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Cross sectional study
Rates of hospital-acquired and healthcare-associated MRSA declined in the USA between 2005 and 2008
  1. Janis R Guilbeau
  1. University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, Department of Nursing, Lafayette, Louisiana, USA
  1. Correspondence to Janis R Guilbeau
    DNP, FNP-BC, Assistant Professor, University of Louisiana at Lafayette, College of Nursing and Allied Health Professions, P.O. Box 43810 Lafayette, LA 70505, USA; jrguilbeau85{at}louisiana.edu

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Purpose

The prevention of infections is an important safety priority in healthcare and the communityand in particular, the drug-resistant pathogens are of major concern. To date, hospital infections are a huge burden to society, and methicillin-resistant Staphylococcus aureus (MRSA) infections are a major focus of healthcare providers. As MRSA is a known pathogen of public importance, there is interest in determining whether there is change in incidence rates in patient populations. There is an estimated 1.7 million healthcare-associated infections that are associated with nearly 99 000 deaths in US hospitals.1 Healthcare-associated infections in general, and MRSA in particular, continue to burden patients and society, and prevention of infection has been a priority of healthcare providers. Data on invasive MRSA infections were collected from participating Centers for Disease Control and Prevention (CDC) Emerging Infections Program/Active Bacterial Core surveillance (ABCs) system that receive laboratory reports on invasive MRSA in nine geographically diverse areas. The goal of the study was to describe changes in rates of invasive healthcare-associated MRSA infections from 2005 through 2008 among residents of diverse metropolitan areas.

Study details

The purpose of the 4-year surveillance study was to examine rates of invasive healthcare-associated MRSA infections from 2005 through 2008 in nine metropolitan areas. Study investigators from the US CDC used data from the ABCs MRSA to determine infection rates covering a population of approximately 15 million persons.

Results of the surveillance

The researchers reported 21 503 cases of invasive MRSA infections from the Emerging Infections Program/ABCs sites. Of the total, 17 508 were healthcare associated and 15 458 were MRSA blood stream infections (BSIs). The findings included an incidence rate of hospital-onset invasive MRSA infections was 1.02 per 10 000 population in 2005 and decreased 9.4% per year (95% CI 14.7% to 3.8%, p=0.005); incidence of healthcare-associated community-onset infections was 2.20 per 10 000 population in 2005 and decreased 5.7% per year (95% CI 9.7% to 1.6%, p=0.01). A significant decrease was noted for the subset of infections with BSIs (hospital onset −11.2%, 95% CI −15.9% to −6.3%; healthcare-associated community onset −6.6%, 95% CI −9.5% to −3.7%). In summary, there was a reduction in hospital-onset MRSA as well as community infections.

Conclusions

The authors concluded that rates of invasive healthcare-associated MRSA infections decreased among patient with healthcare-associated infections that began in the community and also decreased among those with hospital-onset invasive disease. This study utilised data from over a 4-year period from 2005 through 2008 in nine diverse metropolitan areas.

Previous work

The results of this study are congruent with earlier studies suggesting a decrease in MRSA infections in some areas. Researchers in UK reported significant decreases in MRSA BSIs following a government mandate.2 3 Also, there is evidence that MRSA BSIs in intensive care units are decreasing.4

Critique of methods

The analysis for this study was based on cases of invasive MRSA infections reported from surveillance of cases identified from microbiology reports in laboratories in nine metropolitan areas. This study by the CDC was conducted with a large diverse group of patients which was approximately 15 million persons in 2008, and the outcome measures were appropriate for this study.

Implications

The rates of invasive healthcare-associated MRSA infections and healthcare-associated infections that began in the community decreased; there was also a decrease among those with hospital-onset invasive disease. The prevalence of MRSA has increased healthcare provider and public awareness of the burden. The awareness and prevention practice of healthcare providers and the public may have contributed to the reduction of hospital infections and had an impact on nursing practice and patient populations.

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Footnotes

  • Competing interests None.

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