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Methicillin-Resistant Staphylococcus aureus in Two Tertiary-Care Centers in Jeddah, Saudi Arabia

  • Tariq A. Madani (a1) (a2), Nabeela A. Al-Abdullah (a2), Ali A. Al-Sanousi (a3), Tawfik M. Ghabrah (a4), Shadia Z. Afandi (a5) and Huda A. Bajunid (a5)...
Abstract <span class='bold'>Objective:</span>

To review clinical experience with methicillin-resistant Staphylococcus aureus (MRSA) in tertiary-care hospitals in Jeddah, Saudi Arabia.

<span class='bold'>Design:</span>

Retrospective review for the year 1998.

<span class='bold'>Setting:</span>

Two tertiary-care hospitals.

<span class='bold'>Methods:</span>

Results of MRSA-positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the microbiology laboratories' records. Charts of patients were reviewed, with standardized data collection.

<span class='bold'>Results:</span>

Of 673 S aureus isolates identified, 222 (33%, or 6.8 isolates/1,000 admissions) were MRSA Overall MRSA prevalence was 2% in 1988. Nosocomial acquisition occurred in 84.2% of cases. All age groups were affected, and 52% of patients had at least one comorbidity. MRSA prevalence was highest in the intensive care units (26.6% of all isolates), the medical wards (24.8%), and the surgical wards (19.8%). Seventy-three percent of isolates caused infection; the rest represented colonization. Surgical wounds (35.2%), the chest (29%), and central venous catheters (13%) were the most common sites of infection. Bacteremia occurred in 15.4% of patients. Local signs (84%) and fever (75.9%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 30.2% and 13.6% of cases, respectively. Of 162 patients with MRSA infection and 60 patients with MRSA colonization, 95.7% and 70% received antibiotics in the preceding 6 weeks, respectively (P<.0001). The total mortality of patients with MRSA infection was 53.7%: 36.4% as a result of MRSA infection and 17.3% as a result of other causes.

<span class='bold'>Conclusions:</span>

The prevalence of MRSA is high and rapidly increasing in the two hospitals, as it is worldwide. Control measures to prevent die spread of MRSA in hospitals should continue, with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.

Corresponding author
Department of Internal Medicine, King Abdulaziz University Hospital, PO Box 80215, Jeddah 21589, Saudi Arabia
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1. Boyce JM. Methicillin-resistant Staphylococcus aureus: detection, epidemiology, and control measures. Infect Dis Clin North Am 1989;3:901913.
2. Saravolatz LD, Markowitz N, Arking L, Pohlod D, Fisher E. MRSA epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982;96:1116.
3. Moreno F, Crisp C, Jorgensen JH, Patterson JE. Methicillin-resistant Staphylococcus aureus as a community organism. Clin Infect Dis 1995;21:13081312.
4. Pate KR, Nolan RL, Bannerman TL, Feldman S. Methicillin-resistant Staphylococcus aureus in the community. Lancet 1995;346:978.
5. Embil J, Ramotar K, Romance L, Alfa M, Conly J, Cronk S, et al. Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies 1990-1992. Infect Control Hasp Epidemiol 1994;15:646651.
6. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.
7. Boyce JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11:639642.
8. Voss A, Milatovic D, Wallrauch-Schwarz C, Rosdahl VT, Braveny I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:5055.
9. Oguri T. The incidence and antimicrobial susceptibility of clinical isolates of MRSA from 1988 to 1990, from the results of 26 clinical laboratories in Tokyo and the surrounding area. Jap J Clin Med 1992;50:952960.
10. Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639644.
11. Vandenbroucke-Grauls C. Management of methicillin-resistant Staphylococcus aureus in The Netherlands. Rev Med Microbiol 1998;9:109116.
12. Hanifah YA, Hiramatsu K, Yokota T. Characterization of methicillin-resistant Staphylococcus aureus associated with nosocomial infection in the University Hospital, Kuala Lumpur. J Hosp Infect 1992;21:1528.
13. Gales AC, Jones RN, Pfaller MA, Gordon KA, Sader HS. Two-year assessment of the pathogen frequency and antimicrobial resistance patterns among organisms isolated from skin and soft tissue infections in Latin American hospitals: results from the SENTRY antimicrobial surveillance program, 1997-98. SENTRY Study Group. International Journal of Infectious Diseases 2000;4:7584.
14. Geyid A, Lemeneh Y. The incidence of methicillin-resistant Staphylococcus aureus strains in clinical specimens in relation to their β-lactamase producing and multiple-drug resistance properties in Addis Ababa. Ethiop Med J 1991;29:149161.
15. Hart CA, Kariuki S. Antimicrobial resistance in developing countries. BMJ 1998;317:647650.
16. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved standard M2-A5. NCCLS: Villanova, PA; 1993.
17. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Approved standard M7-A3. NCCLS; Villanova, PA: 1993.
18. Panlilio AL, Culver DH, Gaynes RP, Banerjee S, Henderson TS, Tolson JS, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582586.
19. Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520532.
20. Speller DCE, Johnson AP, James D, Marples RR, Charlett A, George RC. Resistance to methicillin and other antibiotics in isolates of Staphylococcus aureus from blood and cerebrospinal fluid, England and Wales, 1989-95. Lancet 1997;350:323325.
21. Mayor S. England sets standards to reduce hospital acquired infection. BMJ 1999;319:1392.
22. Linnemann CC, Moore P, Staneck JL, Pfaller MA. Reemergence of epidemic methicillin-resistant Staphylococcus aureus in a general hospital associated with changing staphylococcal strains. Am J Med 1991;91(suppl 3B):238344.
23. Nettleman MD, Trilla A, Fredrickson M, Pfaller MA. Assigning responsibility: using feedback to achieve sustained control of methicillin-resistant Staphylococcus aureus . Am J Med 1991;91(suppl 3B):228232.
24. Layton MC, Hierholzer WJ, Patterson JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1995;16:1217.
25. Strausbaugh LJ, Jacobson C, Sewell DL, Potter S, Ward TT. Methicillin-resistant Staphylococcus aureus in extended-care facilities: experiences in a Veterans Affairs nursing home and a review of the literature. Infect Control Hosp Epidemiol 1991;12:3645.
26. Coello R, Jimenez J, Garcia M, Arroyo P, Minguez D, Fernandez C, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994;13:7481.
27. Longfield JN, Townsend TR, Cruess DF, Stephen M, Bishop C, Bolyard E, et al. Methicillin-resistant Staphylococcus aureus (MRSA): risk and outcome of colonized vs infected patients. Infect Control 1985;6:445450.
28. Myers JP, Linnemann CC. Bacteraemia due to methicillin-resistant Staphylococcus aureus . J Infect Dis 1982;145:532536.
29. French GL, Cheng AF, Ling JM, Mo P, Donnan S. Hong Kong strains of methicillin-resistant and methiciUin-sensitive Staphylococcus aureus have similar virulence. J Hosp Infect 1990;15:117125.
30. Harbarth S, Rutschmann O, Sudre P, Pittet D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus . Arch Intern Med 1998;158:182189.
31. Romero-Vivas J, Rubio M, Fernandez C, Picazo JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1995;21:14171423.
32. Conterno LO, Wey SB, Castelo A. Risk factors for mortality in Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 1998;19:3237.
33. Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40:135136.
34. Hiramatsu K, Aritaka N, Hanaki H, Kawasaki S, Hosoda Y, Hori S, et al. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997;350:16701673.
35. Smith TL, Pearson ML, Wilcox KR, Cruz C, Lancaster MV, Robinson-Dunn B, et al. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med 1999;340:493501.
36. Tenover FC. Implications of vancomycin-resistant Staphylococcus aureus . J Hosp Infect 1999;43(suppl):37.
37. Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR 1997;46:626628.
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Infection Control & Hospital Epidemiology
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