Hostname: page-component-745bb68f8f-grxwn Total loading time: 0 Render date: 2025-02-04T00:52:20.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Variation in Methicillin-Resistant Staphylococcus aureus Occurrence by Geographic Location and Hospital Characteristics

Published online by Cambridge University Press:  02 January 2015

Douglas S. Wakefield ,
Michael Pfaller ,
R. Michael Massanari  and
Glenn T. Hammons
Douglas S. Wakefield*
Affiliation:
Iowa City Veterans Administration Medical Center and The University of Iowa, Iowa City, Iowa
Michael Pfaller
Affiliation:
Iowa City Veterans Administration Medical Center and The University of Iowa, Iowa City, Iowa
R. Michael Massanari
Affiliation:
Iowa City Veterans Administration Medical Center and The University of Iowa, Iowa City, Iowa
Glenn T. Hammons
Affiliation:
Iowa City Veterans Administration Medical Center and The University of Iowa, Iowa City, Iowa
*
Iowa HSR&D Field Program, Veterans Administration Medical Center, Iowa City, IA 52242
Get access Rights & Permissions [Opens in a new window]

Abstract

A survey of 162 Veterans Administration Medical Center (VAMC) laboratories performing antimicrobial susceptibility testing was performed to determine variation in reported rates of methicillin-resistant Staphylococcus aureus (MRSA) isolation by geographic location and hospital characteristics. Of the 162 VAMC laboratories surveyed, 136 (84%) provided usable data. The percentage of S aureus isolates reported as resistant to methicillin ranged from 0% to 52% with a mean value of 10% among the 136 survey respondents. MRSA were isolated in every VA Medical District and 96% of all respondent laboratories reported isolating at least one MRSA isolate during the preceding year. These data are considered an underestimate of the time MRSA rate in the VA system due to the fact that many laboratories failed to follow key methodologic guidelines for optimal detection of MRSA. A positive correlation was found between MRSA isolation rate and several measures of hospital size and activity including total beds, total admissions, and total antimicrobial susceptibility tests performed. Geographic clustering of MRSA isolation was observed with distinct areas of very high and very low percentages of S aureus isolates reported as MRSA. The data suggest that the geographic distribution of MRSA within the VA system should be monitored closely for evidence of spread from areas with high-MRSA rates to areas of mid- or low-MRSA rates. Evidence of increased MRSA isolation within these areas may necessitate increased caution in patient referral and transfer patterns within the VA system.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 8 , Issue 4 , April 1987 , pp. 151 - 157
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Boyce, JM, Causey, WA: Increasing occurrence of methicillin-resistanl Staphylococcus aureus in the United States. Infect Control 1982; 3:377–383.Google Scholar
2.Crossley, K, Landesman, B, Zaske, D: An outbreak of infections caused by strains Staphylococcus aureus resistant to niethicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979; 139:280–287.CrossRefGoogle ScholarPubMed
3.Centers for Disease Control: Methicillin-resistanl Staphylococcus aureus— United States. MMWR 1981; 30:557–559.Google Scholar
4.Haley, RW, Hightower, AW, Khabbaz, RF, et al: The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Possible role of the housestaff-patient transfer circuit. Ann Intern Med 1982; 97:297–308.CrossRefGoogle ScholarPubMed
5.Klimek, J, Marsik, F, Bartlett, R, et al: Clinical epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med 1976; 61:340–345.Google Scholar
6.Peacock, JE Jr. Marsik, FJ, Wenzel, RP: Methicillin-resistanl Staphylococcus aureus: Introduction and spread within a hospital. Ann Intern Med 1980; 93:526–532.Google Scholar
7.Levine, DP, Cushing, RD. Jui, J, et al: Community-acquired methicillin-resistanl Staphylococcus aureus endocarditis in the Detroit Medical Center. Ann Intern Med 1982; 97:330–338.Google Scholar
8.Saravolatz, LD, Markowitz, N, Arking, L, et al: Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community acquired outbreak. Ann Intern Med 1982; 96:11–16.CrossRefGoogle ScholarPubMed
9.McNeil, MM, Solomon, SL: The epidemiology of methicillin-resistant Staphylococcus aureus. Antimkrob Newsletter 1985; 2:49–57.CrossRefGoogle Scholar
10.Brown, A, Magnussen, MH: Infection control problems. A survey of the Veterans Administration Medical Centers in the northeastern United States. Milit Med 1981; 146:348–352.Google Scholar
11.National Committee for Clinical Laboratory Standards: Approved standard M7-A. Standard methods for dilution antimicrobial tests for bacteria which grow aerobically. National Committee for Clinical Laboratory Standards, Villanova, PA, 1985.Google Scholar
12.National Committee for Clinical Laboratory Standards: Approved standard M2-A3. Performance standards for antimicrobial disk susceptibility tests. National Committee for Clinical Laboratory Standards, Villanova, PA. 1984.Google Scholar
13.McDougal, LK, Thornsberry, C: New recommendations for disc-diffusion antimicrobial susceptibility tests for methicillin-resistant (heteroresistant) staphylococci. J Clin Microbiol 1984; 19:482–488.Google Scholar
14.Sabath, LD: Mechanisms of resistance to beta-lactam antibiotics in strains of Staphylococcus aureus. Ann Intern Med 1982; 97:339–344.Google Scholar
15.Thornsberry, C, Caruthers, JQ, Baker, CN: Effect of temperature on the in vitro susceptibility of Staphylococcus aureus to penicillinase-resistant penicillins. Antimkrob Agents Chemother 1973; 4:263–269.Google Scholar
16.Thornsberry, C, McDougal, LK: Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heteroresistant) staphylococci. J Clin Microbiol 1983; 18:1084–1091.Google Scholar
17.Thornsberry, C: Methicillin-resistant (heteroresistant) staphylococci. Antimkrob Newsletter 1984; 1:43–47.CrossRefGoogle Scholar
18.Barry, AL, Badol, RE: Reliability of the microdilution technique for detection of methicillin-resistant strains of Staphylococcus aureus. Am J Clin Pathol 1977; 67:489–495.CrossRefGoogle ScholarPubMed
19.Drew, WL, Barry, AL, O'Toole, R, et al: Reliability of the Kirby-Bauer disc diffusion method for detecting methicillin-resistant strains Staphylococcus aureus. Appl Microbiol 1972; 24:240–247.Google Scholar
20.Hansen, SL, Freed, PK: Variation in the abilities of automated, commercial, and reference methods to detect methicillin-resistant (heteroresistant) Staphylococcus aureus. J Clin Microbiol 1984; 20:494–499.Google Scholar
21.Jorgensen, JR, Redding, J, Johnson, JE, et al: Rapid recognition of methicillin-resistant Staphylococcus aureus by use of automated test systems. J Clin Microbiol 1984; 20:430–433.Google Scholar
22.Aldridge, KE, Janney, A, Sanders, CV, et al: Interlaboratory variation of antibiograms of methicillin-resistant and methicillin-susceptible Staphylococcus aureus strains with conventional and commercial testing systems. J Clin Microbiol 1983; 18:1226–1236.Google Scholar
23.Lally, RTEderer, MN, Woolfrey, BF: Evaluation of the newly modified Auto-Microbic system gram-positive susceptibility-MIC card for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1986;23:387.Google Scholar
24.Woolfrey, BF. Lally, RT, Ederer, MN: Evaluation of the Auto Microbic system for detection of resistance of Staphylococcus aureus to methicillin. J Clin Microbiol 1984; 19:464–467.CrossRefGoogle Scholar
25.Jones, RN: Status of the art: Past, present and antimicrobial susceptibility testing trends as monitored by the CAP laboratory proficiency surveys. Pathologist 1981; 35:423–430.Google Scholar
26.Jones, RN, Edson, DC: Special topics in antimicrobial susceptibility testing: Test accuracy against methicillin-resistant Staphylococcus aureus, pneumococci, and the sensitivity of ß-lactamase methods. Am J Clin Pathol 1983; 80(suppl):609–614.Google Scholar
27.Flemming, DW, Helgerson, DS, Maller, BL, et al: Methicillin-resistant Staphylococcus aureus. How reliable is laboratory reporting? Infect Control 1986; 7:164–167.CrossRefGoogle Scholar