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Staph Infections Still a Deadly Concern, per CDC

Although healthcare facilities have made some progress in preventing methicillin-resistant S aureus (MRSA) infections, the epidemiology of methicillin-susceptible S aureus(MSSA) infections is not well characterized.

The Centers for Disease Control and Prevention (CDC) used data from the Emerging Infections Program MRSA population surveillance during 2005 to 2016, and from the Premier and Cerner Electronic Health Record databases during 2012 to 2017, to examine trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and to estimate the overall US incidence and associated mortality of these infections. A second report describes MRSA and MSSA infection rates from 2005 to 2017 among inpatients at Department of Veterans Affairs medical centers (VAMCs), which had all begun a multifaceted MRSA prevention program by 2007.

Study Synopsis and Perspective

Infection control efforts in US hospitals have reduced rates of S aureus bloodstream infections, but progress has slowed in recent years, health officials with the CDC warned in a report released online ahead of print March 5 and in the March 8 issue of the CDC's Morbidity and Mortality Weekly Report.[1]

"Staph infections are a serious threat and can be deadly. U.S. hospitals have made significant progress, but this report tells us that all staph infections must remain a prevention priority for healthcare providers," CDC Director Robert Redfield, MD, said in a news release.[2]

"We call on all healthcare providers to step up prevention efforts and follow CDC guidelines to protect patients from staph. Inconsistent or declining adherence to these recommendations might be slowing our progress," Anne Schuchat, MD, CDC principal deputy director, said during a news briefing with reporters.

More than 119,000 people experienced S aureus bloodstream infections in 2017, and nearly 20,000 died as a result, Athena Kourtis, MD, PhD, from the CDC's Division of Healthcare Quality Promotion, and colleagues note in their report.[3]

They analyzed electronic health record data from more than 400 acute care hospitals, as well as population-based surveillance data, to update estimates of MRSA and MSSA bloodstream infections.

Between 2005 and 2012, rates of MRSA infections in healthcare settings fell by 17.1% annually, according to Dr Kourtis and colleagues. But between 2012 and 2017, the rate of decline in hospital-onset MRSA infections slowed considerably (7.3% decline per year), the authors report. Community-onset MRSA infections declined by 6.9% per year between 2005 and 2016. The decrease was mostly related to declines in healthcare-associated infections.

Rates of hospital-onset MSSA infections did not decline substantially during the study period, whereas community-onset MSSA rates rose a significant 3.9% per year from 2012 to 2017, the authors report.

The ongoing opioid epidemic may be contributing to the rise in community-associated S aureus infections, Dr Schuchat said. She noted that in 2016, 9% of invasive MRSA cases occurred in persons who injected drugs, up from 4% in 2011.

"Healthcare 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," Dr Schuchat said during the briefing.

"The bottom line," she said, "is that while we've made important progress, our data show that more needs to be done to stop all types of staph infection."

VA Leads the Charge

Dr Schuchat noted that many healthcare systems in the United States are reducing staph infections by fully implementing current recommendations, continuously reviewing their data, and using additional interventions tailored to their facility if they are not meeting their infection reduction goals.

She cited VA medical centers as a "great success" story.

Beginning in 2005, in response to high rates of MRSA infections, 18 VA medical centers piloted a multifaceted MRSA infection prevention program, according to Makoto Jones, MD, and colleagues.[1] Components of the program included admission screening for nasal MRSA carriage and use of contact precautions for patients found to be carriers. "By October 2007, all 153 VAMCs had implemented the MRSA infection prevention program," the authors write.

The overall rate of S aureus infections in VA medical centers decreased by 43% from 2005 to 2017. The decrease was driven primarily by decreases in MRSA infections, which went down by 55%, Dr Jones and colleagues report.

"CDC continues to fund academic and healthcare investigators working to reduce staph burden in their healthcare facilities through the antibiotic resistance solutions initiative. Collaborating with CDC, experts nationwide are studying innovative ways to prevent staph infections and are exploring promising strategies to stop the spread of staph and other germs in healthcare facilities," said Dr Schuchat.

"Without both renewed commitment to current infection control practices and innovations that identify additional opportunities to reduce infections, staph will kill more people," she added.

Morb Mortal Wkly Rep. 2019;68:214-224.

Study Highlights

  • Analysis of data from 2005 to 2016 Emerging Infections Program population surveillance and from the Premier and Cerner Electronic Health Record databases during 2012 to 2017 allowed determination of trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and estimation of overall US incidence of S aureus bloodstream infections and associated in-hospital mortality.
  • There were an estimated 119,247 S aureus bloodstream infections with 19,832 associated deaths in 2017.
  • Although rates of hospital-onset MRSA septicemia fell by 17.1% annually during 2005 to 2012, this decrease slowed during 2013 to 2016.
  • The decline in community-onset MRSA was less pronounced (6.9% annually during 2005 to 2016), and was mainly attributed to decreases in healthcare-associated infections.
  • From 2012 to 2017, hospital-onset MSSA did not change significantly (P=.11), whereas community-onset MSSA infections increased slightly, going up by 3.9% annually (P<.0001).
  • This increase in community-onset S aureus infections may be a consequence of the opioid epidemic.
  • In 2016, 9% of invasive MRSA cases were in persons who injected drugs compared with 4% in 2011.
  • On the basis of their findings, the investigators concluded that S aureusinfections account for significant morbidity and mortality in the United States, despite decreasing incidence of MRSA septicemia since 2005.
  • They recommend that healthcare facilities fully implement and adhere to CDC recommendations to prevent device- and procedure-associated infections and to interrupt transmission.
  • The findings also mandate new and innovative prevention strategies, such as decolonization and other tailored interventions, as well as suppressing S aureus colonization during periods of high risk for invasive infection, such as during use of invasive devices, during admission to high-risk hospital units, or perioperatively for certain high-risk surgical procedures.
  • The postdischarge period might also be an important target for preventive strategies, as most MRSA bloodstream infections are healthcare-associated, community-onset infections, and most occur in the 3 months after hospital discharge.
  • Clinicians should also take note that persons who inject drugs are 16 times more likely to contract a serious Staphylococcal infection than their peers who do not inject drugs.
  • Useful interventions may therefore include prevention of opioid misuse, increasing access and linkage to medication-assisted treatment for persons with opioid use disorder, providing access to sterile injecting equipment, improving education about safer injection practices and how to recognize early signs of infection, and providing care to those with an infection.
  • To assess trends in hospital-acquired MRSA colonization, the second report analyzed clinical microbiology data from any patient admitted to a US acute-care VAMC in the United States from 2005 through 2017.
  • A multifaceted MRSA infection prevention program begun by 18 VAMCs in 2005 included admission screening for nasal carriage of MRSA and use of contact precautions for those who tested positive.
  • All 153 VAMCs had implemented the MRSA infection prevention program by October 2007.
  • From 2005 through 2017, S aureus infections declined by 43% overall (P<.001).
  • Decrease in MRSA (55%; P<.001) mostly accounted for this decline; MSSA decreased by only 12% (P=.003).
  • Hospital-onset MRSA and MSSA infections fell by 66% (P<.001) and 19% (P=.02), respectively, whereas community-onset MRSA infections fell by 41% (P<.001) and MSSA infections essentially remained stable.
  • During 2008 to 2017, acquisition of MRSA colonization decreased by 78% (17% annually; P<.001).
  • Compared with patients who had positive MRSA screening surveillance tests on admission, those with negative tests had much sharper declines in MRSA infection rates (annual 9.7% vs 4.2% decline; P<.05).
  • On the basis of their findings, the investigators concluded that declines in MRSA were mostly responsible for significant reductions in S aureus infection after the VAMC intervention.
  • In addition, decreases in MRSA infection were much larger among patients not carrying MRSA at the time of admission than among carriers, suggesting that reduced MRSA transmission was a major driver in lowering overall S aureusinfections at VAMCs.
  • While awaiting more information about effective control of bacterial pathogen transmission in healthcare settings, it may be premature and inadvisable to withdraw infection control interventions targeting prevention of MRSA transmission.
  • Such prevention strategies must include compliance with current CDC recommendations for antimicrobial stewardship, for prevention of device- and procedure-associated infections, and for interrupting transmission of strains that are prevalent in the healthcare setting, such as use of contact precautions for MRSA.

Clinical Implications


Authors:News Author: Megan Brooks; CME Author: Laurie Barclay, MDFaculty and Disclosures
Megan Brooks

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