Advertisement

Control of methicillin-resistantStaphylococcus aureus bacteraemia in high-risk areas

  • L. H. Blumberg
  • K. P. Klugman
Article

Abstract

In a 3,000-bed tertiary care hospital, 88 cases of methicillin-resistantStaphylococcus aureus (MRSA) bacteraemia were identified from 22,383 blood cultures (0.39 %) submitted to the microbiology laboratory over a one-year period. Two high-risk areas were identified: the paediatric oncology unit, in which 12 cases of MRSA bacteraemia were identified from 924 blood cultures (1.3 %), and the intensive care unit (ICU), in which 14 cases of MRSA bacteraemia were identified from 1,391 blood cultures (1.0 %). In a one-year targeted intervention programme in which staff and patients were screened for MRSA carriage, patient carriers isolated, and mupirocin and chlorhexidine treatment administered, the number of MRSA bacteraemia cases decreased in these areas to 0 and 4, respectively (p=0.000123 and 0.016), while the incidence of MRSA bacteraemia in non-targeted areas increased from 62 of 20,068 blood cultures (0.3 %) to 82 of 18,784 blood cultures (0.44 %) (p=0.047). In the year post intervention the incidence of MRSA bacteraemia increased to 3 of 815 cultures (0.37 %) in the paediatric oncology unit, 10 of 1,934 cultures (0.5 %) in the ICU, and 112 of 18,977 cultures (0.59 %) in the rest of the hospital (p=0.00004 versus preintervention period). This study demonstrates the efficacy of targeted MRSA control measures in a hospital in which MRSA is endemic.

Keywords

Intensive Care Unit Blood Culture Post Intervention Chlorhexidine Microbiology Laboratory 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cluzel R, Verner M, Vaurs R, Cluzel-Nigay M “Celbenin” resistant staphylococci. British Medical Journal 1961, 1: 113–114.CrossRefGoogle Scholar
  2. 2.
    Colley EW, McNicol MW, Bracken PM Methicillin-resistant staphylococci in a general hospital. Lancet 1965, 1: 595–597.CrossRefPubMedGoogle Scholar
  3. 3.
    Thompson RL, Cabezudo I, Wenzel RP Epidemiology of nosocomial infection caused by methicillin-resistantStaphylococcus aureus. Annals Internal Medicine 1982, 97: 309–317.Google Scholar
  4. 4.
    Chambers HF Treatment of infection and colonization caused by methicillin-resistantStaphylococcus aureus. Infection Control and Hospital Epidemiology 1991, 12: 29–35.PubMedCrossRefGoogle Scholar
  5. 5.
    Casewell MW, Hill RLR The carrier state: methicillin-resistantStaphylococcus aureus. Journal Antimicrobial Agents and Chemotherapy 1986, 18, Supplement A: 1–12.Google Scholar
  6. 6.
    Mulligan ME, Murray-Leisure KA, Ribner BS, Standiford HC, John JF, Korvick JA, Kauffman CA, Yu VL Methicillin-resistantStaphylococcus aureus: a consensus review of the microbiology, pathogens, and epidemiology with implications for preventions and management. American Journal Medicine 1993, 94: 313–328.CrossRefGoogle Scholar
  7. 7.
    Yu VL, Goetz AN, Wagener M, Smith PB, Rihs GD, Zuravleff MSStaphylococcus aureus nasal carriage and infection in patients on haemodialysis. Efficacy of antibiotic prophylaxis. New England Journal of Medicine 1986, 315: 91–96.PubMedCrossRefGoogle Scholar
  8. 8.
    Bartzokas CA, Paton JH, Gibson MF, Graham R, McLaughlin GA, Croton RS Control and eradication of methicillin-resistantStaphylococcus aureus in a surgical unit. New England Journal of Medicine 1984, 311: 1422–1425.PubMedCrossRefGoogle Scholar
  9. 9.
    Brady L, Thomson M, Palmer M Successful control of endemic MRSA in a cardiothoracic surgical unit. Medical Journal of Australia 1990, 152: 240–245.PubMedGoogle Scholar
  10. 10.
    Ayliffe GAJ, Duckworth GJ, Brumfitt W, Casewell MW, Cooke CM, andthe Combined Working Party of the Hospital Infection Society, British Society of Antimicrobial Chemotherapy Guidelines for the control of epidemic methicillin-resistantStaphylococcus aureus. Journal of Hospital Infection 1986, 7: 193–201.CrossRefPubMedGoogle Scholar
  11. 11.
    Brumfitt W, Hamilton-Miller J Methicillin resistantStaphylococcus aureus. New England Journal of Medicine 1989, 320: 1188–1196.PubMedCrossRefGoogle Scholar
  12. 12.
    Casewell MW, Hill RLR Minimal test requirements for nasal mupirocin and its role in the control of epidemic MRSA. Journal of Hospital Infection 1991, 19, Supplement B: 35–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Neu HC The use of mupirocin in controlling methicillin-resistantStaphylococcus aureus. Infection Control and Hospital Epidemiology 1990, 11: 11–16.PubMedGoogle Scholar
  14. 14.
    Bayer AW, Kirby WMM, Sherris JC, Turck M Antibiotic susceptibility testing by a standardised single-disc method. American Journal of Pathology 1966, 45: 493–496.Google Scholar
  15. 15.
    National Committee for Clinical Laboratory Standardisation Document M100-93. Third information supplement, December 1991, Table 2-M2-A4.Google Scholar
  16. 16.
    Tuffnell DJ, Croton RS, Hemingway DM, Hartley MN, Wake PN, Garvey RJP Methicillin resistantStaphylococcus aureus; the role of antisepsis in the control of an outbreak. Journal of Hospital Infection 1987, 10: 255–259.CrossRefPubMedGoogle Scholar

Copyright information

© Friedr. Vieweg & Sohn Verlagsgesellschaft mbH 1994

Authors and Affiliations

  • L. H. Blumberg
    • 1
  • K. P. Klugman
    • 1
  1. 1.Department of Medical Microbiology, Baragwanath HospitalUniversity of the Witwatersrand and the South African Institute for Medical ResearchJohannesburgSouth Africa

Personalised recommendations