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Epidemiology and control of meticillin-resistant Staphylococcus aureus in Stockholm County, Sweden, 2000 to 2016: overview of a “search-and-contain” strategy

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Abstract

To review the epidemiology and measures to control meticillin-resistant Staphylococcus aureus, MRSA, in Stockholm between 2000 and 2016 from the perspective of the Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden. Age, sex, and place of acquisition of their MRSA on all patients reported to the department were reviewed. Measures for control included surveillance through mandatory reporting of cases, screening patients with risk factors for MRSA, strict adherence to basic nursing hygienic principles, isolation of MRSA positive patients in single rooms in dedicated MRSA wards, and cohorting of staff. An MRSA team was created at the Department of Infectious Diseases, Karolinska University Hospital, for follow-up of all cases. Several administrative meetings and cooperative groups were formed that are still in function. From 2000 to 2016, there were 7373 MRSA cases reported. Healthcare-associated MRSA, HA-MRSA, was successfully controlled, and from 2006 onwards, very limited HA-MRSA transmission or outbreaks occurred. However, incidence increased overall, from 9.5 per 100,000 in 2000 to 37.3 per 100,000 in 2016, due to increase of MRSA acquired abroad and of MRSA acquired in the Swedish community. Surveillance and control measures have been successful in containing HA-MRSA in Stockholm, Sweden, but incidence has increased substantially due to imported cases and spread in the Swedish community. The strategy may be termed “search-and-contain” since screening, infection control, follow-up, and advice on personal hygiene were cornerstones of control, whereas eradication of carriage was not.

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Acknowledgments

We wish to thank all colleagues and staff at the departments of Infection Control, Infectious Diseases, and Microbiology Laboratories as well as all clinical staff that have been involved in work with MRSA during these years.

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Authors and Affiliations

  1. Department of Communicable Disease Control and Prevention, Stockholm County Council, Stockholm, Sweden

    Björn K. G. Eriksson, Ulla-Britt Thollström, Joanna Nederby-Öhd & Åke Örtqvist

  2. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Joanna Nederby-Öhd

  3. Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden

    Åke Örtqvist

Authors
  1. Björn K. G. Eriksson
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  2. Ulla-Britt Thollström
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  3. Joanna Nederby-Öhd
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  4. Åke Örtqvist
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Corresponding author

Correspondence to Björn K. G. Eriksson.

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The authors declare that they have no conflicts of interest.

Ethical approval

All data were collected as required by the Swedish Communicable Diseases Act.

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Informed consent was obtained from all patients included in the study. See also above on ethical approval.

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Eriksson, B.K.G., Thollström, UB., Nederby-Öhd, J. et al. Epidemiology and control of meticillin-resistant Staphylococcus aureus in Stockholm County, Sweden, 2000 to 2016: overview of a “search-and-contain” strategy. Eur J Clin Microbiol Infect Dis 38, 2221–2228 (2019). https://doi.org/10.1007/s10096-019-03664-2

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  • DOI: https://doi.org/10.1007/s10096-019-03664-2

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