Methicillin-Resistant Staphylococcus aureus in U.S. Hospitals, 1975–1991

Abstract

OBJECTIVES: Analyze changes that have occurred among U.S. hospitals over a 17-year period, 1975 through 1991, in the percentage of Staphylococcus aureus resistant to b-lactam antibiotics and associated with nosocomial infections. DESIGN: Retrospective review. The percentage of methicillin-resistant S aureus (MRSA) was defined as the number of S aureus isolates resistant to either methicillin, oxacillin, or nafcillin divided by the total number of S aureus isolates for which methicillin, oxacillin, or nafcillin susceptibility test results were reported to the National Nosocomial Infections Surveillance (NNIS) System. SETTING: NNIS System hospitals. RESULTS: Of the 66,132 S aureus isolates that were tested for susceptibility to methicillin, oxacillin, or nafcillin during 1975 through 1991, 6,986 (11%) were resistant to methicillin, oxacillin, or nafcillin. The percentage MRSA among all hospitals rose from 2.4% in 1975 to 29% in 1991, but the rate of increase differed significantly among 3 bed-size categories: <200 beds, 200 to 499 beds, and 2500 beds. In 1991, for hospitals with <200 beds, 14.9% of S aureus isolates were MRSA, for hospitals with 200 to 499 beds, 20.3% were MRSA; and for hospitals with >500 beds, 38.3% were MRSA. The percentage MRSA in each of the bed-size categories rose above 5% at different times: in 1983, for hospitals with 2500 beds; in 1985, for hospitals with 200 to 499 beds; and in 1987, for hospitals with <200 beds. CONCLUSIONS: This study suggests that hospitals of all sizes are facing the problem of MRSA, the problem appears to be increasing regardless of hospital size, and control measures advocated for MRSA appear to require re-evaluation. Further study of MRSA in hospitals would benefit our understanding of this costly pathogen. (Infect Control Hosp Epidemiol. 1992; 13:582-586.) infection. 1 Methicillin-resistant S aureus (MRSA) first emerged as an important clinical problem in the United Kingdom in the early 196Os, shortly after methicillin came into clinical use.2*3 Although MRSA

Personal paper: medicine in the 1990s needs a team approach

“…And must also be able to make independent referral to other health care professionals." 3 The potential value of such a practitioner was recognised by recent reports from both the Clinical Standards Advisory Group and the Audit Commission. 4 5 Nurse practitioners in accident and emergency departments can reduce waiting times, improve staff morale, and facilitate the more sensible use of resources.…”

“…Even in areas without apparent MRSA, speculative screening has detected positive patients, 4 questions-and may not succeed. 3 Even local treatment with topical antiseptics may have adverse effects and is unlikely to reduce carriage in sites such as the gut. 8 Carriage by staff shows that harbouring MRSA is compatible with continuing health.…”

What can be done about resistance to antibiotics?

“…Nevertheless, there is room for improvement. Despite the stringent application of conventional infection control measures, there has been an inexorable increase in multiresistant Staphylococcus aureus in hospitals around the world 17 – 19. Clearly, novel strategies are required if we are not to repeat this with the newly emerged vancomycin resistant strains 20.…”

Incidence of Antibiotic Resistance Bacteria in Jeddah's Ministry of Health Hospitals, Saudi Arabia

“…In the present study, MRSA counted only for 4.6% of the total collected isolates and 89% of S. aureus isolates which probably indicated the need for better understanding to infection control measures in the hospitals. Prevalence of MRSA in hospitals increased from 2.1% in 1975 to 35% in 1991 [24] and it was 46% in Western Pacific region, 5.7% in Canada, varied from less than 2% in the Netherlands to 54.4% in Portugal, from 23.6% in Australia to more than 70% in Japan and Hong Kong [25] [26] and 30% -60% in Thailand [27]. For serious MRSA infections, vancomycin is the treatment of choice and MRSA strains with reduced susceptibility to vancomycin have been reported [28] [29] but in this study no vancomycin resistant isolates were found.…”