Skip to main content

Increasing Burden of Methicillin-Resistant Staphylococcus aureus Hospitalizations at US Academic Medical Centers, 2003–2008

  • Michael Z. David (a1), Sofia Medvedev (a2), Samuel F. Hohmann (a2), Bernard Ewigman (a1) and Robert S. Daum (a1)...

The incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States decreased during 2005–2008, but noninvasive community-associated MRSA (CA-MRSA) infections also frequently lead to hospitalization. We estimated the incidence of all MRSA infections among inpatients at US academic medical centers (AMCs) per 1,000 admissions during 2003–2008.


Retrospective cohort study.

Setting and Participants.

Hospitalized patients at 90% of nonprofit US AMCs during 2003–2008.


Administrative data on MRSA infections from a hospital discharge database (University HealthSystem Consortium [UHC]) were adjusted for underreporting of the MRSA V09.0 International Classification of Diseases, Ninth Revision, Clinical Modification code and validated using chart reviews for patients with known MRSA infections in 2004–2005, 2006, and 2007.


The mean sensitivity of administrative data for MRSA infections at the University of Chicago Medical Center in three 12-month periods during 2004–2007 was 59.1%. On the basis of estimates of billing data sensitivity from the literature and the University of Chicago Medical Center, the number of MRSA infections per 1,000 hospital discharges at US AMCs increased from 20.9 (range, 11.1–47.7) in 2003 to 41.7 (range, 21.9–94.0) in 2008. At the University of Chicago Medical Center, among infections cultured more than 3 days prior to hospital discharge, CA-MRSA infections were more likely to be captured in the UHC billing-derived data than were healthcare-associated MRSA infections.


The number of hospital admissions for any MRSA infection per 1,000 hospital admissions overall increased during 2003–2008. Use of unadjusted administrative hospital discharge data or surveillance for invasive disease far underestimates the number of MRSA infections among hospitalized patients.

Corresponding author
Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC6054, Chicago, IL 60637 (
Hide All
1.Lowy, FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520532.
2.Jevons, MP“Celbenin”-resistant Staphylococci. BMJ 1961;1:124125.
3.Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.
4.Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:29762984.
5.David, MZ, Glikman, D, Crawford, SE, et al. What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 2008;197:12351243.
6.Seybold, U, Kourbatova, EV, Johnson, JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42:647656.
7.Popovich, KJ, Weinstein, RA, Hota, B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial strains? Clin Infect Dis 2008;46:787794.
8.Chua, T, Moore, CL, Perri, MB, et al. Molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates in Detroit. J Clin Microbiol 2008;46:23452352.
9.David, MZ, Daum, RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010;23:616687.
10.Maree, CM, Daum, RS, Boyle-Vavra, S, Matayoshi, K, Miller, LG. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 2007;13:236242.
11.Wibbenmeyer, LA, Kealey, GP, Latenser, BA, et al. Emergence of the USA300 strain of methicillin-resistant Staphylococcus aureus in a burn-trauma unit. J Burn Care Res 2008;29:790797.
12.Klevens, MR, Morrison, MA, Nadle, J. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:17631771.
13.Kallen, AJ, Mu, Y, Bulens, S, et al; Active Bacterial Core Surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. Health care-associated invasive MRSA infections, 2005–2008. JAMA 2010;304:641648.
14.Kuehnert, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant–Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11:868872.
15.Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999–2005. Emerg Infect Dis 2007;13:18401846.
16.McCaig, LF, McDonald, LC, Mandai, S, Jernigan, DB. Staphylococcus awrews-associated skin and soft tissue infections in ambulatory care. Emerg Infect Dis 2006;12:17151723.
17.Zilberberg, MD, Shorr, AF, Kollef, MH. Growth and geographic variation in hospitalizations with resistant infections, United States, 2000–2005. Emerg Infect Dis 2008;14:17561758.
18.Jhung, MA, Banerjee, SN. Administrative coding data and health care-associated infections. Clin Infect Dis 2009;49:949955.
19.Schaefer, MK, Ellingson, K, Conover, C, et al. Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification codes for reporting methicillin-resistant Staphylococcus aureus infections at a hospital in Illinois. Infect Control Hosp Epidemiol 2010;31:463468.
20.Schweizer, ML, Eber, MR, Laxminarayan, R, et al. Validity of ICD-9-CM coding for identifying incident methicillin-resistant Staphylococcus aureus (MRSA) infections: is MRSA infection coded as a chronic disease? Infect Control Hosp Epidemiol 2011;32:148154.
21.Zhan, C, Elixhauser, A, Richards, CL, et al. Identification of hospital-acquired catheter-associated urinary tract infections from Medicare claims: sensitivity and positive predictive value. Med Care 2009;47:364369.
22.Jenkins, TC, Sabel, AL, Sarcone, EE, Price, CS, Mehler, PS, Burman, WJ. Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship. Clin Infect Dis 2010;51:895903.
23. Changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates, 73 Federal Register 48434-49084 (August 19, 2008). Print.
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? *


Altmetric attention score

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