Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T20:23:13.087Z Has data issue: false hasContentIssue false

Surveillance and Control of Methicillin-Resistant Staphylococcus aureus Infections in French Hospitals

Published online by Cambridge University Press:  02 January 2015

Didier Lepelletier*
Affiliation:
Service de Bactériologie, Virologie et Hygiène Hospitalière, Institut de Biologie des hopitaux de Nantes, Centre Hospitalier Universitaire, Nantes, France
Hervé Richet
Affiliation:
Service de Bactériologie, Virologie et Hygiène Hospitalière, Institut de Biologie des hopitaux de Nantes, Centre Hospitalier Universitaire, Nantes, France
*
Service de Bactériologie, Virologie et d'Hygiène Hospitalière, Institut de Biologie des hôpitaux de Nantes, Centre Hospitalier Universitaire, 9 quai Moncousu, 44093 Nantes Cedex 01, France

Abstract

Objective:

To assess the way French hospitals conduct surveillance for, and control infections caused by, methicillin-resis-tant 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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Holmberg, SD, Solomon, SL, Blake, PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis 1992;9:10651078.Google Scholar
2.Haley, RW. Measuring the costs of nosocomial infections: methods for estimating economic burden on the hospital. Am J Med 1991;91(suppl 3B):3238.Google Scholar
3.Jarvis, WR. Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem. Infect Control Hasp Epidemiol 1996;17:490495.Google Scholar
4.Rubin, RJ, Harrington, CA, Poon, A, Dietrich, K, Greene, JA, Moiduddin, A. The economic impact of Staphylococcus aureus infection in New York city hospitals. Emerg Infect Dis 1999;5:917.CrossRefGoogle ScholarPubMed
5.Voss, A, Milatovic, D, Wallrauch-Schwarz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur Clin Microbiol Infect Dis 1994;13:5055.CrossRefGoogle ScholarPubMed
6.Mackintosh, CA, Marples, RR, Kerr, GE, Bannister, A. Surveillance of methicillin-resistant Staphylococcus aureus in England and Wales, 1986-1990. J Hosp Infect 1991;18:279292.Google Scholar
7.Rosdahl, VT. Eradication of MRSA: the Danish experience. Third International Conference on the Prevention of Infection. Nice, France; April 5-6, 1994. Abstract CD1.Google Scholar
8.Vandenbroucke-Grauls, CM. Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 1996;17:512513.Google Scholar
9.Richet, H, Wiesel, M, Le Gallou, F, Andre-Richet, B, Espaze, E. Methicillin-resistant Staphylococcus aureus control in hospitals: the French experience. Infect Control Hosp Epidemiol 1996;17:509511.Google Scholar
10.Struelens, MJ, Ronveaux, O, Jans, B, Mertens, R. Methicillin-resistant Staphylococcus aureus epidemiology and control in Belgian hospitals, 1991 to 1995. Infect Control Hosp Epidemiol 1996;17:503508.Google Scholar
11.Panlilio, AL, Culver, DH, Gaynes, RP, Banerjee, S, Henderson, TS, Tolson, JS, et al.Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582586.Google Scholar
12.Boyce, JM. Patterns of methicillin-resistant Staphylococcus aureus prevalence. Infect Control Hosp Epidemiol 1991;12:7982.Google Scholar
13.Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11:639642.Google Scholar
14.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, 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;94:313328.CrossRefGoogle ScholarPubMed
15.Boyce, JM. Treatment and control of colonization in the prevention of nosocomial infections. Infect Control Hosp Epidemiol 1996;17:256261.Google Scholar
16.Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221227.Google Scholar
17.Bradley, SF, Terpenning, MS, Ramsey, MA, Zarins, LT, Jorgensen, KA, Sottile, WS, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417422.Google Scholar
18.Coello, R, Jimenez, J, Garcia, M, Arroyo, P, Minguez, D, Fernendez, C, et al.Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994;13:7481.Google Scholar
19.Boyce, JM. Preventing staphylococcal infections by eradicating nasal carriage of Staphylococcus aureus proceeding with caution. Infect Control Hosp Epidemiol 1996;17:775779.CrossRefGoogle ScholarPubMed
20.Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725737.Google Scholar
21.Boyce, JM, Jackson, MM, Pugliese, G, Murray, DB, Fleming, D, Garner, JS, et al.Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105115.Google Scholar
22.Muder, RR, Brennen, C, Wagener, MM, Vickers, RM, Rihs, JD, Hancock, GA, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107112.Google Scholar
23.Asensio, A, Guerrero, A, Quereda, C, Elizan, M, Martinez-Ferrer, M. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996;17:2028.Google Scholar
24.Ploy, MC, Grelaud, C, Martin, C, de Lumley, L, Denis, F. First clinical isolate of vancomycin-intermediate Staphylococcus aureus in a French hospital. Lancet 1998;351(9110):1212.Google Scholar
25.Hiramaatsu, K, Hanaki, H, Ino, T, Yabuta, K, Oguri, T, Tenover, FC. Methicillin-resistant Staphylococcus aureus clinical strain with reduced vancomycin susceptibility. J Antimicrob Chemother 1997;40:135136.Google Scholar
26.Centers for Disease Control and Prevention. Staphylococcus aureus reduced susceptibility to vancomycin. United States, 1996. MMWR 1997;46:765766.Google Scholar
27.Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus, Minnesota and North Dakota, 1997-1999. MMWR 1999;48:707710.Google Scholar
28.Galdbart, JO, Morvan, A, El Solh, N. Phenotypic and molecular typing of nosocomial methicillin-resistant Staphylococcus aureus strains susceptible to gentamicin isolated in France from 1995 to 1997. J Clin Microbiol 2000;38:185190.Google Scholar
29.Emori, TG, Culver, DH, Horan, TC, Horan, TC, Jarvis, WR, White, JW, et al.National Nosocomial Infections Surveillance (NNIS) System: description of surveillance methods. Am J Infect Control 1991;19:1935.Google Scholar
30.Weinstein, RA. JCAHO infection control indicators, part I. Infect Control Hosp Epidemiol 1990;11:545546.CrossRefGoogle Scholar
31.Josephson, A, Karanfil, L, Alonso, H, Watson, A, Blight, J. Risk-specific nosocomial infection rates. Am J Med 1991;91(suppl 3B):131137.Google Scholar
32.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609621.Google Scholar
33.Wagenvoort, JHT. Dutch measures to control MRSA and the expanding European Union. Eurosurveillance 2000;5:2628.Google Scholar
34.Maîtrise de la diffusion des bactéries multirésistantes aux antibiotiques. Recommandations pour les établissements de santé. Comité Technique national des Infections Nosocomiales. Ministère de l'Emploi et de la Solidarité 1999, Paris, France.Google Scholar