Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Commentary

Stopping short the spread of methicillin-resistant Staphylococcus aureus

Jan Verhoef
CMAJ July 10, 2001 165 (1) 31-32;
Jan Verhoef
Dr. Verhoef is Director of the Eijkman-Winkler Institute for Microbiology, Infectious Diseases and Inflammation, University Medical Centre, Utrecht, the Netherlands.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

As described by Andrew Simor and colleagues1 elsewhere in this issue (page 21), Canadian hospitals, like many hospitals elsewhere, have recently witnessed an increase in the proportion of Staphylococcus aureus isolates that are resistant to methicillin (known as methicillin-resistant S. aureus or MRSA). The rate has risen from 1% of all isolates in 1995 to 6% in 1999.1 Despite the increase, Canada's rate of MRSA is much lower than those of many other countries, such as the United States (where 40% of strains are resistant), Japan (80%) and European countries such as Italy, Greece, France, Belgium and Spain (all of which have rates higher than those in Canada).2 The Canadian rate is similar to those observed in Switzerland and the Scandinavian countries, but it is 5 times higher than in the Netherlands.3 It is surprising that despite frequent cross-border traffic between the United States and Canada and between Canada and many European countries, there are still such great differences in rates of MRSA strains among these countries. The cause of such substantial differences between countries and between hospitals must relate to local differences in antibiotic policies and infection control measures.

In the Canadian study1 more than half of the isolates could be linked to an index case, and molecular techniques showed that 81% of the isolates were identical with 1 of only 4 epidemic strains. These findings suggest that even in a country as geographically vast as Canada, infection control measures can and should be centrally organized in the battle against MRSA. As discussed by Simor and colleagues,1 there is an urgent need to implement better infection prevention and control measures to limit the spread of MRSA in the hospital setting.

In the Netherlands both colonization and infection with MRSA occur in less than 1% of patients. This low rate can be attributed to hospitals' enforcement of the stringent infection control measures that were established by the Dutch Working Party on Infection Prevention almost 10 years ago.4 The basis of those guidelines is a “search-and-destroy” strategy. For example, all patients transferred to our hospital (a 1042-bed teaching hospital that encompasses all major disciplines) from hospitals outside the Netherlands are kept in quarantine for at least 48 hours. During that time they receive medical care, and screening cultures are taken from the skin and mucous membranes of the nose. At 1-hour intervals over a period of 5 hours, swabs are taken from the patient's nose, throat, perineum, sputum, urine and, if present, wounds. Only if the results of all of these sets of cultures are negative is the patient transferred to an open ward. If a patient is found to carry MRSA, he or she is transferred to an isolation room, and his or her former roommates and all personnel are screened. The former roommates of the patient are nursed in cohort isolation until culture results are negative for MRSA. If 1 or more patients or at least 1 health care worker is found to be carrying the same MRSA strain as the index case, the ward is closed to new admissions. If MRSA is identified in an intensive care unit, the unit is immediately closed to new admissions. Once a ward or an intensive care unit has been closed, all other patients and personnel in the ward or unit are screened, and the ward or unit is not reopened to new admissions until all MRSA-positive patients have been isolated in a separate room and all MRSA-positive personnel have been sent home.

Managing MRSA in this way is expensive. We have calculated that it can cost as much as US$250 000 for our hospital to bring an outbreak of MRSA (in which 3 to 5 patients are infected) under control; these costs relate to isolating patients transferred from other hospitals, closing intensive care units, postponing surgery, obtaining and analyzing surveillance cultures, and other measures.3 Yet one might wonder whether these measures are cost effective.5 It is likely that if we and other hospitals in the Netherlands did not enforce this antibiotic policy and infection control program, the endemic level of MRSA in our country would increase substantially. There is evidence that when no control measures are taken, a rapid increase in the rate of MRSA (to as high as 40% of all S. aureus isolates) can be expected.6 This increase in the rate of MRSA can lead to greater use of vancomycin or teicoplanin, which may hasten the emergence of vancomycin-resistant enterococci and subsequently vancomycin-resistant S. aureus.

It is also possible that when the percentage of MRSA increases, illness and death due to S. aureus also increase. In Spain the mortality rate is higher among patients with MRSA than among those with methicillin-susceptible S. aureus (MSSA), patients with MRSA endocarditis have a slower response to adequate antibiotics than those with MSSA endocarditis, and patients with MRSA are kept in hospital longer than patients with MSSA.7

MRSA strains are usually resistant to many different antibiotics, becoming a reservoir for resistance genes. These genes may then be transferred from the resistant strains to other bacteria. An increase in the incidence of MRSA in the hospital setting would undoubtedly result in the spread of MRSA into the community.

The costs associated with not undertaking aggressive control measures to manage outbreaks of MRSA are thus substantial, and expenditures to contain outbreaks of MRSA seem worthwhile. Given the wide range of negative outcomes associated with MRSA, hospitals with a high endemic level of MRSA should focus attention on the subset of highly epidemic MRSA, defined by DNA fingerprinting techniques.8

A similar search-and-destroy policy would probably be cost effective in Canada, where the situation is still relatively favourable. Because the rate of MRSA is so much higher in the United States, it would also be advisable for Canadian hospitals to start isolating any patients who are transferred in from US hospitals.

Footnotes

  • Competing interests: None declared.

References

  1. 1.↵
    Simor AE, Ofner-Agostini M, Bryce E, Green K, McGeer A, Mulvey M, et al, and the Canadian Nosocomial Infection Surveillance Program, Health Canada. The evolution of methicillin-resistant Staphylococcus aureus in Canadian hospitals: 5 years of national surveillance. CMAJ 2001;165(1):21-6. Available: www.cma.ca/cmaj/vol-165/issue-1/0021.asp
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the sentry antimicrobial surveillance program, 1997–1999. Clin Infect Dis 2001;32(2 Suppl):S114-32.
  3. 3.↵
    Verhoef J, Beaujean D, Blok H, Baars A, Meyler A, van der Werken C, et al. A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999;18:461-6.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Working Party on Infection Prevention (WIP). Policy for MRSA. WIP Guideline 35. Leiden, The Netherlands: WIP; 1994.
  5. 5.↵
    Abramson MA, Sexton DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia. At what costs? Infect Control Hosp Epidemiol 1999;20:408-11.
    OpenUrlCrossRefPubMed
  6. 6.↵
    Voss A, Milatovic D, Wallrauch-Schwarz C, Rosdahl VT, Braveny I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50-5.
    OpenUrlCrossRefPubMed
  7. 7.↵
    Romero-Vivas J, Rubio M, Fernandez C, Picazo JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995;21:1417-23.
    OpenUrlAbstract/FREE Full Text
  8. 8.↵
    Laurent F, Lelievre H, Cornu M, Vandenesch F, Carret G, Etienne J, et al. Fitness and competitive growth advantage of new gentamicin-susceptible MRSA clones spreading in French hospitals. J Antimicrob Chemother 2001;47:277-83.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

CMAJ
Vol. 165, Issue 1
10 Jul 2001
  • Table of Contents
  • Index by author
  • Canadian Adverse Drug Reaction Newsletter (81-88)

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Stopping short the spread of methicillin-resistant Staphylococcus aureus
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Stopping short the spread of methicillin-resistant Staphylococcus aureus
Jan Verhoef
CMAJ Jul 2001, 165 (1) 31-32;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Stopping short the spread of methicillin-resistant Staphylococcus aureus
Jan Verhoef
CMAJ Jul 2001, 165 (1) 31-32;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Ensuring timely genetic diagnosis in adults
  • The case for improving the detection and treatment of obstructive sleep apnea following stroke
  • Laser devices for vaginal rejuvenation: effectiveness, regulation and marketing
Show more Commentary

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

CMA Civility, Accessibility, Privacy

 

Powered by HighWire