Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus (MRSA) infection at a teaching hospital |
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Authors: | Farrington M; Redpath C; Trundle C; Coomber S; Brown NM |
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Institution: | Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK. MFarrington@compuserve.com |
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Abstract: | A methicillin-resistant Staphylococcus aureus (MRSA) control policy, aimed
at eradication, was established at a 1000-bed hospital in 1985, applied
consistently for 10.5 years, and then relaxed. Its components included
screening of high-risk patients, transfer of carriers to exhaust-ventilated
isolation rooms, closure of wards to new admissions when local transmission
was detected, MRSA screening during outbreaks, and prospective collection
of clinical and epidemiological information. During the eradication policy
period, every 6 months, a mean of 5.1 patients (range 1-12) already
carrying MRSA were admitted, and a mean of 3.6 (range 0-16) acquired
carriage in the hospital. The largest outbreak comprised 11 patients
despite epidemic MRSA strain EMRSA-16 being introduced six times, and MRSA
did not become endemic. MRSA- positive admissions increased progressively
from 1993; nursing staff workload increased, areas available for
alternative patient accommodation were reduced, the resulting ward closures
interfered with clinical services, and hence the control policy was relaxed
in mid- 1995. Isolation facilities were overwhelmed with 622 new patient-
isolates in the next 18 months, and there were 67 clinical infections in
1996. The proportion of blood cultures positive for MRSA rose nearly
sevenfold by 1996 and 27-fold by 1997. Thus, repeated eradication of MRSA,
even epidemic strains, by use of a stringent policy, is possible given
sufficient resources, whereas flexible national guidelines designed to
control, but not eradicate, epidemic staphylococci, are currently unlikely
to be successful. The costs of eradication policies need to be weighed
against those of endemicity.
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