MRSA

Active Surveillance Screening of MRSA and Eradication of the Carrier State Decreases Surgical-Site Infections Caused by MRSA



Table of Contents

Introduction3

Literature Review5

Introduction5

Bite-related injuries6

Epidemiology6

Microbiology8

Clinical manifestations9

Management10

Cultures11

Irrigation11

Debridement12

Imaging12

Wound closure12

Antimicrobial therapy12

Hospitalisation12

Immunisations12

Septic syndromes15

Capnocytophaga canimorsus15

Epidemiology16

Clinical manifestations17

Management19

Pasteurella spp20

Epidemiology20

Clinical manifestations21

Management22

Community-associated meticillin-resistant Staphylococcus aureus infections23

Epidemiology24

Clinical manifestations28

Management30

Material and methods31

Setting and screening programme31

Decolonization procedures32

Data recording and statistical analysis33

The following definitions were used:33

Results34

Patients34

Detection of S. aureus and MRSA35

Characteristics35

MRSA eradication38

MRSA frequency and MRSA infections39

spa Typing results41

Costs of the screening in 200442

Discussion42

Conclusion46

Active Surveillance Screening of MRSA and Eradication of the Carrier State Decreases Surgical-Site Infections Caused by MRSA

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important human pathogen since its first documented outbreak in 1968 (Barrett et al., 1968). Asymptomatic colonization with MRSA has been described as a risk factor for subsequent infection (Karchmer et al., 2002; Wernitz et al., 2005b). In Germany, the prevalence of MRSA in S. aureus isolates increased from 9% to 22.% between 1999 and 2004 (Kresken et al., 2004; Tiemersma et al., 2004). The highest prevalence of MRSA is in risk groups such as the elderly and/or patients in critical care units or nursing homes (Chaberny et al., 2005; Wernitz et al., 2005b), since these individuals are most prone to develop infection with MRSA and are the reservoir for MRSA acquisition by other patients. MRSA prevalence data from other countries suggest a rate of less than 1-5% in the general population (Jernigan et al., 2003; Panhotra et al., 2005; Samad et al., 2002; Wertheim et al., 2004); however, little is known about the prevalence in a patient's population of a surgical polyclinic including those who are planning a hospital stay, e.g., for surgical intervention (“elective patients”).

The prevalence of MRSA in risk patients is 20% (Wernitz et al., 2005b). However, little is known about the prevalence of MRSA infection in the regular patient population. After detection of MRSA colonization or infection, the necessary isolation precautions and decolonization measures increase the workload and costs during hospital stay. Screening of potential MRSA carriers in hospitals has proven to reduce hospital-acquired MRSA infections (Jernigan et al., 1995; Wernitz et al., 2005b). Although spreading of MRSA in hospitals can be prevented by active surveillance and isolation of carriers (Karchmer et al., 2002; Wernitz et al., 2005b; Cooper et al., 1999), the efficacy and costs of such surveillance methods have been vigorously debated. For example, Teare and Barrett (1997) suggested that the costs exceed the potential benefits, while Karchmer et al. (2002) estimated that an active surveillance with bacterial sampling leads to a cost reduction by a factor of 19-27.

In 2003, a group of MRSA carriers was detected at the University Hospital of Münster, Germany. After experiencing the consequences, which included an increase in infections, cost and workload, preventative strategies were sought. Since intensified active surveillance is known to detect MRSA carriers and thus, with appropriate isolation measures prevent the spread of MRSA in a hospital, it was the aim of this study to investigate the effectiveness of pre-admission MRSA screening of patients entering the surgical unit for surgical treatment and to calculate the costs and ...