METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AS A DANGEROUS NOSOCOMIAL PATHOGEN
Keywords:
MRSA, epidemiology, modes of transmission, control measuresAbstract
Background. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens. MRSA is often resistant to other antibiotics and represents a challenge for a modern antimicrobial therapy, particularly since the emergence of strains with reduced susceptibility to vancomycin. In this article the microbiology and epidemiology of MRSA in the world and in Slovenia are reviewed. The prevalence of MRSA in Slovenia is high. In addition, modes of MRSA transmission and control measures are described.
Conclusions. The most common route of transmission in the hospital is via hands of the health care personnel. With implementation of adequate control measures it is possible to prevent spread of MRSA. The most important measure is to replace hand washing with alcohol hand rub in most occasions. Other important measures include active search for colonized and infected persons, contact isolation, decolonization and regular sampling of epidemiological data. With a good designed national program it would be possible to achieve better control over the MRSA spread in Slovenia.
Downloads
References
Chambers HF. Methicillin resistance in staphylococci: molecular and biochemical basis and clinical implications. Clin Microbiol Rev 1997; 10: 781– 91.
Jevons MP. ‘Celbenin’ – resistant staphylococci. Br Med J, 1961: 124–5.
Rosendal K, Bulow P, Bentzon MW, Eriksen KR. Staphylococcus aureus strains isolated in Danish hospitals from January 1st, 1966, to December 31st, 1974. Acta Pathol Microbiol Scand 1976; 84B: 359–68.
Parker MT, Hewitt JH. Methicillin resistance in Staphylococcus aureus. Lancet 1970; 1: 800–4.
Benner EJ, Kayser FH. Growing clinical significance of methicillin-resistant Staphylococcus aureus. Lancet 1968; 2: 741–4.
Ayliffe GA. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1997; 24: Suppl 1: 74–9.
Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC. Methicillinresistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997; 40: 135–6.
Smith TL, Pearson ML, Wilcox KR et al. Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med 1999; 340: 493–501.
Anon. Staphylococcus aureus resistant to vancomycin – United States, 2002. MMWR Morb Mortal Wkly Rep 2002; 51: 565–7.
Wenzel RP, Edmond MB. Vancomycin-resistant Staphylococcus aureus: infection control considerations. Clin Infect Dis 1998; 27: 245–9.
Sieradzki K, Roberts RB, Haber SW, Tomasz A. The development of vancomycin resistance in a patient with methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1999; 340: 517–23.
Waldvogel FA. New resistance in Staphylococcus aureus. N Engl J Med 1999; 340: 556–7.
Harbarth S, Rutschmann O, Sudre P, Pittet D. Impact of methicillin resistance on the outcome of patients with bacteremia caused by Staphylococcus aureus. Arch Intern Med 1998; 158: 182–9.
Ibelings MM, Bruining HA. Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur J Surg 1998; 164: 411–8.
Van Griethuysen A, Pouw M, van Leeuwen N et al. Rapid slide latex agglutination test for detection of methicillin resistance in Staphylococcus aureus. J Clin Microbiol 1999; 37: 2789–92.
Casewell MW. The nose: an underestimated source of Staphylococcus aureus causing wound infection. 1998; 40: Suppl B: S3–11.
Ruef C. Prevalence of nosocomial infections – who knows the true rates? Infection 1997; 25: 203–5.
Fluckiger U, Widmer AF. Epidemiology of methicillin-resistant Staphylococcus aureus. Chemotherapy 1999; 45: 121–34.
Voss A, Milatovic D, Wallrauch-Schwarz C, Rosdahl VT, Braveny I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994; 13: 50–5.
Vincent JL, Bihari DJ, Suter PM et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive care (EPIC) study. JAMA 1995; 274: 639–44.
Dornbusch K, King A, Legakis N. Incidence of antibiotic resistance in blood and urine isolates from hospitalized patients. Report from an European collaborative study. Scand J Infect Dis 1998; 30: 281–8.
Panlilio AL, Culver DH, Gaynes RP et al. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975–1991. Infect Control Hosp Epidemiol 1992; 13: 582–6.
Simor AE, Ofner-Agostini M, Bryce E et al. The evolution of methicillinresistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001; 165: 21–6.
Adeyemi-Doro FAB, Scheel O, Lyon DJ, Cheng AFB. Living with methicillinresistant Staphylococcus aureus: A 7-year experience with endemic MRSA in a university hospital. Infect Control Hosp Epidemiol 1997; 18: 765–7.
Blanc D, Pittet D, Ruef C et al. Epidemiology of methicillin-resistant Staphylococcus aureus: results of a nation-wide survey in Switzerland. Swiss Med Wkly 2002; 132: 223–9.
Muzlovič I, Trampuž A. Hospital infection and prevalence study in the ICUs in Slovenia. In: Grosek Š, Dragaš AZ eds. Hospital hygiene and infection control in intensive care units. Ljubljana: Bori, 1998: 100–4.
Mueller-Premru M, Seme K, Križan-Hergouth V, Andlovic A, Gubina M. Občutljivost bakterij, izoliranih na Inštitutu za mikrobiologijo in imunologijo Medicinske fakultete v Ljubljani v letu 1998. Med Razgl 1999; 38: Suppl 2: 25–38.
Mueller-Premru M, Seme K, Križan-Hergouth V, Andlovic A, Gubina M. Občutljivost bakterij, izoliranih na Inštitutu za mikrobiologijo in imunologijo Medicinske fakultete v Ljubljani v letu 1999 in občutljivost bakterij v intenzivnih enotah Kliničnega centra v letu 1998. Med Razgl 2000; 39: 39–48.
Mueller-Premru M, Križan-Hergouth V, Seme K, Gubina M. MRSA – rezultati spremljanja občutljivosti bakterije Staphylococcus aureus v Kliničnem centru v Ljubljani. In: Mueller-Premru M, Gubina M eds. Mikrobi in antibiotiki 2001. Ljubljana: Zavod za farmacijo in za preizkušanje zdravil, 2001: 193–8.
Kolman J, Gubina M, Mueller-Premru M, Sočan M, Cvetkovski L, Koren S. Slovenski rezultati občutljivosti bakterij Staphylococcus aureus in Streptococcus pneumoniae iz hemokultur in likvorjev, zbrani v okviru projekta EARSS. In: Mueller-Premru M, Gubina M eds. Mikrobi in antibiotiki 2001. Ljubljana: Zavod za farmacijo in za preizkušanje zdravil, 2001: 185–92.
Anon. Eurosurveillance 2001; 6: 2–5.
Žohar-Čretnik T, Lešničar G, Štorman A et al. MRSA v Splošni bolnišnici Celje. In: Lešničar G ed. Infektološki simpozij. Celje 2001. Zbornik predavanj. Celje: Splošna bolnišnica Celje, 2001: 89–95.
Trampuž A, Muzlovič I, Jereb M, Vidmar L and the Infection Control Team. Effective control measures for preventing transmission of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. 39th Annual Meeting of the Infectious Diseases Society of America. San Francisco, CA, October 25-28, 2001.
Kotnik-Kevorkijan B, Lorenčič-Robnik S. Obvladovanje na meticilin odpornega Staphylococcus aureus-a (MRSA) v Splošni bolnišnici Maribor. In: Lešničar G ed. Infektološki simpozij. Celje 2001. Zbornik predavanj. Celje: Splošna bolnišnica Celje, 2001: 81–7.
Boyce JM. Methicillin-resistant Staphylococcus aureus. Detection, epidemiology, and control measures. Infect Dis Clin North Am 1989; 3: 901–13.
Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97: 309–17.
Mulligan ME, Murray-Leisure KA, Ribner BS et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993; 94: 313–28.
Žohar-Čretnik T. Problem širjenja proti meticilinu odpornega Staphylococcus aureus. In: Marolt-Gomišček M, Dragaš AZ eds. Bolnišnične okužbe. Zbornik predavanj. Maribor: Splošna bolnišnica Maribor, 1999: 167–80.
Sanford MD, Widmer AF, Bale MJ, Jones RN, Wenzel RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994; 19: 1123–8.
Boyce JM. Methicillin-resistant Staphylococcus aureus: a continuing infection control challenge. Eur J Clin Microbiol Infect Dis 1994; 13: 45–9.
Bradley SF, Terpenning MS, Ramsey MA et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991; 115: 417–22.
Boyce JM, Jackson MM, Pugliese G et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. The AHA Technical Panel on Infections Within Hospitals. Infect Control Hosp Epidemiol 1994; 15: 105–15.
Kibbler CC, Quick A, O’Neill AM. The effect of increased bed numbers on MRSA transmission in acute medical wards. J Hosp Infect 1998; 39: 213–9.
Widmer AF. Vom Ende des Händewaschens: Mit der hygienischen Händedesinfektion ins nächste Jahrtausend. Schweiz Rundsch Med Prax 1999; 88: 761–3.
Zaragoza M, Salles M, Gomez J, Bayas JM, Trilla A. Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness. Am J Infect Control 1999; 27: 258–61.
Rotter ML, Simpson RA, Koller W. Surgical hand disinfection with alcohols at various concentrations: parallel experiments using the new proposed European standards method. Infect Control Hosp Epidemiol 1998; 19: 778–81.
Larson E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999; 29: 1287–94.
Voss A, Widmer AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997; 18: 205–8.
Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med 1999; 130: 126–30.
Widmer AF. Replace hand washing with use of a waterless alcohol hand rub? Clin Infect Dis 2000; 31: 136–43.
Chadwick PR. Revised UK guidelines for the control of methicillin-resistant Staphylococcus aureus in hospitals. Int J Antimicrob Agents 1999; 11: 89–91.
Die Redaktionskomission. Methizillin-resistenter S. aureus. Aktuelle Situation und Bedeutung. Swiss-NOSO 1995; 2: 1–5.
Jernigan JA, Titus MG, Groschel DH, Getchell-White S, Farr BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996; 143: 496–504.
Asensio A, Guerrero A, Quereda C, Lizan M, Martinez-Ferrer M. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996; 17: 20–8.
Kotilainen P, Routamaa M, Peltonen R et al. Eradication of methicillinresistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001; 161: 859–63.
Trampuž A, Pikelj F. Na meticilin odporen Staphylococcus aureus (MRSA): Ali smo zamudili priložnost za zajezitev epidemije? Zbornik predavanj Infektološkega simpozija. Ljubljana, 16.-17. 3. 2001. Med Razgl 2001; 40: S2: 19–20.
Hicks NR, Moore EP, Williams EW. Carriage and community treatment of methicillin-resistant Staphylococcus aureus: What happens to colonized patients after discharge? J Hosp Infect 1991; 19: 17–24.
Ayliffe GAY, Buckles A, Casewel MW et al. Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. J Hosp Infect 1998; 39: 253–90.
Shands JWJ, Wenzel RP, Wolff SM, Eickhoff TC, Fields BN, Jackson GG. From the Infectious Diseases Society of America. Hospital epidemiology and infection control: the changing role of the specialist in infectious diseases. J Infect Dis 1981; 144: 609–13.
Chaix C, Durand-Zaleski I, Alberti C, Brun-Buisson C. Control of endemic methicillin-resistant Staphylococcus aureus. A cost-benefit analysis in an intensive care unit. JAMA 1999; 282: 1745–51.
Lacey RW. Multi-resistant Staphylococcus aureus – a suitable case for inactivity? J Hosp Infect 1987; 9: 103–5.
Downloads
Issue
Section
License
The Author transfers to the Publisher (Slovenian Medical Association) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Slovenian Medical Association) has the right to transfer the rights of acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
