US Pharm. 2014; (39):6.
One percent of the population carries methicillin-resistant Staphylococcus aureus
(MRSA), one of 18 microbes listed by the CDC as being resistant to
numerous antibiotics. Since 2007, the National Center for Health
Statistics’ Active Bacterial Core surveillance (ABCs) program has
tracked the prevalence of invasive MRSA infections. The prevalence
decreased by 12.3%, 19.7%, and 25.92%, respectively, in 2009, 2010, and
2011. Most MRSA infections develop in people in hospitals or other
healthcare settings, such as nursing homes and dialysis centers, but
they also occur in high-risk persons in the community.
Hospital Onset: Each year, 1.2 million people acquire
invasive MRSA infections while inpatients (20% of all hospital
infections). At any given time, one in every 20 inpatients has a MRSA
infection related to hospital care. Of all invasive MRSA infections, 85%
were acquired in the hospital; of these, two-thirds of cases were
detected after the hospital stay, and the rest were detected during the
stay. MRSA infections have occurred during invasive procedures or
through the use of invasive devices. On average, MRSA-infected patients
spent an additional 5 days in the hospital. The rate of staph infections
fell by nearly 30% in the last decade. Patients who were treated and
did well had a high risk of recurrence (20%-40%). Overall, the number of
serious MRSA infections diagnosed in hospitalized patients fell by 54%
between 2005 and 2011, from 9.7 to 4.5 per 100,000 people. The biggest
drop—more than 50%—was in hospital-acquired infections, whereas rates of
drug-resistant infections not linked to hospitals or other healthcare
settings barely changed.
Healthcare-Associated Community Onset: This type
of MRSA infection is acquired by individuals following a hospital stay.
The incidence of serious infections diagnosed in individuals who had
previously been in a healthcare setting decreased 28% between 2009 and
2011, from 21 to 15 infections per 100,000 population.
Community-Associated Onset: In these cases, MRSA
infection is not an outcome of hospitalization, but may include
residency at a long-term care facility prior to acquisition of the
infection. In the community setting, MRSA infection spreads by
skin-to-skin contact, so at-risk populations such as childcare workers
and high school wrestlers must pay attention to small red bumps
resembling pimples, boils, or spider bites. The CDC reported that, in
2007, 14% of people with MRSA infections contracted the infection
outside of a healthcare setting. This number continues to grow.
Dialysis Versus Nondialysis Patients: Invasive
MRSA infection is more prevalent in dialysis patients than in the
general population. The primary goal of clinicians is to prevent
bloodstream infections, particularly among chronic dialysis recipients.
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