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Methicillin-Resistant Staphylococcus aureus in U.S. Hospitals, 1975–1991

Published online by Cambridge University Press:  21 June 2016

Adelisa L. Panlilio
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
David H. Culver
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
Robert P. Gaynes*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
Shailen Banerjee
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
Tonya S. Henderson
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
James S. Tolson
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
William J. Martone
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia
*
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, U.S. Public Health Service, Dept. of Health and Human Services, Atlanta, GA 30333

Abstract

Objectives:

Analyze changes that have occurred among U.S. hospitals over a 17-year period, 1975 through 1991, in the percentage of Staphylococcus aureus resistant to b-lactam antibiotics and associated with nosocomial infections.

Design:

Retrospective review. The percentage of methicillin-resistant S aureus (MRSA) was defined as the number of S aureus isolates resistant to either methicillin, oxacillin, or nafcillin divided by the total number of S aureus isolates for which methicillin, oxacillin, or nafcillin susceptibility test results were reported to the National Nosocomial Infections Surveillance (NNIS) System.

Setting:

NNIS System hospitals.

Results:

Of the 66,132 S aureus isolates that were tested for susceptibility to methicillin, oxacillin, or nafcillin during 1975 through 1991, 6,986 (11%) were resistant to methicillin, oxacillin, or nafcillin. The percentage MRSA among all hospitals rose from 2.4% in 1975 to 29% in 1991, but the rate of increase differed significantly among 3 bed-size categories: <200 beds, 200 to 499 beds, and 2500 beds. In 1991, for hospitals with <200 beds, 14.9% of S aureus isolates were MRSA, for hospitals with 200 to 499 beds, 20.3% were MRSA; and for hospitals with >500 beds, 38.3% were MRSA. The percentage MRSA in each of the bed-size categories rose above 5% at different times: in 1983, for hospitals with 2500 beds; in 1985, for hospitals with 200 to 499 beds; and in 1987, for hospitals with <200 beds.

Conclusions:

This study suggests that hospitals of all sizes are facing the problem of MRSA, the problem appears to be increasing regardless of hospital size, and control measures advocated for MRSA appear to require re-evaluation. Further study of MRSA in hospitals would benefit our understanding of this costly pathogen.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992 

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References

1. Schaberg, DS, Culver, D, Gaynes, R. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991;91(3B):72S75s.10.1016/0002-9343(91)90346-YCrossRefGoogle ScholarPubMed
2. Jevons, MI? ‘Celbenin’-resistant staphylococci. Br Med J. 1961;1:124125.10.1136/bmj.1.5219.124-aCrossRefGoogle Scholar
3. Jevons, MP, Coe, AW, Parker, MT. Methicillin resistance in staphylococci. Lancet. 1963;i:904907.10.1016/S0140-6736(63)91687-8CrossRefGoogle Scholar
4. Barrett, FE, McGehee, RP Jr, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital. N Engl J Med. 1968;279:441448.10.1056/NEJM196808292790901CrossRefGoogle ScholarPubMed
5. Haley, RW, Hightower, AW, Khabbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals: possible role of the house staff-patient transfer circuit. Ann Intern Med. 1982;97:297308.10.7326/0003-4819-97-3-297CrossRefGoogle ScholarPubMed
6. Kavser, FH, Mak, TM. Methicillin-resistant staphylococci. Am J Med Sci 1972;264:197205.Google Scholar
7. O'Toole, RD, Drew, L, Dahjeren, BJ, Beajv, HN. An outbreak of methicillin-resistant Staphylococcus aureus infection. JAMA. 1970;213:257263.10.1001/jama.1970.03170280017003CrossRefGoogle ScholarPubMed
8. Klimek, JJ, Marsik, FJ, Barlett, RC, Weir, B, Shea, P, Quintilliani, R. Clinical, epidemiologic, and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med. 1976;61:340345.10.1016/0002-9343(76)90370-3CrossRefGoogle Scholar
9. Everett, ED, Rahm, AE, McNitt, TR, Stevens, DL, Peterson, HE. Epidemiologic investigation of methicillin-resistant Staphylococcus aureus in a bum unit. Milit Med. 1978;143:165167.10.1093/milmed/143.3.165CrossRefGoogle Scholar
10. Crossley, K, Loesch, D, Iandesman, B, Mead, K, Chem, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: clinical studies. J Infect Dis. 1979;139:273279.10.1093/infdis/139.3.273CrossRefGoogle ScholarPubMed
11. Peacock, JE, Marsik, FJ, Wenzel, RI? Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med. 1980;93:526532.10.7326/0003-4819-93-4-526CrossRefGoogle ScholarPubMed
12. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med. 1981;71:5358.10.1016/0002-9343(81)90258-8CrossRefGoogle ScholarPubMed
13. Boyce, JM, Landy, M, Deetz, TR, et al. Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections, Infect Control. 1981;2:110116.10.1017/S0195941700053881CrossRefGoogle ScholarPubMed
14. Centers for Disease Control. Methicillin-resistant Staphylococcus aureus— United States. MMWR. 1981;30:140147.Google Scholar
15. Ward, TT, Winn, RE, Hartstein, A, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control. 1981;2:453459.10.1017/S0195941700055715CrossRefGoogle Scholar
16. Thompson, RL, Cabeduzo, I, Wenzel, RI? Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:30093017.Google ScholarPubMed
17. Boyce, JM, Causey, WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control. 1982;3:377383.10.1017/S0195941700057337CrossRefGoogle ScholarPubMed
18. Boyce, TM, White, RL, Causey, WA, et al. Burn units as a source of methicillin-resistant Staphylococcus aureus infection. JAMA. 1983;249:20832087.10.1001/jama.1983.03330440041029CrossRefGoogle Scholar
19. Boyce, JM, White, RL, Spruill, EY. Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections. J Infect Dis. 1983;148:763.10.1093/infdis/148.4.763CrossRefGoogle ScholarPubMed
20. Jarvis, WR, Thornsberry, C, Boyce, J, Hughes, JM. Methicillin-resistant Staphylococcus aureus at children's hospitals in the United States. Pediatr Infect Dis J. 1985;4:651655.10.1097/00006454-198511000-00011CrossRefGoogle ScholarPubMed
21. Preheim, LC, Rimland, D, Bittner, MJ. Methicillin-resistant Staphy-Zococcus aureus in Veterans Administration medical centers. Infect Control. 1987;8:191194.10.1017/S0195941700065929CrossRefGoogle ScholarPubMed
22. Wakefield, DS, Pfaller, M, Massanari, RM, Hammons, GT. Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control. 1987;8:151157.10.1017/S0195941700065814CrossRefGoogle ScholarPubMed
23. Jones, RN, Barry, AL, Gardiner, KV, Packer, RR. The prevalence of staphylococcal resistance to penicillinase-resistant penicillins: a retrospective and prospective national surveillance trial of isolates from 40 medical centers. Diagn Microbiol Infect Dis. 1989;12:385394.10.1016/0732-8893(89)90108-9CrossRefGoogle ScholarPubMed
24. Reboli, AC, John, JR, Piatt, CG, Cantey, JR. Methicillin-resistant Staphylococcus aureus outbreak at a Veterans'; Affairs medical center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol. 1990;11:291296.10.1086/646174CrossRefGoogle Scholar
25. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol. 1990;11:639642.10.1086/646114CrossRefGoogle ScholarPubMed
26. Wenzel, Nettleman MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effectivecontrol measures. Am J Med. 1991;91(3B):221S227S.10.1016/0002-9343(91)90372-5CrossRefGoogle ScholarPubMed
27. Cohen, SH, Morita, MM, Bradford, M. A seven-year experience with methicillin-resistant Staphylococcus aureus . Am J Med. 1991;91(3B):233S237S.10.1016/0002-9343(91)90374-7CrossRefGoogle ScholarPubMed
28. Gaynes, RP, Culver, DH, Emori, TG, et al. The National Nosocomial Infections Surveillance (NNIS) System: plans for the 1990s and beyond. Am J Med. 1991;91(3B):116S120S.10.1016/0002-9343(91)90355-2CrossRefGoogle Scholar
29. Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance (NNIS) System: description of surveillance methodology. Am J Infect Control. 1991;19:1935.10.1016/0196-6553(91)90157-8CrossRefGoogle Scholar
30. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988 . Am J Infect Control. 1988;16:128140.10.1016/0196-6553(88)90053-3CrossRefGoogle ScholarPubMed
31. Snedecor, GW, Cocheran, WG. Statistical Methods. 7th ed. Ames, Iowa: Iowa State University Press; 1980.Google Scholar
32. Banejee, SN, Emori, TG, Culver, DH, et al. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med. 1991;91(3B):86S89S.10.1016/0002-9343(91)90349-3CrossRefGoogle Scholar
33. Garner, JS, Simmons, BP. CDC Guideline for Isolation Precautions in Hospitals. Atlanta, Ga: Centers for Disease Control; 1983.Google ScholarPubMed
34. Lynch, P, Jackson, MM, Cummings, MJ, et al. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med. 1987;107:243250.10.7326/0003-4819-107-2-243CrossRefGoogle ScholarPubMed
35. Schwalbe, RS, Stapleton, JT, Gilligan, PH. Emergence of vancomycin resistance in coagulasenegative staphylococci. N Engl J Med. 1987;316:927928.10.1056/NEJM198704093161507CrossRefGoogle ScholarPubMed
36. LeClercq, R, Derlot, E, Duval, J, Couvalin, P. Plasmid-mediated resistance to vancomycin and teichoplanin in Enterococcus faecalis . N Engl J Med. 1988;319:157159.10.1056/NEJM198807213190307CrossRefGoogle Scholar
37. Chambers, HE. Treatment of infection and colonization caused by methicillin-resistant Staphylococcus uureus . Infect Control Hosp Epidemiol. 1991;12:2935.10.1086/646235CrossRefGoogle Scholar
38. National Committee for Clinical Laboratory Standards. Methods for dilution-antimicrobial susceptibility tests for bacteria that grow aerobically. Approved Standard M7-A. Villanova, Pa: National Committee for Clinical Laboratory Standards; 1985.Google Scholar
39. Strasbaugh, 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;12:3645.10.1086/646236CrossRefGoogle Scholar