Skip to main content Accessibility help

Strict Infection Control Leads to Low Incidence of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection over 20 Years

  • Andreas F. Widmer (a1), Botond Lakatos (a1) and Reno Frei (a2)



Methicillin-resistant Staphylococcus aureus (MRSA) is a worldwide issue associated with significant morbidity and mortality. Multiple infection control (IC) approaches have been tested to control its spread; however, the success of the majority of trials has been short-lived and many efforts have failed. We report the long-term success of MRSA control from a prospective observational study over 20 years.


University Hospital Basel is a large tertiary care center with a median bed capacity of 855 and 5 intensive care units (ICUs); currently, the facility has >32,000 admissions per year.


The IC program at the University Hospital Basel was created in 1993, after 2 MRSA outbreaks. The program has included strict contact precautions with single rooms for MRSA-colonized or -infected patients, targeted admission screening of high-risk patients and healthcare workers at risk for carriage, molecular typing of all MRSA strains and routine decolonization of MRSA carriers including healthcare workers. We used the incidence of MRSA bloodstream infections (BSIs) to assess the effectiveness of this program. All MRSA cases were prospectively classified using a standardized case report form in nosocomial and nonnosocomial cases, based on CDC definitions.


Between 1993 and 2012, 540,669 blood samples were cultured. The number of blood cultures increased from 865 per 10,000 patient days in 1993 to 1,568 per 10,000 patient days in 2012 (P<.001). We identified 1,268 episodes of S. aureus BSI from 1,204 patients. MRSA accounted for 34 episodes (2.7%) and 24 of these (1.9%) were nosocomial. MRSA BSI incidence varied between 0 and 0.27 per 10,000 patient days and remained stable with no significant variation throughout the study period (P=.882).


Long-term control of MRSA is feasible when a bundle of IC precautions is strictly enforced over time.

Infect Control Hosp Epidemiol 2015;00(0): 1–8


Corresponding author

Address all correspondence to Andreas F. Widmer, MD, MSc, Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland (


Hide All

PREVIOUS PRESENTATION. Presented in part at the European Society of Clinical Microbiology and Infectious Diseases Conference (ECCMID), Barcelona, Spain, May 10–13, 2014.



Hide All
1. deKraker, ME, Wolkewitz, M, Davey, PG, et al. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011;55:15981605.
2. Diekema, DJ, Edmond, MB. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007;44:11011107.
3. van Rijen, MM, Kluytmans, JA. Costs and benefits of the MRSA search and destroy policy in a Dutch hospital. Eur J Clin Microbiol Infect Dis 2009;28:12451252.
4. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533542.
5. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:14191430.
6. Huskins, WC, Huckabee, CM, O'Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:14071418.
7. Stone, SP, Fuller, C, Savage, J, et al. Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 2012;344:e3005.
8. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:22552265.
9. 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.
10. Rodríguez-Baño, J, García, L, Ramírez, E, et al. Long-term control of endemic hospital-wide methicillin-resistant Staphylococcus aureus (MRSA): the impact of targeted active surveillance for MRSA in patients and healthcare workers. Infect Control Hosp Epidemiol 2010;31:7861795.
11. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol 2003;24:362386.
12. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165S193.
13. Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470485.
14. Harris, AD, Pineles, L, Belton, B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA 2013;310:15711580.
15. Diekema, DJ, Pfaller, MA, Schmitz, FJ, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis 2001;32(Suppl 2):114132.
16. Landrum, ML, Neumann, C, Cook, C, et al. Epidemiology of Staphylococcus aureus blood and skin and soft tissue infections in the US military health system, 2005–2010. JAMA 2012;308:5059.
17. deKraker, ME, Jarlier, V, Monen, JC, Heuer, OE, van de Sande, N, Grundmann, H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect 2013;19:860868.
18. Wenzel, RP, Edmond, MB. Infection control: the case for horizontal rather than vertical interventional programs. Int J Infect Dis 2010;14:S3S5.
19. Mertz, D, Frei, R, Jaussi, B, et al. Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus . Clin Infect Dis 2007;45:475477.
20. Buehlmann, M, Frei, R, Fenner, L, Dangel, M, Fluckiger, U, Widmer, AF. Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2008;29:510516.
21. Tschudin Sutter, S, Frei, R, Dangel, M, Widmer, AF. Effect of teaching recommended World Health Organization technique on the use of alcohol-based hand rub by medical students. Infect Control Hosp Epidemiol 2010;31:11941195.
22. Widmer, AF, Conzelmann, M, Tomic, M, Frei, R, Stranden, AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol 2007;28:5054.
23. Strandén, AM, Frei, R, Adler, H, Flückiger, U, Widmer, AF. Emergence of SCCmec type IV as the most common type of methicillin-resistant Staphylococcus aureus in a university hospital. Infection 2009;37:4448.
24. Strandén, A, Frei, R, Widmer, AF. Molecular typing of methicillin-resistant Staphylococcus aureus: can PCR replace pulsed-field gel electrophoresis? J Clin Microbiol 2003;41:31813186.
25. Fluckiger, U, Widmer, AF. Epidemiology of methicillin-resistant Staphylococcus aureus . Chemotherapy 1999;45:121134.
26. van Cleef, BA, van Benthem, BH, Haenen, AP, Bosch, T, Monen, J, Kluytmans, JA. Low incidence of livestock-associated methicillin-resistant Staphylococcus aureus bacteraemia in The Netherlands in 2009. PLoS One 2013;8:e73096.
27. Chaberny, IF, Sohr, D, Rüden, H, Gastmeier, P. Development of a surveillance system for methicillin-resistant Staphylococcus aureus in German hospitals. Infect Control Hosp Epidemiol 2007;28:446452.
28. Jarlier, V, Trystram, D, Brun-Buisson, C, et al. Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med 2010;170:552559.
29. The Dutch Working Party on Antibiotic Policy website.$FILE/MRSAguideline_en.pdf. Published 2007. Accessed October 10, 2014.
30. The Danish Health and Medicines Authority website on MRSA, Published 2013. Accessed October 10, 2014.
31. Derde, LP, Cooper, BS, Goossens, H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis 2014;14:3139.
32. White, CM, Statile, AM, Conway, PH, et al. Utilizing improvement science methods to improve physician compliance with proper hand hygiene. Pediatrics 2012;129:e1042e1050.
33. Mertz, D, Frei, R, Periat, N, et al. Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med 2009;169:172178.
34. Marshall, C, Spelman, D. Is throat screening necessary to detect methicillin-resistant Staphylococcus aureus colonization in patients upon admission to an intensive unit? J Clin Microbiol 2007;45:3855.
35. Hubben, G, Bootsma, M, Luteijn, M, et al. Modelling the costs and effects of selective and universal hospital admission screening for methicillin-resistant Staphylococcus aureus . PLoS One 2011;6:e14783.
36. Crnich, CJ, Duster, M, Warrack, S, Maki, D, Safdar, N. Comparison of pulsed-gel electrophoresis and a commercial repetitive-element PCR method for assessment of methicillin-resistant Staphylococcus aureus clustering in different health care facilities. J Clin Microbiol 2014;52:20272032.

Strict Infection Control Leads to Low Incidence of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection over 20 Years

  • Andreas F. Widmer (a1), Botond Lakatos (a1) and Reno Frei (a2)


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