MRSA rates continue to decline, but not in the community
About three years ago, Alex Kallen and colleagues published a study in JAMA describing the epidemiology of in invasive MRSA infections in the US from 2005 to 2008. Dan and I wrote the accompanying editorial and said that "The most important finding of (Kallen's) study was documentation of a continuous decline of invasive MRSA disease, including an estimated 9.4% annual decrease in hospital onset and an estimated 5.7% annual decrease in health care–associated community-onset infections." At that time, community-associated infections were increasing.
Fast forward to 2013 and today's JAMA-Internal Medicine. Raymund Dantes and colleagues at the CDC have updated the results and now include data from 2005 to 2011. Using somewhat different methods, they report that there were around 80,000 invasive MRSA infections in 2011, which is 31% lower than 2005 estimates. Importantly, for the first time, the incidence of hospital-onset infections was LOWER than community-associated (no healthcare exposure) rates. Of all healthcare-associated infections, 77% were classified as healthcare associated community-onset or HACO. The continued declines in hospital onset and to a lesser extent HACO MRSA infections suggests that infection control methods including attention to hand hygiene and prevention bundles must be having a positive effect. Estimated deaths attributable to MRSA fell to 11,000.
However, minimal changes in true community-associated infections (a reported 5% decline) suggest that there is much more work to do preventing MRSA in the community. Unfortunately, we don't have evidence-based methods available to prevent community infections, so the lack of community declines is not surprising. I hope we begin to invest in HAI prevention research with a focus on non-acute care populations.
Other media mentions: NY Times, Live Science
Fast forward to 2013 and today's JAMA-Internal Medicine. Raymund Dantes and colleagues at the CDC have updated the results and now include data from 2005 to 2011. Using somewhat different methods, they report that there were around 80,000 invasive MRSA infections in 2011, which is 31% lower than 2005 estimates. Importantly, for the first time, the incidence of hospital-onset infections was LOWER than community-associated (no healthcare exposure) rates. Of all healthcare-associated infections, 77% were classified as healthcare associated community-onset or HACO. The continued declines in hospital onset and to a lesser extent HACO MRSA infections suggests that infection control methods including attention to hand hygiene and prevention bundles must be having a positive effect. Estimated deaths attributable to MRSA fell to 11,000.
However, minimal changes in true community-associated infections (a reported 5% decline) suggest that there is much more work to do preventing MRSA in the community. Unfortunately, we don't have evidence-based methods available to prevent community infections, so the lack of community declines is not surprising. I hope we begin to invest in HAI prevention research with a focus on non-acute care populations.
Other media mentions: NY Times, Live Science
Excellent post thanks. You say that 'the incidence of hospital-onset infections was LOWER than community-associated rates.' which is true, but surely the burden of hospital-acquired MRSA also includes healthcare-associated, community-onset (HACO) cases? Thus, the combined burden of healthcare-associated MRSA is still 3x greater than community-associated MRSA.
ReplyDeleteDo you guys still have the same critiques of the Dept of VA study by Rajiv Jain et al? That work is starting to look even more prophetic. When it was proposed many ID docs and IC professionals said that high MRSA rates were a new normal and that little could be done to bring them down... See slides 11 to 24 in this slide set, for how it looked 6.5 years ago. http://www.slideshare.net/neldridge202/n-eldridge-for-ps-conf-crystal-city-3-2007to-present . Credit to CDC too in that Dr. John Jernigan worked with the VA team on the program.
ReplyDeleteCertainly good timing. Since MRSA is declining everywhere (but the community) and since most facilities aren't doing active surveillance programs, it's hard to pinpoint a cause-effect relationship. Of course, the most important thing is that these infections are declining.
DeleteIt seems like it started going down when people put alcohol hand rub in US hospitals too, and switched to antimicrobial soap. There used to be ICUs with plain soap, which I doubt one will see anymore. I guess cause and effect will never be known, but this is a good problem to have, ie, not knowing exactly why something good is happening.
ReplyDeleteSee this link on one thing that changed in 2003 and 2004:
http://image.slidesharecdn.com/ihs2-28-07neversion2-28final-130831145325-phpapp02/95/slide-73-638.jpg?1378144172
And this set of slides from 2004:
http://www.slideshare.net/neldridge202/qmic-on-hh-feb-2004-ne2 .
Things did start to change around 2003-2005, even before specific MRSA prevention programs of various stripes started up.