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Should We Vigorously Try to Contain and Control Methicillin-Resistant Staphylococcus aureus?

Published online by Cambridge University Press:  21 June 2016

John M. Boyce*
Affiliation:
Department of Medicine, Miriam Hospital and Brown University, Providence, Rhode Island
*
The Miriam Hospital, 164 Summit Ave., Providence, RI 02906

Abstract

Objective:

To review practices currently used to control transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, determine the frequency of their use, and discuss the indications for implementing such measures.

Design:

A questionnaire survey to determine how commonly selected control practices are used, and a literature review of the efficacy of control practices.

Participants:

Two hundred fifty-six of 360 hospital-based members fo the Society for Hospital Epidemiology of America, Inc. (SHEA) completed the survey questionnaire.

Result:

Many different combinations of surveillance and control measures are used by hospitals with MRSA. Nine percent of hospitals stated that no special measures were used to control MRSA. The efficacy of commonly used control measures has not been established by controlled trials.

Conclusions:

Implementing control measures is warranted when MRSA causes a high incidence of serious nosocomial infections, and is desirable when MRSA has been newly introduced into a hospital or into an intensive care unit, or when MRSA accounts for more than 10% of nosocomial staphylococcal isolates. While the value of some practices is well established, measures such as routinely attempting to eradicate carriage of MRSA by colonized patients and personnel require further evaluation.

Information

Type
Original articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991 

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References

1. Boyce, JM, Causey, WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control. 1982;3:377383.Google Scholar
2. Haley, RW, Hightower, AW, Khabbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Possible role of the house staff-patient transfer circuit. Ann Intern Med. 1982;97:297308.Google Scholar
3. Jarvis, WR, Thornsberry, C, Boyce, J, Hughes, JM. Methicillin-resistant Staphylococcus aureus at children's hospitals in the United States. Pediatr Infect Dis.1985;4:651655.Google Scholar
4. Preheim, LC. Rimland, D. Bittner, MT. Methicillin-resistant Staphylococcus aureus in Veterans Administration Medical Centers. Infect Control. 1987;8:191194.Google Scholar
5. Wakefield, DS, Pfaller, M, Massanari, RM, Hammons, GT Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control. 1987;8:151157.Google Scholar
6. Hughes, JM. Study on the efficacy of nosocomial infection control (SENIC Project): results and implications for the future. Chemotherapy. 1988;34:553561.Google Scholar
7. Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol. 1990;11:639642.Google Scholar
8. McDougal, LK, Thornsberry, C. The role of Β-tactamase in staphylococcal resistance to penicillinase-resistant penicillins and cephalosporins. J Clin Microbiol. 1986;23:832839.Google Scholar
9. Thornsberry, C, McDougal, LK. Successful use of broth microdilution in susceptibility tests for methicillin-resistant (heter-oresistant) staphylococci. J Clin Microbiol. 1983;18:10841091.Google Scholar
10. Jorgensen, JH, Redding, JS, Maher, LA Ramirez, PE. Salt-supplemented medium for testing methicillin-resistant staphylococci with newer Β-lactams. J Clin Microbiol. 1988;26:16751678.Google Scholar
11. Archer, GL, Mayhall, CG. Comparison of epidemiological markers used in the investigation of an outbreak of methicillin-resistant Staphylococcus aureus infections. J Clin Microbiol. 1983;18:395399.Google Scholar
12. Mulligan, ME, Kwok, RY, Citron, DM, John, JF Jr, Smith, PB. Immunoblots, antimicrobial resistance, and bacteriophage typing of oxacillin-resistant Staphylococcus aureus . J Clin Microbiol. 1988;26:23952401.Google Scholar
13. Jordens, JZ, Hall, LM. Characterisation of methicillin-resistant Staphylococcus aureus isolates by restriction endonuclease digestion of chromosomal DNA. J Med Microbiol.1988;27:117123.Google Scholar
14. Bigelow, N, Ng, LK, Robson, HG, Dillon, JR. Strategies for molecular characterisation of methicillin- and gentamicin-resistant Staphylococcus aureus in a Canadian nosocomial outbreak. J Med Microbiol. 1989;30:5158.Google Scholar
15. Burnie, JP, Matthews, RC, Lee, W, Murdoch, D. A comparison of immunoblot and DNA restriction patterns in characterising methicillin-resistant isolates of Staphylococcus aureus . J Med Microbiol 1989;29:255261.Google Scholar
16. Chambers, HR Methicillin-resistant staphylococci. Clin Microbiol Rev.1988:1:173186.Google Scholar
17. Watanakunakorn, C. Treatment of infections due to methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:376378.Google Scholar
18. Sorrell, TC, Packham, DR, Shanker, S, Foldes, M, Munro, R. Vancomycin therapy for methicillin-resistant Staphylococcus aureus . Ann Intern Med.1982;97:344350.Google Scholar
19. Marples, RR, Cooke, EM. Current problems with methicillin-resistant Staphylococcus aureus . J Hosp Infect. 1988;11:381392.Google Scholar
20. Guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus. Report of a combined working party of the Hospital Infection Society and British Society for Antimicrobial Chemotherapy. J Hosp Infect.1986;7:193201.Google Scholar
21. Bell, SM. Recommendations for control of the spread of methicillin-resistant Staphylococcus aureus infection based on 18 years' experience in a group of teaching hospitals. Med J Aust.1982;1:472474.Google Scholar
22. McManus, AT, Mason, AD Jr, McManus, WF, Pruitt, BA Jr. What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? Arch Surg.1989;124:14561459.Google Scholar
23. Lacey, RW. Multi-resistant Staphylococcus aureus-a suitable case for inactivity.J Hosp Infect.1987;9:103105.Google Scholar
24. Cookson, BD, Phillips, I. Epidemic methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother. 1988;21 (suppl C):5765.Google Scholar
25. Marples, RR, Richardson, JF, DeSaxe, MJ. Bacteriological characters of strains of Staphylococcus aureus submitted to a reference laboratory related to methicillin resistance journal of Hygiene. 1986;96:217223.Google Scholar
26. Bitar, CM, Mayhall, CG, Lamb, VA, Bradshaw, TJ, Spadora, AC, Dalton , HP. Outbreak due to methicillin-and rifampin-resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control. 1987;8:1523.Google Scholar
27. Alvarez, S, Shell, C, Gage, K, et al.An outbreak of methicillin-resistant Staphylococcus aureus eradicated from a large teaching hospital. Am J Infect Control. 1985;13:115121.Google Scholar
28. Boyce, JM, Landry, M, Deetz, TR, DuPont, HL. Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control.1981;2:110116.Google Scholar
29. Peacock, JE Jr, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med. 1980;93:526532.Google Scholar
30. Thomoson, RL. Cabezudo, L, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:309317.Google Scholar
31. Klimek, JJ, Marsik, FJ, Bartlett, RC, Weir, B, Shea, P, Quintiliani, R. Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med. 1976;61:340345.Google Scholar
32. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med. 1981;71:5358.Google Scholar
33. Locksley, RM. Cohen, ML. Quinn, TC. et al. Multiply antibiotic-resistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med. 1982;97:317324.Google Scholar
34. Millar, MR, Keyworth, N, Lincoln, C, King, B, Congdon, P. 'Methicillin-resistant' Staphylococcus aureus in a regional neonatology unit. J Hosp Infect. 1987;10:187197.Google Scholar
35. Davies, EA, Emmerson, AM, Hogg, GM, Patterson, MF, Shields, MD. An outbreak of infection with a methicillin-resistant Staphylococcus aureus in a special care baby unit: value of topical mupirocin and of traditional methods of infection control. J Hosp Infect. 1987;10:120128.Google Scholar
36. Hill, SF, Ferguson, D. Multiply-resistant Staphylococcus aureus (bacteriophage type 90) in a special care baby unit. J Hosp Infect.1984;5:5662.Google Scholar
37. Price, EH, Brain, A, Dickson, JA. An outbreak of infection with a gentamicin and methicillin-resistant Staphylococcus aureus in a neonatal unit. J Hosp Infect. 1980;1:221228.Google Scholar
38. Dunkle, LM, Naqvi, SH, McCallum, R, Lofgren, JP. Eradication of epidemic methicillin-gentamicin-resistant Staphylococcus aureus in an intensive care nursery. Am J Med. 1981:70:455458.Google Scholar
39. Lejeune, B, Buzit-Losquin, F, Simitzis-Le Flohic, AM, Le Bras, MP, Alix, D. Outbreak of gentamicin-methicillin-resistant Staphylococcus aureus infection in an intensive care unit for children. J Hosp Infect. 1986;7:2125.Google Scholar
40. Reboli, AC, John, JF Jr, Levkoff, AH. Epidemic methicillin-gentamicin-resistant Staphylococcus aureus in a neonatal intensive care unit. Am J Dis Child. 1989;143:3439.Google Scholar
41. Boyce, JM, White, RL, Causey, WA, Lockwood, WR. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA. 1983;249:28032807.Google Scholar
42. Arnow, PM. Allyn, PA, Nichols, EM, Hill, DL, Pezzlo, M, Bartlett, RH. Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing.J Trauma.1982;22:954959.Google Scholar
43. Linnemann, CC Jr. Mason, M. Moore, P. Korfhagen, TR. Staneck, JL. Methicillin-resistant Staphylococcus aureus: experience in a general hospital over four years. Am J Epidemiol. 1982;115:941950.Google Scholar
44. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II Eoidemioloeic studies. I Infect Dis. 1979;139:280287.Google Scholar
45. Walsh, TJ, Vlahov, D, Hansen, SL, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus . Infect Control. 1987;8:714.Google Scholar
46. Onesko, KM, Wienke, EC. The analysis of the impact of a mild, low-iodine lotion soap on the reduction of nosocomial methicillin-resistant Staphylococcus aureus: a new opportunity for surveillance by objectives. Infect Control.1987;8:284288.Google Scholar
47. Bacon, AE., Iornensen, KA. Wilson, KH. Kauffman, CA. Emergence of nosocomial methicillin-resistant Staphylococcus aureus and therapy of colonized personnel during a hospital-wide outbreak. Infect Control. 1987;8:145150.Google Scholar
48. Rhinehart, E, Shlaes, DM, Keys, TF, et al. Nosocomial clonal dissemination of methicillin-resistant Staphylococcus aureus. Elucidation by plasmid analysis. Arch Intern Med. 1987;147:521524.Google Scholar
49. Ribner, BS, Landry, MN, Gholson, GL. Strict versus modified isolation for prevention of nosocomial transmission of methicillin-resistant Staphylococcus aureus . Infect Control. 1986;7:317320.Google Scholar
50. Rimland, D. Nosocomial infections with methicillin and tobramycin resistant Staphylococcus aureus-implication of physiotherany in hospital-wide dissemination. Am I Med Sci.1985;290:9197.Google Scholar
51. Bradley, JM, Noone, P, Townsend, DE, Grubb, WB. Methicillin-resistant Staphylococcus aureus in a London hospital. Lancet.1985;1:1493–1495.Google Scholar
52. Pearman, JW, Christiansen, KJ, Annear, DI, et al. Control of methicillin-resistant Staphylococcus aureus (MRSA) in an Aus-tralian metropolitan teaching hospital complex. Med J Aust. 1985;142:103108.Google Scholar
53. Shanson, DC, Johnstone, D,Midgley, J. Control of a hospital outbreak of methicillin-resistant Staphylococcus aureus infections: value of an isolation unit. J Hosp Infect.1985;6:285292.Google Scholar
54. Tyzack, R. The management of methicillin-resistant Staphylococcus aureus in a major hospital. J Hosp Infect, 1985;6:195199.Google Scholar
55. Bartzokas, CA, Paton, JFF, Gibson, MP, Graham, F, McLoughlin, GA, Croton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med. 1984;311:14221425.Google Scholar
56. Ellison, RT III, Judson, FN, Peterson, LC, Cohn, DL, Ehret, JM. Oral rifampin and trimethoprim/sulfamethoxazole therapy in asymptomatic carriers of methicillin-resistant Staphylococcus aureus infections. West /Med. 1984;140:735740.Google Scholar
57. Selkon, IB. Stokes, ER. Ingham, HR. The role of an isolation unit in the control of hospital infection with methicillin-resistant staphylococci . J Hosp Infect. 1980;1:4146.Google Scholar
58. Ward, TT, Winn, RE, Hartstein, AI, Sewell, DL. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control. 1981;2:453459.Google Scholar
59. Saroglou, G, Cromer, M, Bisno, AL. Methicillin-resistant Staphylococcus aureus: interstate spread of nosocomial infections with emergence of gentamicin-methicillin resistant strains. Infect Control. 1980;1:8189.Google Scholar
60. Pavillard, R, Harvey, K, Douglas, D, et al. Epidemic of hospital acquired infection–; due to methicillin-resistant Staphylococcus aureus in major Victorian hospitals. Med J Aust. 1982:1:451454.Google Scholar
61. Shanson, DC, Kensit, JC, Duke, R. Outbreak of hospital infection with a strain of Staphylococcus aureus resistant to gentamicin and methicillin. Lancet. 1976;2:13471348.Google Scholar
62. Michel, MF, Priem, CC. Control at hospital level of infections by methicillin-resistant staphylococci in children, journal of Hygiene. 1971;69:453460.Google Scholar
63. Drew, WL, Dahlgren, BJ, Beaty, HN. An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA. 1970;213:257262.Google Scholar
64. Hill, RL, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother. 1988;22:377384.Google Scholar
65. Law, MR, Gill, ON, Turner, A. Methicillin-resistant Staphylococcus aureus: associated morbidity and effectiveness of control measures. Epidemiol Infect. 1988;101:301309.Google Scholar
66. Coovadia, YM, Bhana, RH, Johnson, AP, Haffejee, I, Marples, RR. A laboratory-confirmed outbreak of rifampicin-methicillin-resistant Staphylococcus aureus (RMRSA) in a newborn nursery. J Hosp Infect. 1989;14:303312.Google Scholar
67. Dacre, J, Emmerson, AM, Jenner, EA. Gentamicin-methicillin-resistant Staphylococcus aureus: epidemiology and containment of an outbreak, J Hosp Infect. 1986;7:130136.Google Scholar
68. Duckworth, GJ, Lothian, JLE, Williams, JD. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London hospital. J Hosp Infect.1988;11:115.Google Scholar
69. Murray-Leisure, KA, Geib, S, Graceley, D, et al. Control of epidemic methicillin-resistant Staphylococcus aureus .Infect Control Hosp Epidemiol. 1990;11:343350.Google Scholar
70. Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol. 1988;9:255260.Google Scholar
71. Tuffnell, DJ, Croton, RS, Hemingway, DM, Hartley, MN, Wake, PN, Garvey, RJP. Methicillin resistant Staphylococcus aureus; the role of antisepsis in the control of an outbreak. J Hosp Infect. 1987;10:255259.Google Scholar
72. Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis. 1979;139:273279.Google Scholar
73. Lewis, E, Saravolatz, LD. Comparison of methicillin-resistant and methicillin-sensitive Staphylococcus aureus bacteremia. Am J Infect Control. 1985;13:109114.Google Scholar
74. Mehtar, S, Drabu, YJ, Mayet, F. Expenses incurred during a five-week epidemic methicillin-resistant Staphylococcus aureus outbreak. J Hosp Infect. 1989;13:199203.Google Scholar
75. Mulligan, ME, Ruane, PJ, Johnston, L, et al. Ciprofloxacin for eradication of methicillin-resistant Staphylococcus aureus colonization. Am J Med. 1987:82(suppl 4A):215219.Google Scholar
76. Blumberg, HM, Rimland, D, Wachsmuth, IK. Rapid development of ciprofloxacin resistance in methicillin-sensitive and methicillin-resistant S aureus. The 29th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 18, 1989; Houston, TX: Abstract 7.Google Scholar
77. Peterson, L, Quick, J, Jensen, B, et al. Emergence of ciprofloxacin resistance in nosocomial methicillin-resistant Staphylococcus aureus (MRSA) isolates during ciprofloxacin plus rifampin therapy for MRSA colonization. The 29th Interscience Conference on Antimicrobial Agents and Chemotherapy, September 20, 1989; Houston, TX: Abstract 1255.Google Scholar
78. Cafferkey, MT, Hone, R, Keane, CT Sources and outcome for methicillin-resistant Staphylococcus aureus bacteremia. J Hosp Infect. 1988;11:136143.Google Scholar
79. Boyce, JM. Nosocomial staphylococcal infections. Ann Intern Med. 1981;95:241242.Google Scholar
80. Casewell, MW. Epidemiology and control of the 'modern' methicillin-resistant Staphylococcus aureus . J Hosp Infect. 1986;7:111.Google Scholar
81. Sahm, DF, Kissinger, J, Gilmore, MS, et al. In vitro susceptibility studies of vancomycin-resistant Enterococcus faecalis . Antimicrob Agents Chemother. 1989;33:15881591.Google Scholar
82. Nicas, Tl, Cole, CT, Preston, DA, Schabel, AA, Nagarajan, R. Activity of glycopeptides against vancomycin-resistant gram-positive bacteria. Antimicrob Agents Chemother. 1989;33:14771481.Google Scholar
83. Bingen, E, Lambert-Zechovsky, N, Mariani-Kurkdjian, P, JP, Cezard, Navarro, J. Bacteremia caused by a vancomycin-resistant Enterococcus . Pediatr Infect Dis J. 1989;8:475476.Google Scholar
84. Leclercq, R, Derlot, E, Weber, M, Duval, J, Courvalin, P. Transferrable vancomycin and teicoplanin resistance in Enterococcus faecium. Antimicrob Agents Chemother. 1989;33:1015.Google Scholar
85. Ruoff, KL, Kuritzkes, DR, Wolfson, JS, Ferraro, MJ. Vancomycin-resistant gram-positive bacteria isolated from human sources. J Clin Microbiol. 1988;26:20642068.Google Scholar
86. Kaplan, AH, Gilligan, PH, Facklam, RR. Recovery of resistant enterococci during vancomycin prophylaxis. J Clin Microbiol. 1988;26:12161218.Google Scholar
87. Uttley, AH, Collins, CH, Naidoo, J, George, RC. Vancomycin-resistant enterococci. Lancet.1988;1:5758.Google Scholar
88. Duckworth, GJ, Lothian, JL, Williams, JD. Methicillin-resistant Staphylococcus aureus: report of an outbreak in a London teaching hospital. J Hosp Infect. 1988;11:115.Google Scholar
89. Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus . J Clin Microbiol. 1989;27:14711476.Google Scholar
90. Shanson, DC. McSwiggan, DA. Operating theatre acquired infection with a gentamicin-resistant strain of Staphylococcus aureus: outbreak in two hospitals attributable to one surgeon. J Hosp Infect. 1980;1:171172.Google Scholar
91. Spicer, WJ. Three strategies in the control of staphylococci including methicillin-resistant Staphylococcus aureus . J Hosp Infect. 1984;5:4549.Google Scholar
92. Rahman, M, Noble, WC, Cookson, B. Mupirocin-resistant Staphylococcus aureus . Lancet. 1987;2:387.Google Scholar
93. Smith, GE, Kennedy, CTC. Staphylococcus aureus resistant to mupirocin. J Antimicrob Chemother.1988;21:14142.Google Scholar
94. Casewell, MW, Hill, RL. The carrier state: methicillin-resistant Staphylococcus aureus . J Antimicrob Chemother. 1986;18:112.Google Scholar
95. Fekety, R. The management of the carrier of methicillin-resistant Staphylococcus aureus . Curr Clin Top Infect Dis.1987;8:169180.Google Scholar