Skip to main content

Active Surveillance for Methicillin-Resistant Staphylococcus aureus(MRSA) Decreases the Incidence of MRSA Bacteremia

  • Pnina Shitrit (a1), Bat-Sheva Gottesman (a1), Michal Katzir (a1), Avi Kilman (a2), Yona Ben-Nissan (a2) and Michal Chowers (a1) (a3)...

To evaluate the influence of performance of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) on the incidence of nosocomial MRSA bacteremia in an endemic hospital.


Before-after trial.


A 700-bed hospital.


All patients admitted to the hospital who were at high risk for MRSA bacteremia.


Performance of surveillance cultures for detection of MRSA were recommended for all patients at high risk, and contact isolation was implemented for patients with positive results of culture. Each MRSA-positive patient received one course of eradication treatment. We compared the total number of surveillance cultures, the percentage of surveillance cultures with positive results, and the number of MRSA bacteremia cases before the intervention (from January 2002 through February 2003) after the start of the intervention (from July 2003 through October 2004).


The number of surveillance cultures performed increased from a mean of 272.57 cultures/month before the intervention to 865.83 cultures/month after the intervention. The percentage of surveillance cultures with positive results increased from 3.13% before to 5.22% after the intervention (P<.001). The mean number of MRSA bacteremia cases per month decreased from 3.6 cases before the intervention to 1.8 cases after the intervention (P< 0.001).


Active surveillance culture is important for identifying hidden reservoirs of MRSA. Contact isolation can prevent new colonization and infection and lead to a significant reduction of morbidity and healthcare costs.

Corresponding author
Infectious Diseases Unit, Meir Medical Center, 59 Tsharnichovski, Kfar Saba, Israel 44281, (chowersm@post.
Hide All
1. Engemann JJ, Carmeli Y, Cosgrove SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003; 36:592598.
2. Merrer J, Santoli F, Appere de Vecchi C, Tran B, De Jonghe B, Outin H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000; 21:718723.
3. Davis KA, Stewart JJ, Crouch HK, Florez CE, Hospenthal DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004; 39:776782.
4. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001; 344:1116.
5. Corbella X, Dominguez MA, Pujol M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997; 16:351357.
6. Pujol M, Pena C, Pallares R, et al. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996; 100:509516.
7. Wertheim HF, Vos MC, Ott A, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004; 364:703705.
8. Garner JS, Simmons BP. Guideline for isolation precautions in hospitals. Infect Control 1983; 4:245325.
9. Panlilio AL, Culver DH, Gaynes RP, et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992; 13:582586.
10. Marshall C, Wesselingh S, McDonald M, Spelman D. Control of endemic MRSA-what is the evidence? A personal view. J Hosp Infect 2004; 56:253268.
11. Cooper BS, Stone SP, Kibbler CC, et al. Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature. BMJ 2004; 329:533.
12. LeDell K, Muto CA, Jarvis WR, Farr BM. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003; 24:639641.
13. National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Test for Bacteria That Grow Aerobically. 5th ed. Villanova, PA: NCCLS; 2000. Approved standard M7-A5.
14. Girou E, Azar J, Wolkenstein P, Cizeau F, Brun-Buisson C, Roujeau JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 2000; 21:583587.
15. Papia G, Louie M, Tralla A, Johnson C, Collins V and Simor AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999; 20:473477.
16. Rubinovitch B, Pittet D. Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned? J Hosp Infect 2001;47:918.
17. Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003; 36:281285.
18. Pan A, Carnevale G, Catenazzi P, et al. Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA “search and isolate” strategy in a hospital in Italy with hyperendemic MRSA. Infect Control Hosp Epidemiol 2005; 26:127133.
19. Crossley K. Long-term care facilities as sources of antibiotic-resistant nosocomial pathogens. Curr Opin Infect Dis 2001; 14:455459.
20. McNeil SA, Mody L, Bradley SF. Methicillin-resistant Staphylococcus aureus: management of asymptomatic colonization and outbreaks of infection in long-term care. Geriatrics 2002; 57:16-18,21-24,27.
21. Lucet JC, Grenet K, Armand-Lefevre L, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005; 26:121126.
22. Kotilainen P, Routamaa M, Peltonen R, et al. Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001; 161:859863.
23. Kotilainen P, Routamaa M, Peltonen R, et al. Elimination of epidemic methicillin-resistant Staphylococcus aureus from a university hospital and district institutions, Finland. Emerg Infect Dis 2003; 9:169175.
24. Tomic V, Svetina Sorli P, Trinkaus D, Sorli J, Widmer AF, Trampuz A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004; 164:20382043.
25. Verhoef J, Beaujean D, Blok H, et al. A Dutch approach to methicillin-resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1999; 18:461466.
26. Vriens M, Blok H, Fluit A, Troelstra A, Van Der Werken C, 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.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 2 *
Loading metrics...

Abstract views

Total abstract views: 147 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th February 2018. This data will be updated every 24 hours.