%0 Journal Article %1 burton_methicillin-resistant_2009 %A Burton, Deron C %A Edwards, Jonathan R %A Horan, Teresa C %A Jernigan, John A %A Fridkin, Scott K %D 2009 %J JAMA: The Journal of the American Medical Association %K Analysis, Bacteremia, Care Catheterization, Central Cross Distribution, Humans, Incidence, Infection, Infections, Intensive Poisson Population Regression Staphylococcal Staphylococcus States Surveillance, United Units, Venous, aureus, {Methicillin-Resistant} %N 7 %P 727--736 %R 10.1001/jama.2009.153 %T Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007 %U http://www.ncbi.nlm.nih.gov/pubmed/19224749 %V 301 %X CONTEXT: Concerns about rates of methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections have prompted calls for mandatory screening or reporting in efforts to reduce MRSA infections. OBJECTIVE: To examine trends in the incidence of MRSA central line-associated bloodstream infections (BSIs) in US intensive care units (ICUs). DESIGN, SETTING, AND PARTICIPANTS: Data reported by hospitals to the Centers for Disease Control and Prevention (CDC) from 1997-2007 were used to calculate pooled mean annual central line-associated BSI incidence rates for 7 types of adult and non-neonatal pediatric ICUs. Percent MRSA was defined as the proportion of S aureus central line-associated BSIs that were MRSA. We used regression modeling to estimate percent changes in central line-associated BSI metrics over the analysis period. MAIN OUTCOME MEASURES: Incidence rate of central line-associated BSIs per 1000 central line days; percent MRSA among S. aureus central line-associated BSIs. RESULTS: Overall, 33,587 central line-associated BSIs were reported from 1684 ICUs representing 16,225,498 patient-days of surveillance; 2498 reported central line-associated BSIs (7.4\%) were MRSA and 1590 (4.7\%) were methicillin-susceptible S. aureus (MSSA). Of evaluated ICU types, surgical, nonteaching-affiliated medical-surgical, cardiothoracic, and coronary units experienced increases in MRSA central line-associated BSI incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical, and pediatric units experienced no significant changes. From 2001 through 2007, MRSA central line-associated BSI incidence declined significantly in all ICU types except in pediatric units, for which incidence rates remained static. Declines in MRSA central line-associated BSI incidence ranged from -51.5\% (95\% CI, -33.7\% to -64.6\%; P \textless .001) in nonteaching-affiliated medical-surgical ICUs (0.31 vs 0.15 per 1000 central line days) to -69.2\% (95\% CI, -57.9\% to -77.7\%; P \textless .001) in surgical ICUs (0.58 vs 0.18 per 1000 central line days). In all ICU types, MSSA central line-associated BSI incidence declined from 1997 through 2007, with changes in incidence ranging from -60.1\% (95\% CI, -41.2\% to -73.1\%; P \textless .001) in surgical ICUs (0.24 vs 0.10 per 1000 central line days) to -77.7\% (95\% CI, -68.2\% to -84.4\%; P \textless .001) in medical ICUs (0.40 vs 0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated BSIs due to MRSA increased 25.8\% (P = .02) in the 1997-2007 period, overall MRSA central line-associated BSI incidence decreased 49.6\% (P \textless .001) over this period. CONCLUSIONS: The incidence of MRSA central line-associated BSI has been decreasing in recent years in most ICU types reporting to the CDC. These trends are not apparent when only percent MRSA is monitored.

@article{burton_methicillin-resistant_2009, abstract = {{CONTEXT:} Concerns about rates of methicillin-resistant Staphylococcus aureus {(MRSA)} health care-associated infections have prompted calls for mandatory screening or reporting in efforts to reduce {MRSA} infections. {OBJECTIVE:} To examine trends in the incidence of {MRSA} central line-associated bloodstream infections {(BSIs)} in {US} intensive care units {(ICUs).} {DESIGN,} {SETTING,} {AND} {PARTICIPANTS:} Data reported by hospitals to the Centers for Disease Control and Prevention {(CDC)} from 1997-2007 were used to calculate pooled mean annual central line-associated {BSI} incidence rates for 7 types of adult and non-neonatal pediatric {ICUs.} Percent {MRSA} was defined as the proportion of S aureus central line-associated {BSIs} that were {MRSA.} We used regression modeling to estimate percent changes in central line-associated {BSI} metrics over the analysis period. {MAIN} {OUTCOME} {MEASURES:} Incidence rate of central line-associated {BSIs} per 1000 central line days; percent {MRSA} among S. aureus central line-associated {BSIs.} {RESULTS:} Overall, 33,587 central line-associated {BSIs} were reported from 1684 {ICUs} representing 16,225,498 patient-days of surveillance; 2498 reported central line-associated {BSIs} (7.4\%) were {MRSA} and 1590 (4.7\%) were methicillin-susceptible S. aureus {(MSSA).} Of evaluated {ICU} types, surgical, nonteaching-affiliated medical-surgical, cardiothoracic, and coronary units experienced increases in {MRSA} central line-associated {BSI} incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical, and pediatric units experienced no significant changes. From 2001 through 2007, {MRSA} central line-associated {BSI} incidence declined significantly in all {ICU} types except in pediatric units, for which incidence rates remained static. Declines in {MRSA} central line-associated {BSI} incidence ranged from -51.5\% (95\% {CI,} -33.7\% to -64.6\%; P {\textless} .001) in nonteaching-affiliated medical-surgical {ICUs} (0.31 vs 0.15 per 1000 central line days) to -69.2\% (95\% {CI,} -57.9\% to -77.7\%; P {\textless} .001) in surgical {ICUs} (0.58 vs 0.18 per 1000 central line days). In all {ICU} types, {MSSA} central line-associated {BSI} incidence declined from 1997 through 2007, with changes in incidence ranging from -60.1\% (95\% {CI,} -41.2\% to -73.1\%; P {\textless} .001) in surgical {ICUs} (0.24 vs 0.10 per 1000 central line days) to -77.7\% (95\% {CI,} -68.2\% to -84.4\%; P {\textless} .001) in medical {ICUs} (0.40 vs 0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated {BSIs} due to {MRSA} increased 25.8\% {(P} = .02) in the 1997-2007 period, overall {MRSA} central line-associated {BSI} incidence decreased 49.6\% {(P} {\textless} .001) over this period. {CONCLUSIONS:} The incidence of {MRSA} central line-associated {BSI} has been decreasing in recent years in most {ICU} types reporting to the {CDC.} These trends are not apparent when only percent {MRSA} is monitored.}, added-at = {2011-03-11T10:05:34.000+0100}, author = {Burton, Deron C and Edwards, Jonathan R and Horan, Teresa C and Jernigan, John A and Fridkin, Scott K}, biburl = {https://www.bibsonomy.org/bibtex/2293a74192b738662e8bd91a23a38e8b2/jelias}, doi = {10.1001/jama.2009.153}, interhash = {12410aed055a3afa1abbe27c7b7f9aeb}, intrahash = {293a74192b738662e8bd91a23a38e8b2}, issn = {1538-3598}, journal = {{JAMA:} The Journal of the American Medical Association}, keywords = {Analysis, Bacteremia, Care Catheterization, Central Cross Distribution, Humans, Incidence, Infection, Infections, Intensive Poisson Population Regression Staphylococcal Staphylococcus States Surveillance, United Units, Venous, aureus, {Methicillin-Resistant}}, month = feb, note = {{PMID:} 19224749}, number = 7, pages = {727--736}, timestamp = {2011-03-11T10:06:14.000+0100}, title = {Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in {US} intensive care units, 1997-2007}, url = {http://www.ncbi.nlm.nih.gov/pubmed/19224749}, volume = 301, year = 2009 }