Progress against staph infections has ‘stalled,’ CDC says

Anne Schuchat, MD 
Anne Schuchat
Hilary Babcock, MD, MPH 
Hilary M. Babcock

Hospital infection control measures have reduced the rates of Staphylococcus aureus bloodstream infections in the United States, including from MRSA, but that success is slowing and some staph infections are on the rise, according to the CDC.

“Although we have made significant progress, more recently this progress has stalled,” CDC Principal Deputy Director Anne Schuchat, MD, said today in a telebriefing.

According to a Vital Signs report published in MMWR, researchers used EHR data from more than 400 acute-care hospitals and recent population-based surveillance data from the CDC’s Emerging Infectious Program to update estimates on MRSA and methicillin-susceptible S. aureus (MSSA) bloodstream infections and associated in-hospital mortality in the U.S.

According to the findings, there were an estimated 119,247 S. aureus bloodstream infections in 2017, with 19,832 associated deaths.

Adjusted MRSA bloodstream infection rates in health care settings decreased nationally by 17.1% per year between 2005 and 2012, but did not significantly change during 2013-2016, the researchers reported. Adjusted community-onset MRSA declined less, going down 6.9% annually between 2005 and 2016, they said.

The researchers also reported that community-onset MSSA increased 3.9% per year from 2012 to 2107 (P < .0001), but there was no significant change in hospital-onset MSSA during the study period.

The rise in staph infections in the community might be linked to the nation’s opioid crisis. According to the report, in 2016, 9.2% of all invasive MRSA infections occurred in people who inject drugs, rising from 4% in 2011, Schuchat said.

“Health care providers should be aware that the people who inject drugs are 16 times more likely to develop a serious staph infection than those who do not,” Schuchat said.

She noted that the CDC has made recommendations to health care providers to help prevent the spread of MRSA. These strategies include contact precautions, wearing gowns and gloves when caring for patients with MRSA and targeted screening of patients who might carry MRSA.

“We believe that those actions, along with preventing infections in the first place, keeping hands clean and improving how antibiotics are used have contributed to the decline in overall staph infections nationally,” Schuchat said.

Inconsistent or declining adherence to the recommendations might also be slowing the progress, she said.

“We have prevented many staph infections, but while we have made important progress, our data show that more needs to be done to stop all types of staph infections,” she said.

Going forward, health care providers and administrators should review their data on an ongoing basis and decide when to add additional interventions if they are not meeting their infection reduction goals, she said.

Additional prevention measure include decolonization during high-risk periods, including ICU stays, surgery or device use, according to the CDC.

"The report highlights the critical impact made by dedicated health care epidemiologists working with their hospital and health system partners to protect patients over the last decade. It also shows that there is more work to be done,” Hilary M. Babcock, MD, MPH, president of the Society for Healthcare Epidemiology of America (SHEA), said in a news release.

“For MRSA and MSSA, no single prevention approach works in all situations. Combination, or bundled, interventions are usually the best approach. Which strategies will have the biggest impact may depend on the local context. SHEA urges expanded funding support for research into what interventions are most effective in what settings, so that infection prevention programs can continue to reduce these infections in patients across health care settings.” – by Bruce Thiel

Reference:

Kourtis AP, et al. MMWR Morb Mortal Wkly Rep. 2019:doi:10.15585/mmwr.mm6809e1.

Disclosure: Babcock is the president of SHEA. Schuchat works for the CDC.

Anne Schuchat, MD 
Anne Schuchat
Hilary Babcock, MD, MPH 
Hilary M. Babcock

Hospital infection control measures have reduced the rates of Staphylococcus aureus bloodstream infections in the United States, including from MRSA, but that success is slowing and some staph infections are on the rise, according to the CDC.

“Although we have made significant progress, more recently this progress has stalled,” CDC Principal Deputy Director Anne Schuchat, MD, said today in a telebriefing.

According to a Vital Signs report published in MMWR, researchers used EHR data from more than 400 acute-care hospitals and recent population-based surveillance data from the CDC’s Emerging Infectious Program to update estimates on MRSA and methicillin-susceptible S. aureus (MSSA) bloodstream infections and associated in-hospital mortality in the U.S.

According to the findings, there were an estimated 119,247 S. aureus bloodstream infections in 2017, with 19,832 associated deaths.

Adjusted MRSA bloodstream infection rates in health care settings decreased nationally by 17.1% per year between 2005 and 2012, but did not significantly change during 2013-2016, the researchers reported. Adjusted community-onset MRSA declined less, going down 6.9% annually between 2005 and 2016, they said.

The researchers also reported that community-onset MSSA increased 3.9% per year from 2012 to 2107 (P < .0001), but there was no significant change in hospital-onset MSSA during the study period.

The rise in staph infections in the community might be linked to the nation’s opioid crisis. According to the report, in 2016, 9.2% of all invasive MRSA infections occurred in people who inject drugs, rising from 4% in 2011, Schuchat said.

“Health care providers should be aware that the people who inject drugs are 16 times more likely to develop a serious staph infection than those who do not,” Schuchat said.

She noted that the CDC has made recommendations to health care providers to help prevent the spread of MRSA. These strategies include contact precautions, wearing gowns and gloves when caring for patients with MRSA and targeted screening of patients who might carry MRSA.

“We believe that those actions, along with preventing infections in the first place, keeping hands clean and improving how antibiotics are used have contributed to the decline in overall staph infections nationally,” Schuchat said.

Inconsistent or declining adherence to the recommendations might also be slowing the progress, she said.

“We have prevented many staph infections, but while we have made important progress, our data show that more needs to be done to stop all types of staph infections,” she said.

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Going forward, health care providers and administrators should review their data on an ongoing basis and decide when to add additional interventions if they are not meeting their infection reduction goals, she said.

Additional prevention measure include decolonization during high-risk periods, including ICU stays, surgery or device use, according to the CDC.

"The report highlights the critical impact made by dedicated health care epidemiologists working with their hospital and health system partners to protect patients over the last decade. It also shows that there is more work to be done,” Hilary M. Babcock, MD, MPH, president of the Society for Healthcare Epidemiology of America (SHEA), said in a news release.

“For MRSA and MSSA, no single prevention approach works in all situations. Combination, or bundled, interventions are usually the best approach. Which strategies will have the biggest impact may depend on the local context. SHEA urges expanded funding support for research into what interventions are most effective in what settings, so that infection prevention programs can continue to reduce these infections in patients across health care settings.” – by Bruce Thiel

Reference:

Kourtis AP, et al. MMWR Morb Mortal Wkly Rep. 2019:doi:10.15585/mmwr.mm6809e1.

Disclosure: Babcock is the president of SHEA. Schuchat works for the CDC.