Surveillance and control of methicillin-resistant Staphylococcus aureus infections in French hospitals.

OBJECTIVE: To assess the way French hospitals conduct surveillance for, and control infections caused by, methicillin-resistant Staphylococcus aureus (MRSA), and to evaluate the incidence of these infections. DESIGN: Retrospective analysis of sample surveillance data. SETTING: Representative sample of French hospitals. PARTICIPANTS: Representative sample of 38 French public hospitals. METHODS: Hospitals were selected randomly in 1996, taking into account their location and number of beds. Administrative data, surveillance denominators used, antimicrobial resistance rates, and infection control practices were analyzed for the period 1990 to 1995. The same 38 centers were contacted 3 years later, in 1998, to reassess their surveillance and control activities. RESULTS: French hospitals were slow to implement MRSA surveillance programs; only 5% had such programs in 1990, when the median incidence per admission (0.37%) and per patient-days (0.04%) of MRSA infections was already high. Despite the implementation of surveillance programs in 66% of French hospitals in 1995 and 87% in 1998, the MRSA infection rates remained stable from 1990 to 1995 and increased from 1995 to 1998. The proportion of French hospitals having a policy for the transfer of MRSA-infected patients to other hospitals increased from 47% in 1995 to 61% in 1998, whereas screening for MRSA colonization (42%-53%) and isolation for colonized or infected patients (87%-89%) remained stable. CONCLUSIONS: This first national survey showed that French hospitals probably were not optimally prepared to control and prevent MRSA infections, since they were slow to respond to the growing problem.