sábado, 19 de mayo de 2012

Trends in Invasive Infection with Methicillin-Resistant Staphylococcus aureus, Connecticut, USA, 2001–2010 - Vol. 18 No. 6 - June 2012 - Emerging Infectious Disease journal - CDC

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Trends in Invasive Infection with Methicillin-Resistant Staphylococcus aureus, Connecticut, USA, 2001–2010 - Vol. 18 No. 6 - June 2012 - Emerging Infectious Disease journal - CDC

Volume 18, Number 6—June 2012


Trends in Invasive Infection with Methicillin-Resistant Staphylococcus aureus, Connecticut, USA, 2001–2010

James L. HadlerComments to Author , Susan Petit, Mona Mandour, and Matthew L. Cartter
Author affiliations: Yale University School of Public Health, New Haven, Connecticut, USA (J.L. Hadler); Connecticut Department of Public Health, Hartford, Connecticut, USA (S. Petit, M. Mandour, M.L. Cartter)
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We examined trends in incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections in Connecticut, with emphasis on 2007–2010, after legislation required reporting of hospital infections. A case was defined as isolation of MRSA from normally sterile body sites, classified after medical record review as hospital onset (HO), community onset, health care–associated community onset (HACO), or community-associated (CA). Blood isolates collected during 2005–2010 were typed and categorized as community- or health care–related strains. During 2001–2010, a total of 8,758 cases were reported (58% HACO, 31% HO, and 11% CA), and MRSA incidence decreased (p<0.05) for HACO and HO, but increased for CA. Significant 3- to 4-year period trends were decreases in all MRSA (–18.8%), HACO (–12.8%), HO (–33.2%), and CA (–12.7%) infections during 2007–2010, and an increase in CA infections during 2004–2006. Decreases in health care–related isolates accounted for all reductions. Hospital infections reporting may have catalyzed the decreases.
Methicillin-resistant Staphylococcus aureus (MRSA) was first identified in 1961 in England (1). The pathogen became a growing concern in US hospitals as S. aureus infections steadily increased, from causing 2.4% of nosocomial infections in 1975 to 29% by 1991 (2). In the mid-1990s, reports of community-onset infections caused by MRSA increased (3,4), including in children with no health care–associated risk factors (5,6). A 1998 population-based study in Connecticut showed that MRSA accounted for 23% of all blood isolates from persons with community-onset S. aureus infection admitted to the hospital (7). Subsequent studies showed that 2 epidemiologically distinct, although overlapping, MRSA problems were occurring, one in the hospital associated with highly antimicrobial drug–resistant MRSA strains and the other in the community. The infections in the community were fueled by 2 factors: persons’ exposure during health care to hospital-generated strains and the emergence and transmission of strains in the community that are less resistant to antimicrobial drugs (8,9).
In the late 1990s, the Emerging Infections Program (EIP), funded by the Centers for Disease Control and Prevention (CDC), became interested in better defining MRSA dynamics from a population-based perspective and established pilot surveillance systems at sites in 4 states for either all MRSA infections (Minnesota, Georgia, Maryland) or for invasive disease (Connecticut) (8,10,11). On the basis of findings from these efforts, formal population-based surveillance for invasive MRSA began in mid-2004 in 9 EIP sites comprising 16.5 million persons to obtain a national picture of the magnitude and trends in the most serious MRSA infections. A summary of data from 2005, the first full year of EIP invasive disease surveillance, was published in 2007 and revealed the full magnitude of invasive MRSA in the United States: ≈94,360 persons had invasive infections in 2005, and 18,650 patients died while hospitalized (12). This study also demonstrated that most MRSA infections (85%) were health care–associated, with 69% occurring in the community rather than in the hospital.
Since 2004, health care–associated infections have received increasing national attention. Efforts by patients’ advocate groups beginning in 2004 have resulted in the passage of legislation mandating that hospitals report infections to their state health department in 27 states, and in at least 12 states, legislation related to MRSA reporting, screening, or producing MRSA infection control plans (13). Since then, state-level involvement in health care–associated infections, including MRSA, has become commonplace. Given that hospital and community factors can affect trends in MRSA incidence, determining their net population level (as well as hospital-level) effects is crucial.
Connecticut began population-based surveillance for invasive MRSA infection in 2001, thus providing an opportunity to examine trends over a 10-year period. Our objectives in this analysis were twofold: 1) to describe the epidemiology of invasive MRSA in Connecticut and trends over time by place of illness onset (community vs. hospital) and relationship to health care, and 2) to describe MRSA strain subtypes associated with place of onset and trends over time.

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