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The incidence of MRSA infections in the United States: is a more comprehensive tracking system needed?

View Article: PubMed Central - PubMed

ABSTRACT

A review of epidemiological studies on the incidence of MRSA infections overtime was performed along with an analysis of data available for download from Hospital Compare (https://data.medicare.gov/data/hospital-compare). We found the estimations of the incidence of MRSA infections varied widely depending upon the type of population studied, the types of infections captured and in the definitions and terminology used to describe the results. We could not find definitive evidence that the incidence of MRSA infections in U.S. community or facilities is decreasing significantly. Of concern are recent data reported to the National Healthcare Safety Network (NHSN) on MRSA bloodstream infections which indicate that by the end of 2015 there had been little change in the average facility Standardized Infection Ratio (0.988), compared to a 2010–2011 baseline and is significantly increased compared to the previous year. This is in contradistinction to the recent Veterans Administration study which reported over an 80% reduction in MRSA infections. However, this discrepancy may be due to the inability to reconcile the baselines of the two data sets; and the observed increase may be artifactual due to aberrations in the NHSN tracking system. Our review supports the need for implementation of a comprehensive tracking and monitoring system involving all types of healthcare facilities for multi-drug resistant organisms, along with concomitant funding for both staff and infrastructure. Without such a system, determining the effectiveness of interventions such as antibiotic stewardship and chlorhexidine bathing will be hindered.

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Related in: MedlinePlus

MRSA infection which would not necessarily be reportable under the bloodstream or invasive infection metrics. Centers of Disease Control and Prevention photo archive (Photo credit: Gregory Moran, M.D)
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Fig1: MRSA infection which would not necessarily be reportable under the bloodstream or invasive infection metrics. Centers of Disease Control and Prevention photo archive (Photo credit: Gregory Moran, M.D)

Mentions: There are three major papers which summarized progressive results in adult patients from the EIP surveillance program which derives its data from nine metropolitan areas in the United States [2–4]. Since each paper encompasses and adds onto the data previously reported, we will focus our comments on the last report of Dantes, et al. [4]. These studies reported “invasive” MRSA infections as detected by laboratory-based case finding. An invasive infection was defined as a positive MRSA culture from a normally sterile site, such as blood, pleural fluid, peritoneal fluid, cerebral spinal fluid, or bone [2, 4, 5]. Eighty percent of invasive infections had positive blood cultures and only 22% were skin infections [4]. The overall in-hospital fatality rate was 13%. This definition mainly captures severe infections. The infection shown in Fig. 1 would not necessarily be reportable under the invasive infection metric. For data acquisition dates 2005–2011, Dantes, et al., reported a 27.7% decrease for healthcare-associated community-onset, 54.2% decrease in hospital-onset (culture taken greater than three days after admission), but only a 5.0% decrease in community associated infections.Fig. 1


The incidence of MRSA infections in the United States: is a more comprehensive tracking system needed?
MRSA infection which would not necessarily be reportable under the bloodstream or invasive infection metrics. Centers of Disease Control and Prevention photo archive (Photo credit: Gregory Moran, M.D)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5383958&req=5

Fig1: MRSA infection which would not necessarily be reportable under the bloodstream or invasive infection metrics. Centers of Disease Control and Prevention photo archive (Photo credit: Gregory Moran, M.D)
Mentions: There are three major papers which summarized progressive results in adult patients from the EIP surveillance program which derives its data from nine metropolitan areas in the United States [2–4]. Since each paper encompasses and adds onto the data previously reported, we will focus our comments on the last report of Dantes, et al. [4]. These studies reported “invasive” MRSA infections as detected by laboratory-based case finding. An invasive infection was defined as a positive MRSA culture from a normally sterile site, such as blood, pleural fluid, peritoneal fluid, cerebral spinal fluid, or bone [2, 4, 5]. Eighty percent of invasive infections had positive blood cultures and only 22% were skin infections [4]. The overall in-hospital fatality rate was 13%. This definition mainly captures severe infections. The infection shown in Fig. 1 would not necessarily be reportable under the invasive infection metric. For data acquisition dates 2005–2011, Dantes, et al., reported a 27.7% decrease for healthcare-associated community-onset, 54.2% decrease in hospital-onset (culture taken greater than three days after admission), but only a 5.0% decrease in community associated infections.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

A review of epidemiological studies on the incidence of MRSA infections overtime was performed along with an analysis of data available for download from Hospital Compare (https://data.medicare.gov/data/hospital-compare). We found the estimations of the incidence of MRSA infections varied widely depending upon the type of population studied, the types of infections captured and in the definitions and terminology used to describe the results. We could not find definitive evidence that the incidence of MRSA infections in U.S. community or facilities is decreasing significantly. Of concern are recent data reported to the National Healthcare Safety Network (NHSN) on MRSA bloodstream infections which indicate that by the end of 2015 there had been little change in the average facility Standardized Infection Ratio (0.988), compared to a 2010–2011 baseline and is significantly increased compared to the previous year. This is in contradistinction to the recent Veterans Administration study which reported over an 80% reduction in MRSA infections. However, this discrepancy may be due to the inability to reconcile the baselines of the two data sets; and the observed increase may be artifactual due to aberrations in the NHSN tracking system. Our review supports the need for implementation of a comprehensive tracking and monitoring system involving all types of healthcare facilities for multi-drug resistant organisms, along with concomitant funding for both staff and infrastructure. Without such a system, determining the effectiveness of interventions such as antibiotic stewardship and chlorhexidine bathing will be hindered.

No MeSH data available.


Related in: MedlinePlus