Methicillin-resistant<i>Staphylococcus aureus</i>in Europe, 1999–2002

Tiemersma, Edine; Bronzwaer, S L A M; Lyytikäinen, Outi; Degener, John E.; Schrijnemakers, P; Bruinsma, Nienke; Monen, Jos; Witte, Wolfgang; Grundmann, Hajo

doi:10.3201/eid1009.040069

Cited by 476 publications

(319 citation statements)

References 36 publications

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“…N osocomial infections with methicillin-resistant Staphylococcus aureus (MRSA) are a major healthcare problem in most developed countries (1). Despite an increasing number of reports on infections caused by so-called community-associated MRSA (2), the majority of MRSA infections are still hospital-related (3).…”

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confidence: 99%

Controlling methicillin-resistant Staphylococcus aureus : Quantifying the effects of interventions and rapid diagnostic testing

Bootsma

Diekmann

Bonten

2006

Proc. Natl. Acad. Sci. U.S.A.

253

221

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Control of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) has been unsuccessful in most countries. Yet, some countries have maintained low endemic levels by implementing nationwide MRSA-specific infection control measures, such as ''search & destroy'' (S&D). These strategies, however, are not based on well designed studies, and their use in countries with high levels of endemicity is controversial. We present a stochastic three-hospital model and an analytical one-hospital model to quantify the effectiveness of different infection control measures and to predict the effects of rapid diagnostic testing (RDT) on isolation needs. Isolation of MRSA carriers identified by clinical cultures is insufficient to control MRSA. However, combined with proactive search (of high-risk patients on admission and͞or contacts of index patients), it will maintain prevalence levels <1%. Concerted implementation of S&D in countries with high nosocomial endemicity reduces nosocomial prevalence to <1% within 6 years. Stepwise implementation of control measures can reduce isolation capacities needed. RDT can reduce isolation needs by >90% in low-endemic settings and by 20% in high-endemic settings. Surveillance of colonization and improved hand hygiene can markedly increase control efficacy. These findings strongly suggest that: (i) causality exists between S&D and low MRSA prevalence; (ii) isolating MRSA carriers identified by clinical cultures as a single measure is insufficient for control; (iii) a combined approach of isolation and screening confers efficacy; and (iv) MRSA-prevalence levels can be reduced to <1% in high-endemic settings by S&D or a stepwise approach to interventions. RDT can markedly enhance feasibility.infection control ͉ mathematical model ͉ search & destroy ͉ antibiotic resistance

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mentioning

confidence: 99%

Controlling methicillin-resistant Staphylococcus aureus : Quantifying the effects of interventions and rapid diagnostic testing

Bootsma

Diekmann

Bonten

2006

Proc. Natl. Acad. Sci. U.S.A.

253

221

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“…The European Antimicrobial Resistance Surveillance System reported an MRSA prevalence in Portugal in blood isolates of around 39% in 2002, which is one of the highest in Europe (33). During the last 15 years there were successive waves of dominant MRSA clones in Portuguese hospitals: (i) in 1992 and 1993, the Iberian clone replaced the Portuguese clone (ST239-III variant) widely spread in the country in the mid-1980s and early 1990s; (ii) in 1994 and 1995, the Brazilian clone was introduced, and its representation has rapidly increased since then; and (iii) in 2001, clone EMRSA-15 emerged and is nowadays becoming the dominant clone in the hospital setting (1).…”

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confidence: 99%

Comparison of Genetic Backgrounds of Methicillin-Resistant and -Susceptible Staphylococcus aureus Isolates from Portuguese Hospitals and the Community

et al. 2005

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In order to understand the origins of the dominant methicillin-resistant Staphylococcus aureus (MRSA) clones in Portuguese hospitals, we compared the genetic backgrounds of nosocomial MRSA with methicillinsusceptible S. aureus (MSSA) isolates from the same hospitals (n ‫؍‬ 155) and from the community (n ‫؍‬ 157) where they were located. Pulsed-field gel electrophoresis, spa typing, multilocus sequence typing, and agr type analysis revealed that the genetic backgrounds correspondent to the dominant MRSA clones in Portuguese hospitals during the last 15 years (Iberian ST247, Brazilian ST239, and EMRSA-15 ST22) were scarcely or not found among the present MSSA collection. The four major MSSA clones encountered (A-ST30, B-ST34, C-ST5, and H-ST45) correspond, or are very similar, to the background of other international MRSA pandemic clones, i.e., EMRSA-16, New York/Japan, Pediatric, and Berlin clones. However, with the exception of the Pediatric clone, none of these MRSA clones has been detected in Portugal. Our findings suggest the three major MRSA clones identified in Portuguese hospitals have not originated from the introduction of SCCmec into dominant MSSA backgrounds present in the Portuguese nosocomial or community environment but were probably imported from abroad. In contrast, the MRSA Pediatric clone might have originated in our country by the acquisition of SCCmec type IV into MSSA clone C. Furthermore, we provide evidence that the introduction of SCCmec into sensitive clones is most likely a relatively infrequent event that seems to depend not exclusively on the presence of a successful MSSA lineage.

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“…1 The proportion of S. aureus isolates with methicillin resistance is increasing in both the United States and several European countries. 2,3 Nasal colonization with S. aureus predisposes to subsequent infection, particularly in surgical patients. [4][5][6] Infections caused by methicillin-resistant S. aureus (MRSA) have been associated with increased mortality and hospital costs, compared with methicillin-susceptible strains.…”

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confidence: 99%

Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

Warren

Guth

Coopersmith

et al. 2006

Infect. Control Hosp. Epidemiol.

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of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit." Infection Control and Hospital Epidemiology. 27,10. 1032-1040. (2006 http://www.jstor.org/page/info/about/policies/terms.jsp JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. The University of Chicago Press andThe Society for Healthcare Epidemiology of America are collaborating with JSTOR to digitize, preserve and extend access to Infection Control and Hospital Epidemiology.

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Methicillin-resistantStaphylococcus aureusin Europe, 1999–2002

Abstract: European Antimicrobial Resistance Surveillance System shows large variations in methicillin-resistant S. aureus .

Cited by 476 publications

References 36 publications

Controlling methicillin-resistant Staphylococcus aureus : Quantifying the effects of interventions and rapid diagnostic testing

Controlling methicillin-resistant Staphylococcus aureus : Quantifying the effects of interventions and rapid diagnostic testing

Comparison of Genetic Backgrounds of Methicillin-Resistant and -Susceptible Staphylococcus aureus Isolates from Portuguese Hospitals and the Community

Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

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