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Methicillin-Resistant Staphylococcus aureus: A 5-Year Review of Surveillance Data in a Tertiary Care Hospital in Saudi Arabia

Published online by Cambridge University Press:  02 January 2015

H. H. Balkhy ,
Z. A. Memish ,
M. A. Almuneef ,
G. C. Cunningham ,
C. Francis ,
K. C. Fong ,
Z. B. Nazeer  and
E. Tannous
H. H. Balkhy
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Z. A. Memish*
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
M. A. Almuneef
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
G. C. Cunningham
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
C. Francis
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
K. C. Fong
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Z. B. Nazeer
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
E. Tannous
Affiliation:
Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
*
Department of Infection Prevention and Control (MC 2134), King Abdulaziz Medical City-King Fa-had National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia ([email protected]; [email protected])
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Abstract

Background.

Staphylococcus aureus is an important pathogen that leads to serious infections in the community and in hospitals. Evidence has shown that the prevalence of infection and colonization with drug-resistant S. aureus, such as methicillin-resistant S. aureus (MRSA) and glycopeptide intermediately susceptible S. aureus, is increasing. Authorities must be aware of the prevalence of MRSA infection and colonization in their country in order to implement and monitor infection control policies that help curtail further emergence of this pathogen.

Objectives.

To examine the trend of hospital-acquired MRSA infection and colonization in a tertiary care institution in Saudi Arabia during a 5-year period in order to identify specific areas at high risk for MRSA transmission, and to review our MRSA decolonization procedure and outcomes.

Methods.

Surveillance data prospectively collected from January 1, 2000, through December 31, 2004, on hospital-acquired (HA) MRSA were analyzed, with an emphasis on the trend of HA-MRSA infection and colonization, areas of high transmission, risk factors, and effectiveness of the implemented decolonization policy.

Results.

During the study period, 442 cases of HA-MRSA infection and colonization were identified. Of these, 51.2% were infections, and 48.8% were colonizations. An increasing trend in the incidence rates of infection and colonization was noticed during the study period, and most cases were identified on the surgical ward (33.3%) and medical ward (32.1%). Of the 34 infected patients who underwent systematic decolonization, 35.3% were successfully decolonized, and of the 11 who underwent topical decolonization, 63.6% were successfully decolonized.

Conclusion.

The increasing trend of HA-MRSA infections has been a noticeable global problem. We identified a gradual increase in the rates of MRSA colonization and infection in a tertiary care center Saudi Arabia and recognize the importance of abiding by strict infection control policies, including hand hygiene and proper isolation practices. Continued surveillance for MRSA and other emerging multidrug-resistant pathogens is also needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 976 - 982
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. 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.CrossRefGoogle ScholarPubMed
2. Hiramatsu, K, Aritaka, N, Hanaki, H, et al. Dissemination in Japanese hospitals of strains of Staphylococcus aureus heterogeneously resistant to vancomycin. Lancet 1997;350:1670–1673.CrossRefGoogle ScholarPubMed
3. Shanson, D. Antibiotic resistance in Staphylococcus aureus . In: Cafferkey, M, ed. Methicillin-Resistant Staphylococcus aureus: Clinical Management and Laboratory Aspects. New York: Marcel Dekker; 1992:11–20.Google Scholar
4. Naimi, TS, LeDell, KH, Como-Sabetti, K, et al. Comparison of community-and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976–2984.CrossRefGoogle ScholarPubMed
5. Gorak, EJ, Yamada, SM, Brown, JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999;29:797–800.CrossRefGoogle ScholarPubMed
6. Perl, TM. The threat of vancomycin resistance. Am J Med 1999;106:26S–37S; discussion 48S-52S.CrossRefGoogle ScholarPubMed
7. Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381–386.CrossRefGoogle ScholarPubMed
8. Pittet, D. Infection control and quality health care in the new millennium. Am J Infect Control 2005;33:258–267.CrossRefGoogle ScholarPubMed
9. Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Régnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188.CrossRefGoogle Scholar
10. Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:1051–1057.CrossRefGoogle ScholarPubMed
11. National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically: Approved Standard. 5th ed. Wayne, PA: NCCLS; 2000:M7–A5.Google Scholar
12. National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing: 12th Informational Supplement. Wayne, PA: NCCLS; 2002:M100–S12.Google Scholar
13. Khan, MY, Kinsara, AJ, Osoba, AO, Wali, S, Samman, Y, Memish, Z. Increasing resistance of M. tuberculosis to anti-TB drugs in Saudi Arabia. Int J Antimicrob Agents 2001;17:415–418.CrossRefGoogle ScholarPubMed
14. Al-Jahdali, H, Al-Zahrani, K, Amene, P, et al. Clinical aspects of miliary tuberculosis in Saudi adults. Int J Tubero Lung Dis 2000;4:252–255.Google ScholarPubMed
15. Memish, ZA, Mah, MW, Mahmood, SA, Bannatyne, RM, Khan, MY. Clinico-diagnostic experience with tuberculous lymphadenitis in Saudi Arabia. Clin Microbiol Infect 2000;6:137–141.CrossRefGoogle ScholarPubMed
16. Memish, Z. Brucellosis control in Saudi Arabia: prospects and challenges. J Chemother 2001;13(suppl 1):11–17.CrossRefGoogle ScholarPubMed
17. Khan, MY, Mah, MW, Memish, ZA. Brucellosis in pregnant women. Clin Infect Dis 2001;32:1172–1177.CrossRefGoogle ScholarPubMed
18. Memish, ZA, Mah, MW. Brucellosis in laboratory workers at a Saudi Arabian hospital. Am J Infect Control 2001;29:48–52.CrossRefGoogle Scholar
19. Boyce, JM, Cookson, B, Christiansen, K, et al. Methicillin-resistant Staphylococcus aureus . Lancet Infect Dis 2005;5:653–663.CrossRefGoogle Scholar
20. Beedle, D. Infection control: beating the bug. Nurs Times 1993;89:ii, iv, vi.Google ScholarPubMed
21. Fridkin, SK, Hageman 1?, Morrison, M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436–1444.CrossRefGoogle ScholarPubMed
22. Diekema, DI, Pfaller, MA, Schmitz, FJ, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001;32(suppl 2):S114–S132.CrossRefGoogle ScholarPubMed
23. Tiemersma, EW, Bronzwaer, SL, Lyytikainen, O, et al. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004;10:1627–1634.CrossRefGoogle ScholarPubMed
24. Haq, JA, Rahman, MM, Asna, SM, et al. Methicillin-resistant Staphylococcus aureus in Bangladesh: a multicentre study. Int J Antimicrob Agents 2005;25:276–277.CrossRefGoogle ScholarPubMed
25. Kikuchi, K, Takahashi, N, Piao, C, Totsuka, K, Nishida, H, Uchiyama, T. Molecular epidemiology of methicillin-resistant Staphylococcus aureus strains causing neonatal toxic shock syndrome-like exanthematous disease in neonatal and perinatal wards. J Clin Microbiol 2003;41:3001–3006.CrossRefGoogle ScholarPubMed
26. Jernigan, JA, Clemence, MA, Stott, GA, et al. Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.CrossRefGoogle Scholar
27. Leman, R, Alvarado-Ramy, F, Pocock, S, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus in an American Indian population. Infect Control Hosp Epidemiol 2004;25:121–125.CrossRefGoogle Scholar
28. 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;340:517–523.CrossRefGoogle Scholar
29. Madani, T. Epidemiology and clinical features of methicillin-resistant Staphylococcus aureus in the University Hospital, Jeddah, Saudi Arabia. Can J Infect Dis 2002;13:245–250.Google ScholarPubMed
30. Madani, TA, Al-Abdullah, NA, Al-Sanousi, AA, Ghabrah, TM, Afandi, SZ, Bajunid, HA. Methicillin-resistant Staphylococcus aureus in two tertiary-care centers in Jeddah, Saudi Arabia. Infect Control Hosp Epidemiol 2001;22:211–216.CrossRefGoogle ScholarPubMed
31. Bilal, N, Gedebou, M. Staphylococcus aureus as a paradigm of a persistent problem of bacterial multiple antibiotic resistance in Abha, Saudi Arabia. East Mediten Health J 2000;6:948–954.CrossRefGoogle ScholarPubMed
32. Baddour, MM, Abuelkheir, MM, Fatani, AJ. Trends in antibiotic susceptibility patterns and epidemiology of MRSA isolates from several hospitals in Riyadh, Saudi Arabia. Ann Clin Microbiol Antimicrob 2006;5:30.CrossRefGoogle ScholarPubMed
33. Al-Tawfiq, JA. Incidence and epidemiology of methicillin-resistant Staphylococcus aureus infection in a Saudi Arabian Hospital, 1999-2003. Infect Control Hosp Epidemiol 2006;27:1137–1139.CrossRefGoogle Scholar
34. Asghar, AH, Momenah, AM. Methicillin resistance among Staphylococcus aureus isolates from Saudi hospitals. Med Princ Pract 2006;15:52–55.CrossRefGoogle ScholarPubMed
35. Pittet, D, Donaldson, L. Clean care is safer care: the first global challenge of the WHO World Alliance for Patient Safety. Infect Control Hosp Epidemiol 2005;26:891–894.CrossRefGoogle ScholarPubMed
36. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene: Infection Control Programme. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
37. Pittet, D. The Lowbury lecture: behaviour in infection control. J Hosp Infect 2004;58:1–13.CrossRefGoogle ScholarPubMed
38. Abramson, MA, Sexton, DI. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.CrossRefGoogle ScholarPubMed
39. Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus . Arch Intern Med 2002;162:2229–2235.CrossRefGoogle ScholarPubMed
40. Cosgrove, SE, Carmeli, Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis 2003;36:1433–1437.Google ScholarPubMed
41. Panhotra, BR, Saxena, AK, Al Mulhim, AS. Prevalence of methicillin-resistant and methicillin-sensitive Staphylococcus aureus nasal colonization among patients at the time of admission to the hospital. Ann Saudi Med 2005;25:304–308.CrossRefGoogle ScholarPubMed
42. Islam, S, Moore, C. Prevalence of methicillin-resistant Staphylococcus aureus and associated risk factors on admission to a specialist care eye hospital. Ann Saudi Med 2002;22:153–157.CrossRefGoogle ScholarPubMed
43. Bukharie, HA, Abdelhadi, MS, Saeed, IA, Rubaish, AM, Larbi, EB. Emergence of methicillin-resistant Staphylococcus aureus as a community pathogen. Diagn Microbiol Infect Dis 2001;40:1–4.CrossRefGoogle ScholarPubMed
44. Fierobe, L, Deere, D, Muller, C, et al. Methicillin-resistant Staphylococcus aureus as a causative agent of postoperative intra-abdominal infection: relation to nasal colonization. Clin Infect Dis 1999;29:1231–1238.CrossRefGoogle ScholarPubMed
45. Fridkin, SK. Routine cycling of antimicrobial agents as an infection-control measure. Clin Infect Dis 2003;36:1438–1444.Google ScholarPubMed
46. Fridkin, SK, Hageman, I, McDougal, LK, et al. Epidemiological and microbiological characterization of infections caused by Staphylococcus aureus with reduced susceptibility to vancomycin, United States, 1997-2001. Clin Infect Dis 2003;36:429–439.CrossRefGoogle ScholarPubMed
47. Herr, CE, Heckrodt, TH, Hofmann, FA, Schnettler, R, Eikmann, TF, Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 2003;24:673–678.CrossRefGoogle Scholar