Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later.

OBJECTIVE

To investigate the cause of increasing rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection at a university hospital.

DESIGN

Review of data collected by prospective hospital wide surveillance regarding rates of nosocomial MRSA colonization and infection.

SETTING

A 700-bed university hospital providing primary and tertiary care.

PATIENTS

Patients admitted to the hospital between 1986 and 1993 who were found to be infected or colonized with MRSA.

MAIN OUTCOME MEASUREMENT

Rates of MRSA infection and colonization.

RESULTS

MRSA infection or colonization was identified in 399 patients (0.18%) admitted during the 8-year study. There was no correlation between the annual rates of MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infections (P = .66). The frequency of both nosocomial and non-nosocomial cases increased significantly over the last 4 years of the study (P < .001 for trend). The ratio of patients who had acquired MRSA nosocomially to those admitted who already were infected or colonized decreased significantly during the study period (P = .002 for trend). There was a significant increase in the frequency of patients with MRSA being transferred from nursing homes and other chronic care facilities (P = .011). A cost-benefit analysis suggested that surveillance cultures of patients transferred from other healthcare facilities would save between $20,062 and $462,067 and prevent from 8 to 41 nosocomial infections.

CONCLUSIONS

An increase in the incidence of nosocomial MRSA infection was associated with an increased frequency of transfer of colonized patients from nursing homes and other hospitals. The lack of correlation between rates of MRSA and MSSA infections suggested that MRSA infections significantly increased the overall rate of staphylococcal infection. Screening cultures of transfer patients from facilities with a high prevalence of MRSA may offer significant benefit by preventing nosocomial infections and reducing patient days spent in isolation.