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Controlling the Spread of Healthcare Associated Methicillin Resistant Staphylococcus aureus Requires Active Surveillance


Both methicillin sensitive and methicillin resistant Staphylococcus aureus (MSSA, MRSA) can cause invasive and life-threatening infections such as osteomyelitis, septicemia, endocarditis, and pneumonia. Healthcare associated MRSA is of particular clinical importance because it is not only predictably cross resistant to all penicillins and cephalosporins, but is also typically resistant to multiple other antibiotics. Possibly because of inadequate initial antibiotic treatment, infections with health care associated MRSA result in increased costs and worse outcomes compared to infections with MSSA.

Methicillin was introduced in 1959, and as early as 1961 MRSA strains were being reported. Since then, MRSA has become increasingly prevalent worldwide, and in the past decade or more has increased dramatically in North America, Australia, and many European countries. A recent US hospital survey by the National Nosocomial Infections Surveillance System estimates that 55% of Staphylococcus aureus isolates are methicillin resistant, with the prevalence of MRSA strains being almost as high in non-ICU as in ICU settings. MRSA is also common in long-term care facilities.

MRSA may colonize mucosal or epithelial surfaces, the most common colonized site being the anterior nares. Sites of colonization are important not only as a source of subsequent infection, but also serve as a reservoir for transmission. Although frequent antibiotic use in healthcare settings selects for resistant flora, genetic evidence suggests that virtually all patients with MRSA acquire it from an external source. Patient to patient spread is most frequently caused by health care providers after direct contact with patients.

In January 2000, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors made reducing antibiotic-resistant infections a strategic SHEA goal. SHEA guidelines include active screening of patients for MRSA and implementation of co
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