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Enhanced surveillance of meticillin-resistant Staphylococcus aureus bacteraemia in a London teaching hospital.
J Hosp Infect 2006; 63(4):365-73JH

Abstract

In 2001, the UK Department of Health introduced mandatory surveillance of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias (blood-culture-positive episodes) in English hospitals. We performed enhanced surveillance in their hospital between April 2001 and March 2003 to determine the epidemiology of MRSA bacteraemia across different specialities. There were 267 MRSA-blood-culture-positive episodes, giving a rate of 0.37 per 1000 occupied bed-days (OBD). Thirty-three (12.4%) episodes were false positives due to contaminants and 15 (5.6%) originated in the community or at another institution. Thirty-one (11.6%) episodes were in outpatients or occurred after recent discharge and were designated 'hospital associated'. The remaining 188 cases were clinically significant hospital-acquired episodes in inpatients, with a rate of 0.26 per 1000 OBDs. The highest rates were in the intensive therapy unit (ITU; 2.74 per 1000 OBDs) and the high-dependency unit (HDU; 1.68 per 1000 OBDs). Fifty-five non-ITU, non-HDU episodes occurred in patients who had been discharged from ITU or HDU prior to the development of bacteraemia but during the same admission. The number of MRSA bacteraemias related to ITU/HDU suggests that these wards may be hubs of MRSA infection. Haematology, oncology and renal (HOR) patients had the greatest number of hospital-associated episodes. The most common source of MRSA bacteraemia was a vascular access device (VAD) (108 episodes, 57%, 64% of which were central lines). The high bacteraemia rates in ITU, HDU and HOR patients were associated with high usage of VADs. The majority of episodes occurred in patients who were newly colonized with MRSA after admission. Thus, in this hospital, VADs and stays in ITU or HDU are important risk factors for bacteraemia, and VAD care and prevention of cross-infection are priorities for intervention. We recommend that the mandatory national surveillance scheme should collect additional data on MRSA bacteraemia to provide information for a national strategy for MRSA control and to allow appropriate comparison between institutions.

Authors+Show Affiliations

Department of Infection, Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, UK.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16765481

Citation

Jeyaratnam, D, et al. "Enhanced Surveillance of Meticillin-resistant Staphylococcus Aureus Bacteraemia in a London Teaching Hospital." The Journal of Hospital Infection, vol. 63, no. 4, 2006, pp. 365-73.
Jeyaratnam D, Edgeworth JD, French GL. Enhanced surveillance of meticillin-resistant Staphylococcus aureus bacteraemia in a London teaching hospital. J Hosp Infect. 2006;63(4):365-73.
Jeyaratnam, D., Edgeworth, J. D., & French, G. L. (2006). Enhanced surveillance of meticillin-resistant Staphylococcus aureus bacteraemia in a London teaching hospital. The Journal of Hospital Infection, 63(4), pp. 365-73.
Jeyaratnam D, Edgeworth JD, French GL. Enhanced Surveillance of Meticillin-resistant Staphylococcus Aureus Bacteraemia in a London Teaching Hospital. J Hosp Infect. 2006;63(4):365-73. PubMed PMID: 16765481.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enhanced surveillance of meticillin-resistant Staphylococcus aureus bacteraemia in a London teaching hospital. AU - Jeyaratnam,D, AU - Edgeworth,J D, AU - French,G L, Y1 - 2006/06/09/ PY - 2005/07/11/received PY - 2005/12/06/accepted PY - 2006/6/13/pubmed PY - 2006/10/5/medline PY - 2006/6/13/entrez SP - 365 EP - 73 JF - The Journal of hospital infection JO - J. Hosp. Infect. VL - 63 IS - 4 N2 - In 2001, the UK Department of Health introduced mandatory surveillance of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemias (blood-culture-positive episodes) in English hospitals. We performed enhanced surveillance in their hospital between April 2001 and March 2003 to determine the epidemiology of MRSA bacteraemia across different specialities. There were 267 MRSA-blood-culture-positive episodes, giving a rate of 0.37 per 1000 occupied bed-days (OBD). Thirty-three (12.4%) episodes were false positives due to contaminants and 15 (5.6%) originated in the community or at another institution. Thirty-one (11.6%) episodes were in outpatients or occurred after recent discharge and were designated 'hospital associated'. The remaining 188 cases were clinically significant hospital-acquired episodes in inpatients, with a rate of 0.26 per 1000 OBDs. The highest rates were in the intensive therapy unit (ITU; 2.74 per 1000 OBDs) and the high-dependency unit (HDU; 1.68 per 1000 OBDs). Fifty-five non-ITU, non-HDU episodes occurred in patients who had been discharged from ITU or HDU prior to the development of bacteraemia but during the same admission. The number of MRSA bacteraemias related to ITU/HDU suggests that these wards may be hubs of MRSA infection. Haematology, oncology and renal (HOR) patients had the greatest number of hospital-associated episodes. The most common source of MRSA bacteraemia was a vascular access device (VAD) (108 episodes, 57%, 64% of which were central lines). The high bacteraemia rates in ITU, HDU and HOR patients were associated with high usage of VADs. The majority of episodes occurred in patients who were newly colonized with MRSA after admission. Thus, in this hospital, VADs and stays in ITU or HDU are important risk factors for bacteraemia, and VAD care and prevention of cross-infection are priorities for intervention. We recommend that the mandatory national surveillance scheme should collect additional data on MRSA bacteraemia to provide information for a national strategy for MRSA control and to allow appropriate comparison between institutions. SN - 0195-6701 UR - https://www.unboundmedicine.com/medline/citation/16765481/Enhanced_surveillance_of_meticillin_resistant_Staphylococcus_aureus_bacteraemia_in_a_London_teaching_hospital_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(06)00038-7 DB - PRIME DP - Unbound Medicine ER -