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Press Start: Lead an Empowered Life as a Clinical Laboratorian

MRSA-A Deadly Threat on the Rise

Published May 21, 2008 12:03 PM by Glen McDaniel
The incidence of methicillin-resistant Staphylococcus aureus (MRSA) is increasing at an alarming rate. In fact, MRSA is now the No. 1 diagnosis in people presenting to U.S. emergency departments with skin and soft tissue infections. The infection is not entirely benign either; MRSA infections result in approximately 19,000 deaths annually. With over 94,000 people being infected with MRSA each year, there exists a real need for surveillance programs including prompt diagnosis and treatment.

As a relatively healthy person, not hospitalized, living in a typical community, I had my own sudden frightening brush with community acquired MRSA (CA-MRSA) just over a year ago.

Another consideration: With Medicare's decision not to reimburse hospitals for treating otherwise-preventable episodes such as nosocomial infections and states beginning to mandate MRSA surveillance programs now is the time for your lab to evaluate its protocols. 

As I indicated in that ADVANCE article: Many European countries use an aggressive "search-and-destroy" tactic whereby patients are screened on admission and immediately decolonized and placed on contact isolation if MRSA is present. Many U.S. hospitals regard this as overkill, but the incidence of MRSA (including CA-MRSA) in Europe is much less than in the U.S., largely due to this aggressive procedure. For example, in France it is less than 1 percent, according to sources at the American Hospital of Paris (personal communication, January 2007).

The CDC is pretty equivocal and still trying to find its footing on coming up with consistent recommendations. How big a problem do you consider MRSA infections (nosocomial and community acquired)? What is your laboratory's strategy to fight this new villain?  Any experience with rapid kits?

4 comments

MRSA acquired in the community setting is not the same strain as hospital acquired MRSA, so the European approach will not help.  The strain you most likely contracted, USA 300, is responsible for most of the increase in US MRSA infection rates.  We need to study how best to treat and prevent it, not assume it is the same bug as hospital acquired MRSA, which has stable infection rates that are already being addressed and reduced.

Carlos October 24, 2008 4:22 PM
Kansas City MO

"search and destroy" is what I did in western europe 34 yrs ago, maintaining a 0% secondary infectious rate.  for these criminal medical cartels to intentionally smear MRSA around by refusing to isolate, identify, find what works, treat and cure to put money in there pockets,  is nothing but an act of bio-terrorism...... and that is a felony.

tom July 21, 2008 12:57 PM

Katherine:

Thanks for your insightful post. I agree wholeheartedly that clinical laboratorians ought to take a leadership role in guiding how institutions wage this war on MRSA. As laboratorians we have the knowledge and training to see the big picture and help with development of protocols that make sense.

I just read an article in Modern Healthcare magazine that describes a recent survey geared at infection control practitioners. 2041 individuals responded regarding their institutions' efforts to track and prevent the spread of  MRSA.

Over 76% of the practitioners (mostly members of APIC-the Association for Professionals in Infection Control and Epidemiology) said progress is been made against MRSA but 50% said hospitals can do much more.

This is significany because hospitals are gearing up to meet the CMS nonpayment for hospita; acquired infections (HAI). Infection control measures geared towards reducing MRSA is often very helpful in reducing otherinfections as well. So adherence  reduces all infections, while noncompliance has implications for other HAIs as well.

Glen McDaniel June 26, 2008 6:39 PM
Atlanta GA

Current attention to the increasing evidence of community acquired MRSA within the local area has all but caused an uproar within our medical community. With CMS lowering the gauntlet on  nosicomal infections by threatening payment refusal for health care related costs assocaited with "hospital aquired" infections, it is increasingly important for medical facilities to investigate the true source of such infections.  

A vital part of this investigation centers on screening pre-admission patients for MRSA before placing them among the general patient population. This detection is not only important for the infected patient...allowing early treatment leading to decolonization of the potentially deadly invader...but equally important to other patients who may inadvertently be exposed and possibly infected due to the lack of required contact isolation precautions.

As laboratory technicians and technologists, it is our responsibility to guide infection control epidemiologists toward  cost effective solutions that are both timely and accurate in the identification of this "Super Bug".

Undoubtedly, in the near future, more and more methods will become available and increasingly faster. Increased sensitivity and specificity will lead to more rapid identification of not only MRSA but other emerging antibiotic resistant organisms. Currently, BD GeneOhm™utilizes a real-time polymerase chain reaction (PCR) diagnostic test to identify MRSA infections within two hours, a technology that is destine to grow exponentially.

Although our facility is yet in it's infancy regarding our investigation on the best possible approach, we have activated a screening test for our surgical patients...identifying MRSA from nasal specimens grown on selective agar. Although this is a slow process, generally taking 48 hours for negative cultures...it is at least a step in the right direction. A direction that will undoubtedly lead to an increase in positive patient outcomes...and after all, isn't that what we are all striving for?

Katherine Rhodes, Microbiology - Sr. Medical Technologist, Lenoir Memorial Hospital June 2, 2008 8:25 PM
Kinston NC

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