Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007.

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.

[1]  A. Hidrón,et al.  Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007 , 2008, Infection Control &#x0026; Hospital Epidemiology.

[2]  L. Mermel,et al.  Methicillin-resistant Staphylococcus aureus transmission: the possible importance of unrecognized health care worker carriage. , 2008, American journal of infection control.

[3]  David L. Smith,et al.  Hospitalizations and Deaths Caused by Methicillin-Resistant Staphylococcus aureus, United States, 1999–2005 , 2007, Emerging infectious diseases.

[4]  E. Larson,et al.  Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates. , 2007, American journal of infection control.

[5]  Roberta B Carey,et al.  Invasive methicillin-resistant Staphylococcus aureus infections in the United States. , 2007, JAMA.

[6]  D. Maki,et al.  Intravascular catheter-related infections: advances in diagnosis, prevention, and management. , 2007, The Lancet. Infectious diseases.

[7]  Michael B Edmond,et al.  Mandatory public reporting in the USA: an example to follow? , 2007, The Journal of hospital infection.

[8]  L. Mermel Prevention of central venous catheter-related infections: what works other than impregnated or coated catheters? , 2007, The Journal of hospital infection.

[9]  Susan S. Huang,et al.  Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force , 2007, Infection Control &#x0026; Hospital Epidemiology.

[10]  P. Pronovost,et al.  An intervention to decrease catheter-related bloodstream infections in the ICU. , 2006, The New England journal of medicine.

[11]  O. Stine,et al.  Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. , 2006, The American journal of medicine.

[12]  H. Rüden,et al.  Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. , 2006, The Journal of hospital infection.

[13]  E. Wong,et al.  A Multicenter Intervention to Prevent Catheter-Associated Bloodstream Infections , 2006, Infection Control &#x0026; Hospital Epidemiology.

[14]  N. Oztoprak,et al.  Risk factors for ICU-acquired methicillin-resistant Staphylococcus aureus infections. , 2006, American journal of infection control.

[15]  P. Gastmeier,et al.  Methicillin-Resistant Staphylococcus aureus in German Intensive Care Units During 2000-2003: Data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units) , 2006, Infection Control &#x0026; Hospital Epidemiology.

[16]  R. Wenzel,et al.  Bacteremias: a leading cause of death. , 2005, Archives of medical research.

[17]  James G. Johnson,et al.  Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  S. Cosgrove,et al.  The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges , 2005, Infection Control &#x0026; Hospital Epidemiology.

[19]  J. Basualdo,et al.  Prevention of central venous catheter-related bloodstream infections using non-technologic strategies. , 2004, Infection control and hospital epidemiology.

[20]  P Gastmeier,et al.  Surveillance of nosocomial infections , 2004 .

[21]  Nnis System National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. , 2003, American journal of infection control.

[22]  R. Gaynes,et al.  Antimicrobial Proficiency Testing of National Nosocomial Infections Surveillance System Hospital Laboratories , 2003, Infection Control &#x0026; Hospital Epidemiology.

[23]  Carlene A. Muto,et al.  SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus , 2003, Infection Control &#x0026; Hospital Epidemiology.

[24]  Sanjay Saint,et al.  Guidelines for the prevention of intravascular catheter-related infections. , 2002, American journal of infection control.

[25]  Didier Pittet,et al.  Guideline for Hand Hygiene in Health-Care Settings Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC / SHEA / APIC / IDSA Hand Hygiene Task Force , 2002 .

[26]  Didier Pittet,et al.  Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. , 2002, American journal of infection control.

[27]  D. Pittet,et al.  Infection control in the ICU. , 2001, Chest.

[28]  J Edwards,et al.  Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. , 2001, American journal of infection control.

[29]  L. Mermel,et al.  New technologies to prevent intravascular catheter-related bloodstream infections. , 2001, Emerging infectious diseases.

[30]  A. Karchmer Nosocomial bloodstream infections: organisms, risk factors, and implications. , 2000, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[31]  D. Pittet,et al.  Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care , 2000, The Lancet.

[32]  Nnis System,et al.  National Nosocomial Infections Surveillance (NNIS) System Report, Data Summary from January 1990-May 1999, issued June 1999. A report from the NNIS System. , 1999, American journal of infection control.

[33]  I. Raad,et al.  Intravascular catheters impregnated with antimicrobial agents: a milestone in the prevention of bloodstream infections , 1999, Supportive Care in Cancer.

[34]  D. Sexton,et al.  Nosocomial Methicillin-Resistant and Methicillin-Susceptible Staphylococcus Aureus Primary Bacteremia: At What Costs? , 1999, Infection Control &#x0026; Hospital Epidemiology.

[35]  R. Gaynes,et al.  Accuracy of Reporting Nosocomial Infections In Intensive-Care–Unit Patients to the National Nosocomial Infections Surveillance System: A Pilot Study , 1998, Infection Control &#x0026; Hospital Epidemiology.

[36]  D A Rasley,et al.  Surveillance of nosocomial infections , 1989, Critical care nursing quarterly.

[37]  J. Edwards,et al.  National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. , 2008, American Journal of Infection Control.

[38]  National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. , 2004, American journal of infection control.

[39]  S. Cosgrove,et al.  Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[40]  M. Żywicki Monitoring hospital-acquired infections to promote patient safety--United States, 1990-1999. , 2000, MMWR. Morbidity and mortality weekly report.