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Trends in Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections: Effect of the MRSA “Search and Isolate” Strategy in a Hospital in Italy with Hyperendemic MRSA

Published online by Cambridge University Press:  21 June 2016

Angelo Pan ,
Giuseppe Carnevale ,
Patrizia Catenazzi ,
Paolo Colombini ,
Luciano Crema ,
Lucia Dolcetti ,
Lucio Ferrari ,
Placido Mondello ,
Liana Signorini  and
Carmine Tinelli
...Show all authors
Angelo Pan*
Affiliation:
Divisione di Malattie Infettive, Sanitaria, Istituti Ospitalieri di Cremona, Cremona, Italy Istituto di Malattie Infettive e Tropicali, Spedali Civili, Università di Brescia, Brescia, Italy
Giuseppe Carnevale
Affiliation:
Divisione di Malattie Infettive, Sanitaria, Istituti Ospitalieri di Cremona, Cremona, Italy
Patrizia Catenazzi
Affiliation:
Direzione Sanitaria, Istituti Ospitalieri di Cremona, Cremona, Italy
Paolo Colombini
Affiliation:
Istituto di Malattie Infettive e Tropicali, Spedali Civili, Università di Brescia, Brescia, Italy
Luciano Crema
Affiliation:
Servizio di Terapie Intensive, Istituti Ospitalieri di Cremona, Cremona, Italy
Lucia Dolcetti
Affiliation:
Direzione Sanitaria, Istituti Ospitalieri di Cremona, Cremona, Italy
Lucio Ferrari
Affiliation:
Laboratorio di Microbiologia, Istituti Ospitalieri di Cremona, Cremona, Italy
Placido Mondello
Affiliation:
Divisione di Malattie Infettive, Sanitaria, Istituti Ospitalieri di Cremona, Cremona, Italy
Liana Signorini
Affiliation:
Istituto di Malattie Infettive e Tropicali, Spedali Civili, Università di Brescia, Brescia, Italy
Carmine Tinelli
Affiliation:
Servizio Biometria ed Epidemiologia Clinica, Direzione Scientifica, IRCCS Policlinico San Matteo, Università di Pavia, Pavia, Italy
Eugenia Quiros Roldan
Affiliation:
Istituto di Malattie Infettive e Tropicali, Spedali Civili, Università di Brescia, Brescia, Italy
Giampiero Carosi
Affiliation:
Istituto di Malattie Infettive e Tropicali, Spedali Civili, Università di Brescia, Brescia, Italy
*
Clinica di Malattie Infettive e Tropicali, Spedali Civili - Università degli Studi di Brescia, Piazzale Spedali Civili, 1, 20123 Brescia, Italy. ange.pan@tiscali.it
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Abstract

Objective:

To evaluate the secular trends in MRSA BSIs after the introduction of a nosocomial MRSA control intervention.

Design:

Before-after study.

Setting:

An 850-bed community hospital with an ICU and vascular surgery, neurosurgery, bone marrow transplantation, and AIDS units. MRSA is endemic at this hospital; the prevalence of methicillin resistance among patients with S. aureus infection is greater than 50%.

Patients:

Among all inpatients, MRSA BSI was identified, its origin defined, and incidence rates calculated by ward and origin.

Intervention:

A MRSA control program was implemented based on active surveillance cultures to identify MRSA-colonized patients, followed by isolation using contact precautions. Incidence rates of MRSA BSI during the intervention (ie, July 1, 1997, to December 31, 2001) and preintervention (ie, January 1, 1996, to June 30, 1997) periods were compared.

Results:

Sixty-nine MRSA BSIs were identified. When compared with the preintervention period, the incidence rate of MRSA BSI was reduced from 0.64 to 0.30 per 1,000 admissions (RR, 0.46; CI95, 0.25–0.87; P = .02) during the intervention period. The impact was greater in the ICU, with an 89% reduction (RR, 0.11; CI95, 0.01–0.98; P = .03), and for CVC-associated MRSA BSIs, with an 82% decrease (RR, 0.17; CI95, 0.05–0.55; P = .002). Methicillin resistance among S. aureus blood isolates decreased from 46% to 17% (RR, 0.36; CI95, 0.22–0.62; P = .0002).

Conclusion:

A reduction in MRSA bacteremia is achievable through use of the MRSA “search and isolate” intervention even in a hospital with high rates of endemic MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 127 - 133
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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