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The War Against MRSA
By Cynthia Zips, M, SM(ASCP), CIC
October 25, 2013
MPH 500- Fundamentals of Public Health – Section 01Fall A 2013
Instructor: Madeline Angela Meyer, PhD
The Epidemiology of MRSA
• Methicillin-resistant Staphylococcus aureus
(MRSA) has become a prevalent pathogen in
the United States.
• 94,000 invasive infections in 2005
• 18,500 deaths (mortality rate 20%)
(Hirschmann, 2007)
The Epidemiology of MRSA
• Healthcare Associated Infections
– Deep wound and invasive infections
• Community Acquired Infections
– Usually soft tissue infections
(Farley, 2008)
The Epidemiology of MRSA
• 25% to 30% of people are colonized with MRSA
(NIOSH, 2013)
• Colonization often precedes invasive infection
• In 2003, up to 60% of hospitalized patients with
MRSA colonization developed an infection, and
5–15% of colonized residents in a LTCF developed
an MRSA infection (McNeil, 2003).
Biostatistics of MRSA
MRSA infections increased between 1974 and 2004
Number of MRSA Infections
70%
64%
60%
50%
40%
30%
MRSA
Infections
22%
20%
10%
2%
0%
1974
(Klevens, 2006)
1995
2004
Biostatistics of MRSA
MRSA invasive infections have caused
• an estimated 278,000 hospitalizations in 2005 (Klein,
2008)
• 56% of device related infections in 2006 and 2007
(Hidron, 2008)
Device related infections include
• Central Line Associated Bloodstream
Infections (CLABSI)
• Ventilator Associated Pneumonia (VAP)
• Catheter Associated Urinary Tract Infections (CAUTI)
Biostatistics of MRSA
Because MRSA is so invasive and so pathogenic
measures were implemented to reduce infection.
Because of measures to reduce
transmission of MRSA,
infections were reduced!
Break the Cycle
Prevent Transmission
In Order to Prevent
Colonization
In Order to Prevent
Infection
Biostatistics of MRSA
• Recent studies indicate Healthcare
Associated Invasive Infections due to MRSA
have been reduced by more than 54.2%
between 2005 and 2011.
• Community associated infections have
decreased by only 5%.
(Laidman, 2013)
Biostatistics of MRSA
Success in the war against MRSA does not mean
the war is over.
In a recent study, 1 in 5 patients with hospital
onset MRSA infection died, which is still a
mortality rate of 20%. (Chen, 2013)
So the war against MRSA continues….
The Biomedical Aspect of MRSA
MRSA produces toxins that help it to be invasive
•
Hemolysin- lyses red blood cells (Koneman, 1988)
•
Coagulase –prevents phagocytosis (Koneman, 1988)
•
Hyaluronidases-degrades the cellular matrix of tissue (Hart, 2009)
•
Exfoliatins – sloughing (Koneman, 1988)
•
Leukocidins- destroys leukocytes, causes necrosis (Adler, 2006)
•
Lipases-hydrolyzes lipids in the skin, reduces the phagocytic killing of Staph aureus
(Rollo, 1988)
•
Nuclease- inhibits antimicrobial activity of neutrophils (Berends, 2010)
The Social Aspect of MRSA
• MRSA is spread by touch or contact
with infected or colonized people,
or surfaces.
• MRSA is viable as long as 56 days (Huang, 2006)
• MRSA transmission is a problem where people
gather and interact with each other.
Social Aspect of MRSA
• CDC has established guidelines to prevent the
transmission of MRSA
– Hand hygiene
– Isolation practices
– Gloving
– Gowning
– Good cleaning and disinfection of patient care
equipment and environments
(HICPAC, 2007)
Government Policy and MRSA
CMS and other regulatory agency requirements
– Policy for the prevention of MRSA and other
multidrug-resistant organisms
– Mandatory reporting
– Public reporting
– Reduced reimbursements for HAIs
Because of the high cost of infection, it is now
more cost-effective to implement measures to
prevent infection. (CMS, 2013)
Conclusion
• 85% of all HAIs were caused by MRSA in 2007 (APIC, 2007)
• Measures were implemented to reduce MRSA transmission
• A study in 2011 indicates Hospital Onset invasive MRSA
were decreased 54.2% from 2005 (Laidman, 2013)
• Success means that we are on the right track
• Measures already implemented should be continued.
• The war against MRSA goes on.
References
Adler , A., et.al., Leukocidin-producing Staphylococcus aureus, Emerg Infect Dis. ,2006 November; 12(11): 1789-1790.
Berends, E., et.al., Nuclease Expression by Staphylococcus aureus Facilitates Escape from Neutrophil Extracellular Traps,
J Innate Immun., 2010, October; 2(6):576-586.
Chen, L., The Changing Epidemiology of Methicillin-Resistant Staphylococcus aureus: 50 years of a Superbug. American
Journal of Infection Control. 2013; 41:448-451.
CMS, (2013), Acute Inpatient PPS.
Farley, J., Epidemiology, Clinical Manifestations, and Treatment Options for Skin and Soft Tissue Infection Caused by
Community-acquired Methicillin-resistant Staphylococcus aureus, J AM Acad Nurse Pract, 2008, February; 20 (2):85-92.
Hart, M., Hart, M., Roop, A., Genotypic and Phenotypic Assessment of Hyaluronidase Among Type Strains of a Select
Group of Staphylococcal Species, Int J Microbiol. , 2009; 2009: 614371
HICPAC, 2007, Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
2007. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Atlanta, GA
30333
Hidron, A., et.al., Infecti Control Hosp Epidemiol; 2008; 29:996-1011.
References
Hirschmann, J., The Epidemiology of MRSA, Journal Watch Dermatology, 2007; 6(10).
Huang, R., Mehta S., Weed, D., Price, C., Methicillin-Resistant Staphylococcus aureus Survival on
Hospital Fomities., Infect Control Hosp Epidemiol, 2006; 27: 1267-1269.
Klein, E et. al., Emerging Infectious Diseases., 2007; 13:1840-6.
Klevens, R.M., et.al., Clinical Infectious Disease; 2006; 42:389-91
Koneman, E., Color Atlas and Textbook of Diagnostic Microbiology, 3rd Edition, 1988
Laidman, J., MRSA: Hospital-Related Infections Fell 50% From 2005 to 2011, Medscape Medical
News, Sept 16, 2013.
McNeil, S., Mody, L., Bradley, S., Methicillin-resistant Staphylococcus aureus and Vancomycinresistant Enterococci Among Older AdultsFocus on Long-term Care Facilities, Geriatrics &Aging,
October 2003, Vol 6, Num 9
The War Against MRSA