Issue: February 2013
Source: Stenehjem E. Infect Control Hosp Epidemiol. 2013;34:62-68.
January 03, 2013
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8-year MRSA reduction observed at Atlanta VA hospital

Issue: February 2013
Source: Stenehjem E. Infect Control Hosp Epidemiol. 2013;34:62-68.
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A reduction in the incidence of methicillin-resistant Staphylococcus aureus was observed during an 8-year period among veterans receiving treatment at the Atlanta Veterans Affairs Medical Center, recent study results indicated.

“Our study demonstrates a consistent trend in the reduction of both community-onset and hospital-onset MRSA infections in Atlanta veterans,” Edward Stenehjem, MD, previously with the Atlanta Veterans Affairs Medical Center and Emory University School of Medicine, now with Intermountain Healthcare in Salt Lake City, told Infectious Disease News. “Whether this reduction is a regional phenomenon or a national trend is yet to be determined.”

Eddie Stenehjem, MD 

Edward Stenehjem

Stenehjem and colleagues conducted an observational study of prospectively collected data to evaluate the incidence of both community-onset and hospital-onset MRSA. All patients who presented to the Atlanta VA Medical Center with MRSA from Oct. 1, 2003, to Sept. 31, 2011, were included in the study.

During this timeframe, there were 2,028 MRSA infections in 1,620 veterans. Most of the infections (91.6%) were community-onset. Community-onset infections were classified into two groups: health care-associated community-onset (HACO) and community-associated. HACO infections were isolated from outpatients or from patients within the first 48 hours of hospital admission. Among the community-onset infections, 59.6% were HACO. The rate of community-onset infections peaked in 2007, with a rate of 5.45 MRSA infections per 1,000 veterans. The rate decreased to 3.14 infections per 1,000 veterans in 2011. HACO infections comprised the majority each year.

Since the implementation of the Veterans Health Administration MRSA directive in 2007 requiring active surveillance for MRSA nasal colonization in all patients admitted to, transferred within or discharged from VA facilities, the prevalence of nasal colonization in the Atlanta VA Medical Center has decreased from 15.8% to 11.2% in 2011.

For hospital-onset MRSA, the rate of ICU-related MRSA infections was decreasing before the 2007 directive. After the directive was implemented, the rate of ICU-related MRSA infections remained stable. After the directive, there was no change in the infection rates of non-ICU–related MRSA infections.

“MRSA continues to be a common pathogen encountered in both the outpatient and inpatient settings,” Stenehjem said. “Even with the reduction in infection rates, practice patterns and antibiotic usage are not likely going to change anytime soon. This study, as well as others, does call into question the effectiveness of the Veterans Health Administration MRSA directive. Its universal use needs to be evaluated.”

Disclosure: The researchers report no relevant financial disclosures.