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Biosensor for Detection of Antibiotic Resistant Staphylococcus Bacteria
Published on: May 8, 2013
Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care
Deron C Burton1, Jonathan R Edwards, Teresa C Horan
1Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dburton@cdc.gov
Context:
Concerns about rates of methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections have prompted calls for mandatory screening or reporting in efforts to reduce MRSA infections.
Objective:
To examine trends in the incidence of MRSA central line-associated bloodstream infections (BSIs) in US intensive care units (ICUs).
Design, Setting, And Participants:
Data reported by hospitals to the Centers for Disease Control and Prevention (CDC) from 1997-2007 were used to calculate pooled mean annual central line-associated BSI incidence rates for 7 types of adult and non-neonatal pediatric ICUs. Percent MRSA was defined as the proportion of S aureus central line-associated BSIs that were MRSA. We used regression modeling to estimate percent changes in central line-associated BSI metrics over the analysis period.
Main Outcome Measures:
Incidence rate of central line-associated BSIs per 1000 central line days; percent MRSA among S. aureus central line-associated BSIs.
Results:
Overall, 33,587 central line-associated BSIs were reported from 1684 ICUs representing 16,225,498 patient-days of surveillance; 2498 reported central line-associated BSIs (7.4%) were MRSA and 1590 (4.7%) were methicillin-susceptible S. aureus (MSSA). Of evaluated ICU types, surgical, nonteaching-affiliated medical-surgical, cardiothoracic, and coronary units experienced increases in MRSA central line-associated BSI incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical, and pediatric units experienced no significant changes. From 2001 through 2007, MRSA central line-associated BSI incidence declined significantly in all ICU types except in pediatric units, for which incidence rates remained static. Declines in MRSA central line-associated BSI incidence ranged from -51.5% (95% CI, -33.7% to -64.6%; P < .001) in nonteaching-affiliated medical-surgical ICUs (0.31 vs 0.15 per 1000 central line days) to -69.2% (95% CI, -57.9% to -77.7%; P < .001) in surgical ICUs (0.58 vs 0.18 per 1000 central line days). In all ICU types, MSSA central line-associated BSI incidence declined from 1997 through 2007, with changes in incidence ranging from -60.1% (95% CI, -41.2% to -73.1%; P < .001) in surgical ICUs (0.24 vs 0.10 per 1000 central line days) to -77.7% (95% CI, -68.2% to -84.4%; P < .001) in medical ICUs (0.40 vs 0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated BSIs due to MRSA increased 25.8% (P = .02) in the 1997-2007 period, overall MRSA central line-associated BSI incidence decreased 49.6% (P < .001) over this period.
Conclusions:
The incidence of MRSA central line-associated BSI has been decreasing in recent years in most ICU types reporting to the CDC. These trends are not apparent when only percent MRSA is monitored.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) central line-associated bloodstream infections (BSIs) decreased in most US intensive care units (ICUs) from 1997-2007. Monitoring only the percentage of MRSA BSIs may mask these important incidence trends.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Healthcare-associated infections, particularly MRSA, are a significant concern.
- Mandatory screening and reporting are proposed to reduce MRSA infections.
Purpose of the Study:
- To analyze trends in MRSA central line-associated bloodstream infections (BSIs) within US intensive care units (ICUs).
Main Methods:
- Utilized CDC data from 1997-2007 for 1684 ICUs.
- Calculated pooled mean annual BSI incidence rates and percent MRSA.
- Employed regression modeling to assess changes over time.
Main Results:
- MRSA BSI incidence declined significantly in most ICU types between 2001-2007, with reductions up to 69.2%.
- Methicillin-susceptible S. aureus (MSSA) BSI incidence also decreased across all ICU types.
- Despite an overall increase in the proportion of S. aureus BSIs that were MRSA, the total MRSA BSI incidence decreased by 49.6%.
Conclusions:
- MRSA central line-associated BSI incidence has been declining in most ICUs.
- Monitoring only the percentage of MRSA among S. aureus BSIs may not accurately reflect incidence trends.
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