Methicillin-resistant Staphylococcus aureus. Past, present, and future

The MRSA control program at UCDMC is one of many approaches used in hospitals today. With this less restrictive program, we have been able to maintain control of MRSA for approximately 5 years. By establishing a threshold for investigation at four new nosocomial cases per month, the ICD has been able to maintain a manageable endemic level of MRSA. Figure 2 shows the downward trend of new cases of MRSA per fiscal year. During 1991, however, we experienced clustering of cases in two areas of the hospital along with a major outbreak in our burn unit. This is reflected in the significant rise in the number of new cases for that year. Even with these outbreaks, however, we have been able to re-establish control. Figure 3 represents the number of new MRSA cases per month during fiscal year 1991. After the peak in April, we have again seen a downward trend, with an average of four new cases per month during the first quarter of fiscal year 1992. The success of this program is attributed to the cooperation and excellent communication among the hospital departments who are active participants in this control program. It is also owing to the establishment of a very active antibiotic control program that discourages inappropriate use of antimicrobial agents. This team effort is critical to the success of any infection control program. Infection control protocols are constantly changing, even if they are directed toward the same pathogen. Hospital epidemiology provides us with a very systematic approach to controlling the spread of disease. During the process, however, we are constantly collecting new information about the pathogen, allowing us to re-evaluate and, we hope, improve our approach to control. This is one reason for the numerous approaches to control found in the vast array of MRSA literature. MRSA continues to be a challenge of the 1990s. It appears to be an increasing problem in US hospitals, regardless of hospital size. Although its elusive behavior evades the most comprehensive and carefully planned control programs of even the most skilled hospital epidemiologists, hospitals continue to struggle for control of this organism. The alternative to control is probable resistance to vancomycin, which would have devastating public health consequences, particularly as alternative antibiotic therapy is not yet available.