, a total of 600 patients and 135 staff members were found to be newly colonized. The yearly incidence of cases of MRSA colonization and infection decreased from 351 in 2002 to 56 in 2005. Typing of the isolates showed that 3 MRSA clones were predominant. Outbreaks of colonization involving these clones did not occur after 2003.


Our observations show that strict application of “search-and-destroy” measures can effectively control a huge epidemic of MRSA colonization and infection.


Corresponding author

Medical Center Rijnmond-Zuid, Laboratory of Medical Microbiology, Olympiaweg 350, 3078 HT Rotterdam, The Netherlands (


Hide All
1. European Antimicrobial Resistance Surveillance System (EARSS) Annual Report. EARSS-2003. Bilthoven, The Netherlands: the National Institute for Public Health and the Environment (RIVM); 2004.
2. Boyce, JM, Cookson, B, Christiansen, K, et al. Methicillin-resistant Staphylococcus aureus . Lancet Infect Dis 2005;5:653663.
3. 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.
4. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003;31:481498.
5. 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;42:389391.
6. Goossens, H, Ferech, M, Vander, SR, Elseviers, M. Outpatient antibiotic use in Europe and association with resistance: a cross-national database study. Lancet 2005;365:579587.
7. Dutch Working Party on Infection Prevention (STWIP). Policy for methicillin-resistant Staphylococcus aureus. Guideline 35A. 1994. Available at: Accessed November 23, 2006.
8. Verhoef, I, Beaujean, D, Blok, H, et al. A Dutch approach to methicillin-resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1999;18:461466.
9. Cepeda, JA, Whitehouse, T, Cooper, B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005;365:295304.
10. Farr, BM. What to think if the results of the National Institutes of Health randomized trial of methicillin-resistant Staphylococcus aureus and van-comycin-resistant Enterococcus control measures are negative (and other advice to young epidemiologists): a review and an au revoir. Infect Control Hosp Epidemiol 2006;27:10961106.
11. Bootsma, MC, Diekmann, O, Bonten, MJ. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci USA 2006;103:56205625.
12. Wertheim, H, Verbrugh, HA, van Pelt, C, de Man, P, van Belkum, A, Vos, MC. Improved detection of methicillin-resistant Staphylococcus aureus using phenyl mannitol broth containing aztreonam and ceftizoxime. J Clin Microbiol 2001;39:26602662.
13. National Committee on Clinical and Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing: 12th Informational Supplement. Wayne, PA: NCCLS; 2002:M100-S12.
14. Tenover, FC, Arbeit, R, Archer, G, et al. Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus . I Clin Microbiol 1994;32:407415.
15. Wannet, WJ, Spalburg, E, Heck, ME, Pluister, GN, Willems, RJ, de Neeling, AJ. Widespread dissemination in The Netherlands of the epidemic Berlin methicillin-resistant Staphylococcus aureus clone with low-level resistance to oxacillin. J Clin Microbiol 2004;42:30773082.
16. Lessing, MP, Jordens, JZ, Bowler, IC. Molecular epidemiology of a multiple strain outbreak of methicillin-resistant Staphylococcus aureus amongst patients and staff. J Hosp Infect 1995;31:253260.
17. Saiman, L, Cronquist, A, Wu, F, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317321.
18. 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;43:971978.
19. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309317.
20. de long, B, Verbrugh, HA. Ramp in het ziekenhuis. Med Contact 2003;15.
21. Vriens, M, Blok, H, Fluit, A, Troelstra, A, Van Der, WC, Verhoef, J. Costs associated with a strict policy to eradicate methicillin-resistant Staphylococcus aureus in a Dutch University Medical Center: a 10-year survey. Eur J Clin Microbiol Infect Dis 2002;21:782786.

Successful Control of Widespread Methicillin-Resistant Staphylococcus aureus Colonization and Infection in a Large Teaching Hospital in The Netherlands

  • M. J. C. A. van Trijp (a1) (a2), D. C. Melles (a2), W. D. H. Hendriks (a1), G. A. Parlevliet (a2), M. Gommans (a1) and A. Ott (a2) (a3)...


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