Methicillin-resistant Staphylococcus aureus (MRSA): is there a need to change clinical practice?

Poor survival of Methicillin-resistant Staphylococcus aureus on inanimate objects in the public spaces

We investigated the prevalence of Staphylococcus aureus on shopping baskets in Osaka Prefecture, Japan. Multilocus sequence typing was performed to determine the genotypes of S. aureus isolates, and then a polymerase chain reaction method was used to detect staphylococcal enterotoxins and antibiotic resistance genes. In addition, desiccation tolerance of S. aureus isolates was evaluated in vitro. Forty‐six (6.2%) S. aureus isolates were collected from 740 shopping baskets, though only one MRSA strain was identified. In multilocus sequence typing findings, ten sequence types and 24 singletons were classified, which were divided into ten clonal complexes and six singletons. The most frequent staphylococcal enterotoxin gene was seg (30.4%). Our in vitro findings demonstrated that 70% of the S. aureus isolates, including the MRSA strain, became undetectable at 12 h after desiccation at an appropriate cell density, while the others remained viable for up to 24 h. Thus, it is difficult for MRSA organisms to survive on dry surfaces found in public areas. We speculated that inanimate objects in the community are unlikely to be a potential source for transmission of MRSA and that S. aureus on such objects outside of hospital settings is not a public health threat.

Different trends of MRSA and VRE in a German hospital, 1999-2005

Some of the clinically most menacing nosocomial pathogens are Methicillin-resistent Staphylococcus aureus (MRSA) and Vancomycin-resistent Enterococcus (VRE). During the last years both pathogens showed dramatic increases in colonization and infection rates in Germany. This study covers all patients positively tested for MRSA and VRE in a German University Hospital from 1999-2005. About 1,179 MRSA cases and 116 VRE cases have been reported. VRE was significantly associated with less infection, female gender, more death and higher nosocomial acquisition than MRSA. While MRSA rates increased impressively from 1999 to 2005 VRE rates decreased clearly. Assuming that compliance with hygienic measures is similar in dealing with MRSA and VRE it is quite unclear why these two major pathogens differ so much in their trends. One possibility is that the MRSA problem has been caused by an increasing share of nonnosocomially acquired MRSA.

Use of stochastic epidemic modeling to quantify transmission rates of colonization with methicillin-resistant Staphylococcus aureus in an intensive care unit

OBJECTIVE

To consider statistical methods for estimating transmission rates for colonization of patients with methicillin-resistant Staphylococcus aureus (MRSA) in an intensive care unit (ICU) from three different sources: background contamination, non-isolated patients, and isolated patients.

METHODS

We developed statistical methods that allowed for the analysis of interval-censored, routine surveillance data and extended the general epidemic model for the flow of patients through the ICU.

RESULTS

Within this ICU, the rate of transmission to susceptible patients from a background source of MRSA (0.0092 case per day; 95% confidence interval [CI95], 0.0062-0.0126) is approximately double the rate of transmission from a non-isolated patient (0.0052 case per day; CI95, 0.0013-0.0096) and six times the rate of transmission from an isolated patient (0.0015 case per day; CI95, 0.0001-0.0043). We used the methodology to investigate whether transmission rates vary with workload.

CONCLUSION

Our methodology has general application to infection by and transmission of pathogens in a hospital setting and is appropriate for quantifying the effect of infection control interventions.