Hospitals are curbing the most common strain of MRSA, but the incidence hasn't decreased in the broader community.
The incidence of the most common strain of MRSA infections has decreased in hospital-onset cases, but has failed to do so in the broader community, finds a study published in September in the journal Infection Control & Hospital Epidemiology.
Kyle Popovich, MD |
"Illicit drug use was a predictor for both community onset infections and hospital onset infections" of the USA 300 strain of MRSA, says Kyle Popovich, MD, MS, lead author of the study and assistant professor in the Section of Infectious Diseases, Rush University Medical Center.
Keith Armitage, MD, of the Division of Infectious Diseases at University Hospitals Case Medical Center says the study data reinforces what he has seen over past decade: That this strain, which was strongly associated with community onset, "has spilled over into the hospital." The Centers for Disease Control and Prevention describe USA 300 as the cause of "most community-associated MRSA infections [and] an increasingly common cause of health care-associated MRSA infections."
The rise of this strain reflects the way MRSA infections have evolved. Armitage says that up until about 10 or 15 years ago, MRSA was primarily seen in certain high-risk groups.
"Then the paradigm shifted," he says. Patients who are completely healthy, and have no risk factors, now come in already colonized with MRSA. Such an evolution isn't unusual, he says. "Things change. The prevalence and incidents... is constantly evolving and the model changes."
A study published in March by the American Society for Microbiology identified found that "households can serve as a reservoir for transmitting [MRSA]... Once the bacteria enters a home, it can linger for years, spreading from person to person and evolving genetically to become unique to that household."
The Rush researchers say that national surveillance has suggested a decrease in the incidence of invasive hospital-acquired MRSA infections during the past decade, and that is reiterated by this new study.
"A big take-home point of this is in hospitals there has been a lot of effort to reduce all healthcare-acquired infections, but particularly MRSA," Popovich says. "I think our study shows that hospitals have done a good job with infection control."
Keith Armitage, MD |
"There's always been a strong emphasis in hospitals in trying to decrease complications. I think the patient safety and quality movements have really escalated in the last decade, especially since hospitals are faced with financial penalties," he says. "Hospitals always wanted to do the right thing, but these additional financial penalties" gave them even greater incentive.
Despite hospitals' diligence with curbing MRSA infections, the wider community clearly has additional work to do.
"I think still we probably need to do more research to see how we can optimize our infection prevention and infection control in the community," Popovich says.
A 2011 study published in the Annals of Emergency Medicine found that five percent of patients in a Boston emergency department tested positive for MRSA.
Popovich acknowledges that curbing infections within the community is much harder than it is in the hospital, where infection control measures are the standard operating procedure. In addition, the community is a much bigger population.
The key is figuring out where to target measures aimed at community infection control, she says. For instance, efforts to enhance awareness among people seeking care at health clinics, dialysis centers, and other healthcare associated or affiliated places, as well as general education about infection control, could be worthwhile.
"It's probably worth it to investigate this more because they're probably going to come into the hospital with a bloodstream infection," Popovich says. "So prevention of this is important."
Alexandra Wilson Pecci is an editor for HealthLeaders.
