Skip to main content
×
Home

Methicillin-Resistant Staphylococcus aureus Colonization or Infection in Canada: National Surveillance and Changing Epidemiology, 1995–2007

  • Andrew E. Simor (a1), Nicolas L. Gilbert (a2), Denise Gravel (a2), Michael R. Mulvey (a3), Elizabeth Bryce (a3), Mark Loeb (a4), Anne Matlow (a5), Allison McGeer (a6), Lisa Louie (a1), Jennifer Campbell (a3) and Canadian Nosocomial Infection Surveillance Program...
Abstract
Objective.

To determine the incidence and describe the changing epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in Canadian hospitals from 1995–2007.

Setting.

Forty-eight hospitals participating in the Canadian Nosocomial Infection Surveillance Program.

Design.

Prospective, laboratory-based surveillance for incident cases of MRSA colonization or infection among hospitalized patients.

Methods.

Clinical and epidemiologic data were obtained by review of hospital records. Standard criteria were used to determine whether MRSA colonization or infection was present and whether the MRSA strain was healthcare associated or community associated. A representative subset of isolates was characterized by use of pulsed-field gel electrophoresis and staphylococcal cassette chromosome (SCC) mec typing.

Results.

From 1995 to 2007, a total of 37,169 hospitalized patients were newly identified as either infected or colonized with MRSA, and the overall incidence of both MRSA colonization and MRSA infection increased from 0.65 to 11.04 cases per 10,000 patient-days (P < .001). Of these 37,169 patients, 11,828 (32%) had an MRSA infection, and infection rate increased from 0.36 to 3.43 cases per 10,000 patient-days. The proportion of community-associated MRSA strains increased from 6% to 23% (P < .001). The most common genotype (47% of isolates) was CMRSA-2 (USA100/800); in 2007, CMRSA-10 (USA300) was the second most common strain (27% of isolates), associated with SCCmec type IV. Patients with CMRSA-10 were predominantly from western Canada and were more likely to be children (odds ratio [OR], 10.0 [95% confidence interval {CI}, 7.4–13.4]) and to have infection (OR, 2.3 [95% CI, 1.9–2.7]), especially skin and/or soft tissue infection (OR, 5.9 [95% CI, 5.0–6.9]).

Conclusions.

The overall incidence of both MRSA colonization and MRSA infection increased 17-fold in Canadian hospitals from 1995 to 2007. There has also been a dramatic increase in cases of community-associated MRSA infection due to the CMRSA-10 (USA300) clone. Continued surveillance is needed to monitor the ongoing evolution of MRSA colonization or infection in Canada and globally.

Copyright
Corresponding author
Department of Microbiology, Sunnybrook Health Sciences Centre, B103-2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada (andrew.simor@sunnybrook.ca)
References
Hide All
1. Deresinski S. Methicillin-resistant Staphylococcus aureus: an evolutionary, epidemiologic, and therapeutic Odyssey. Clin Infect Dis 2005;40:562573.
2. Boucher HW, Corey GR. Epidemiology of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2008;46(suppl 5):S344-S349.
3. 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.
4. Li M, Diep BA, Villacruz AE, et al. Evolution of virulence in epidemic community-associated methicillin-resistant Staphylococcus aureus . Proc Natl Acad Sci USA 2009;106:58835888.
5. Grundmann H, Aires-de-Sousa M, Boyce J, Tiemersma E. Emergence and resurgence of meticillin-resistant Staphylococcus aureus as a public health threat. Lancet 2006;368:874885.
6. Tiemersma EW, Bronzwaer SLAM, Lyytikäinen O, et al. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004;10:16271634.
7. Jarvis WR, Schlosser J, Chinn RY, Tweeten S, Jackson M. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control 2007;35:631637.
8. Aires de Sousa M, Miragala M, Santos Sanches I, et al. Three-year assessment of methicillin-resistant Staphylococcus aureus clones in Latin America from 1996 to 1998. J Clin Microbiol 2001;39:21972205.
9. McDougal LK, Steward CD, Killgore GE, Chaitram JM, McAllister SK, Tenover FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:51135130.
10. Ko KS, Lee J-Y, Suh JY, et al. Distribution of major genotypes among methicillin-resistant Staphylococcus aureus clones in Asian countries. J Clin Microbiol 2005;43:421426.
11. Simor AE, Ofner-Agostini M, Bryce E, et al. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001;165:2126.
12. Simor AE, Ofner-Agostini M, Bryce E, et al. Laboratory characterization of methicillin-resistant Staphylococcus aureus in Canadian hospitals: re-suits of 5 years of national surveillance, 1995-1999. J Infect Dis 2002;186: 652660.
13. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care Setting. Am J Infect Control 2008;36:309332.
14. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352: 14361444.
15. Louie L, Matsumura SO, Choi E, Louie M, Simor AE. Evaluation of three rapid methods for detection of methicillin resistance in Staphylococcus aureus . J Clin Microbiol 2000;38:21702173.
16. Mulvey MR, Chui L, Ismail J, et al. Development of a Canadian standardized protocol for subtyping methicillin-resistant Staphylococcus aureus using pulsed-field gel electrophoresis. J Clin Microbiol 2001;39:34813485.
17. Christiansen S, Golding GR, Campbell J, Canadian Nosocomial Infection Surveillance Program, Mulvey MR. Comparative genomics of Canadian epidemic lineages of methicillin-resistant Staphylococcus aureus . J Clin Microbiol 2007;45:19041911.
18. Oliveira DC, de Lencastre H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 2002;46:21552161.
19. Lina G, Piémont Y, Godail-Gamot F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:11281132.
20. 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.
21. Ofner-Agostini M, Varia M, Johnston L, et al. Infection control and antimicrobial restriction practices for antimicrobial resistant organisms in Canadian tertiary care hospitals. Am J Infect Control 2007;35:563568.
22. Canadian Institute for Health Information. Number of hospital inpatient days, inpatient admissions, ambulatory care visits, emergency visits, Canada, 2006-2007. Canadian Institute for Health Information, ref. CMDB3.1.
23. Rubin RJ, Harrington CA, Poon A, et al. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerg Infect Dis 1999;5:917,
24. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:5359.
25. Kurbis CA, Wylie JL. Community-based cluster of methicillin-resistant Staphylococcus aureus in Manitoba. Can J Infect Dis 2001;12:149152.
26. Mulvey MR, MacDougall L, Cholin B, et al. Community-associated methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis 2005;11:844850.
27. Gilbert M, MacDonald J, Gregson D, et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006;175:149154.
28. Dalloo A, Soboi I, Palacios C, Mulvey M, Gravel D, Panaro L. Investigation of community-associated methicillin-resistant Staphylococcus aureus in a remote northern community, Nunavut, Canada. Can Commun Dis Rep 2008;34:17.
29. 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.
30. Otter JA, French GL. Nosocomial transmission of community-associated meticillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2006;6:753755.
31. Patel M, Kumar RA, Stamm AM, Hoesley CJ, Moser SA, Waites KB. USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. J Clin Microbiol 2007;45:34313433.
32. Liu C, Graber CJ, Karr M, et al. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004-2005. Clin Infect Dis 2008;46: 16371646.
33. Popovich KJ, Weinstein RA, Hota B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008;46:787794.
34. David MZ, Glikman D, Crawford SE, et al. What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 2008;197: 12351243.
35. McGeer A, Fleming CA, Willey BM, Green KA, Low DE. Antimicrobial resistance in common hospital pathogens in Ontario. QMP-LS News. October 2008; No. 131:4-14. http://www.qmpls.org/pub_resources/publications/qmpls_news/pdf/qmplsnews131.pdf. Accessed July 25, 2009.
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? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 4 *
Loading metrics...

Abstract views

Total abstract views: 134 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 15th December 2017. This data will be updated every 24 hours.