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Programs to prevent healthcare-associated methicillin-resistant Staphylococcus aureus (HCA-MRSA) infections have received much attention in U.S. hospitals, but have they made a difference? Using data from the CDC's Emerging Infections Program/Active Bacterial Core surveillance system, researchers examined the incidence of invasive HCA-MRSA infections in nine geographically diverse U.S. metropolitan areas from 2005 through 2008.
During the study period, 21,503 invasive MRSA infections were reported, of which 57% were HCA with community onset, 25% were hospital onset, and 18% were community onset. The most common HCA infections were bacteremia alone (43%), pneumonia/empyema (14%), bone or joint infection (11%), and skin or soft-tissue infection (11%). The incidence of both HCA community-onset and hospital-onset infections decreased incrementally in each of the 4 years studied, with a 17% overall decrease in HCA community-onset infections and a 28% overall decrease in hospital-onset infections between 2005 and 2008. The magnitude of the decrease was greatest for bloodstream infections (20% and 34%, respectively).
Kallen AJ et al. Health care–associated invasive MRSA infections, 2005-2008. JAMA 2010 Aug 11; 304:641.
Perencevich EN and Diekema DJ. Decline in invasive MRSA infection: Where to go from here? JAMA 2010 Aug 11; 304:687.
Comment
The authors acknowledge limitations to this analysis, including the small number of geographic areas surveyed and an inability to precisely define population denominators. Still, the results are consistent with recent findings from both the U.S. and England. As noted by editorialists, the key unanswered question now is why this decrease in HCA-MRSA infections is occurring. An understanding of the cause is essential to guiding future preventive efforts.