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Are There Regional Variations in the Diagnosis, Surveillance, and Control of Methicillin-Resistant Staphylococcus aureus?

  • Hervé M. Richet (a1), Mohamed Benbachir (a2), Derek F. J. Brown (a3), Helen Giamarellou (a4), Ian Gould (a5), Marija Gubina (a6), Piotr Heczko (a7), Smilja Kalenic (a8), Marina Pana (a9), Didier Pittet (a10), Saida Ben Redjeb (a11), Jiri Schindler (a12), Carlos Starling (a13), Marc J. Struelens (a14), Wolfgang Witte (a15), William R. Jarvis (a1) and International Network for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR)...



To assess the way healthcare facilities (HCFs) diagnose, survey, and control methicillin-resistant Staphylococcus aureus (MRSA).




Ninety HCFs in 30 countries.


Evaluation of susceptibility testing methods showed that 8 laboratories (9%) used oxacillin disks with antimicrobial content different from the one recommended, 12 (13%) did not determine MRSA susceptibility to vancomycin, and 4 (4.5%) reported instances of isolation of vancomycin-resistant S. aureus but neither confirmed this resistance nor alerted public health authorities. A MRSA control program was reported by 55 (61.1%) of the HCFs. The following isolation precautions were routinely used: hospitalization in a private room (34.4%), wearing of gloves (62.2%), wearing of gowns (44.4%), hand washing by healthcare workers (53.3%), use of an isolation sign on the patient's door (43%), or all four. When the characteristics of HCFs with low incidence rates (< 0.4 per 1,000 patient-days) were compared with those of HCFs with high incidence rates (P = 0.4 per 1,000 patient-days), having a higher mean number of beds per infection control nurse was the only factor significantly associated with HCFs with high incidence rates (834 vs 318 beds; P = .02).


Our results emphasize the urgent need to strengthen the microbiologic and epidemiologic capacities of HCFs worldwide to prevent MRSA transmission and to prepare them to address the possible emergence of vancomycin-resistant S. aureus.


Corresponding author

Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Institut de Biologie des Hôpitaux de Nantes, 9, quai Moncousu, BP 1005, 44093 Nantes cedex 01, France


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1.Go, ES, Urban, C, Burns, J, et al.Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:13291332.
2.Richard, P, Le Floch, R, Chamoux, C, Pannier, M, Espaze, E, Richet, H. Pseudomonas aeruginosa outbreak in a burn unit: role of antimicrobials in the emergence of multiply resistant strains. J Infect Dis 1994;170:377383.
3.French, GL, Shannon, KP, Simmons, N. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and β-lactam-β-lactamase inhibitor combinations by hyperproduction of SHV5 β-lactamase. J Clin Microbiol 1996;34:358363.
4.Neuwirth, C, Siebor, E, Pechinot, A, Kazmierczak, A. Outbreak of TEM-24-producing Enterobacter aerogenes in an intensive care unit and dissemination of the extended spectrum β-lactamase to other members of the family enterobacteriaceae. J Clin Microbiol 1996;34:7679.
5.Morosini, MI, Canton, R, Martinez-Beltran, J, et al.New extended-spectrum TEM-type β-lactamase from Salmonella enterica isolated in a nosocomial outbreak. Antimicrob Agents Chemother 1995;39:458461.
6.Pagani, L, Luzzaro, F, Ronza, P, et al.Outbreak of extended spectrum β-lactamase producing Serratia marcescens in an intensive care unit. FEMS Immunol Med Microbiol 1994;10:3946.
7.Johnson, DR, Love-Dixon, MA, Brown, WJ, Levine, DP, Downes, FP, Hall, WN. Delayed detection of an increase in resistant Acinetobacter bau-mannii at a Detroit hospital. Infect Control Hosp Epidemiol 1992;13:394398.
8.Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353358.
9.Trick, WE, Kuehnert, MJ, Quirk, SB, et al.Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients. J Infect Dis 1999;180:391396.
10.Austin, DJ, Anderson, RM. Transmission dynamics of epidemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in England and Wales. J Infect Dis 1999;179:883891.
11.Kim, WJ, Weinstein, RA, Hayden, MJ. The changing molecular epidemiology and establishment of endemicity of vancomycin resistance in enterococci at one hospital over a 6-year period. J Infect Dis 1999;179:163171.
12.Michel, M, Gutmann, L. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: therapeutic realities and possibilities. Lancet 1997;349:19011906.
13.Smith, TL, Pearson, ML, Wilcox, KR, et al.Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-intermediate Staphylococcus aureus working group. N Engl J Med 1999;340:493501.
14.Barber, M. Methicillin-resistant staphylococci. J Clin Pathol 1961;14:385393.
15.Chabbert, YA, Baudens, JG. Souches de staphylocoques resistants naturellement a la meticilline et a la 5 methyl-3-phenyl-4-iso-oxazyl penicilline (P12). Annales de l'Institut Pasteur (Paris) 1962:103:222230.
16.Richet, H, Wiesel, M, Le Gallou, F, Andre-Richet, B, Espaze, E. Methicillin-resistant Staphylococcus aureus control in hospitals: the French experience. Infect Control Hosp Epidemiol 1996;17:509511.
17.Farrington, M, Redpath, C, Trundle, C, Coomber, S, Brown, NM. Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infections at a teaching hospital. QJM 1998;91:539548.
18.Hiramatsu, K, Aritaka, N, Hanaki, H, et al.Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997;350:16701673.
19.Ploy, MC, Grelaud, C, Martin, C, de Lumley, L, Denis, F. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French Hospital. Lancet 1998;351:1212.
20.Maguire, GRArthur, AD, Boustead, PJ, Dwyer, B, Currie, BJ. Clinical experience and outcomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital. J Hosp Infect 1998;38:273281.
21.Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus: Minnesota and North Dakota, 1997-1999. MMWR 1999;48:707710.
22.L'Heriteau, F, Lucet, JC, Scanvic, A, Bouvet, E. Community-acquired methicillin-resistant Staphylococcus aureus and familial transmission. JAMA 1999;282:10381039.
23.Shahin, R, Johnson, IL, Jamieson, F, McGeer, A, Tolkin, J, Ford-Jones, EL. Methicillin-resistant Staphylococcus aureus carriage in a child care center following a case of disease: Toronto Child Care Study Group. Arch Pediatr Adolesc Med 1999;153:864868.
24.Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C.Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:17451751.
25.Schentag, JJ, Hyatt, JM, Carr, JR, et al.Genesis of methicillin-resistant Staphylococcus aureus (MRSA): how treatment of MRSA infections has selected for vancomycin-resistant Enterococcus faecium and the importance of antibiotic management and infection control. Clin Infect Dis 1998;26:12041214.
26.Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496504.
27.Barrett, SP, Mummery, RV, Chattopadhyay, B. Trying to control MRSA causes more problems than it solves. J Hosp Infect 1998;39:8593.
28.Fazal, BATelzak, EE, Blum, S, Turett, GS, Ptersen-Fitzpatrick, FE, Lorian, V. Trends in the prevalence of methicillin-resistant Staphylococcus aureus associated with discontinuation of an isolation policy. Infect Control Hosp Epidemiol 1996;17:372374.
29.Harbarth, S, Martin, Y, Rohner, P, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2000;46:4349.
30.Garner, IS. Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:5380.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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