How many mrsa deaths

National MRSA reductions primarily reflect declines in the incidence of infections caused by USA strains, which are predominantly transmitted in health care settings, and, to a lesser extent, USA strains, which are predominantly transmitted in the community Historically, large shifts in S.

Whereas the reasons for some of these shifts might be related to strain virulence and fitness, health care—related interventions are likely to have played a role in the decrease in USA These include strategies to suppress S.

The experience with MRSA suggests that the postdischarge period might also be important for targeting innovative prevention efforts: EIP data suggest that the majority of all MRSA bloodstream infections are health care—associated community-onset, and most occur in the 3 months after hospital discharge 3. A recent study suggests that prescribing serial decolonization protocols at the time of hospital discharge could significantly reduce postdischarge S.

Suppression of S. All hospitals should have strategies in place for preventing S. A recent review of NHSN data indicated that a relatively small number of hospitals approximately account for slightly over half of the hospital-onset MRSA incidence in excess of the goals and could be prioritized for prevention to reduce MRSA bloodstream infections nationally NHSN, unpublished data.

Community-associated MRSA infections provide a reservoir that contributes to health care—associated disease incidence and fuels transmission both outside and within health care settings.

USA strains, for example, emerged in the community and spread to health care settings Community-associated S. Emerging evidence suggests a fold risk for invasive MRSA infection among persons who inject drugs; 9. Prevention of opioid misuse, increasing access and linkage to medication-assisted treatment for persons with opioid use disorder 27 , ensuring access to sterile injecting equipment, improving education about safer injection practices and how to recognize early signs of infection, and linking those with an infection to care are needed.

Additionally, community-associated S. The observed increases in rates of community-onset MSSA infections highlight the need to systematically study the epidemiology of MSSA and develop innovative, evidence-based prevention strategies for this setting. Research for a vaccine or for novel ways to decrease S. The incidence of S. Mortality was unchanged over the time studied and comparable to what was achieved in the VA hospital system through implementation of improved clinical management of infection Appropriate and timely diagnosis and antimicrobial susceptibility-guided treatment of S.

The findings in this report are subject to at least two limitations. First, the lack of detailed epidemiologic information on previous health care exposures captured in EHR precluded subclassification of community-onset infections into those with and without previous health care exposures. Second, possible variability in clinical or data capture practices across different hospitals might affect the validity of EHR data and trends.

Strengths of this study include the use of multiple data sources; the detailed epidemiologic information provided in the population-based EIP surveillance; the inclusion of two widely used EHR systems representing a large number of U. As has been previously shown with another infection-related condition sepsis , clinical criteria using EHR data are immune to temporal variations in coding practices that can be significant 30 , whereas death-certificate data are an insensitive measure of sepsis-related mortality Despite significant reductions in health care—associated MRSA infections, progress is slowing.

MSSA infections have not decreased as much in hospitals and might be increasing in the community. Adherence to CDC recommendations 32 for preventing device- and procedure-associated infections and interrupting transmission, along with innovative interventions tailored to the needs of health care facilities including decolonization are needed to further prevent S.

Corresponding author: Athena P. Kourtis, apk3 dc. All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed. Model adjusts for discharge month and year and hospital region, teaching status, bed size, and distributions of patient age, sex and race, in addition to accounting for repeated measures and clustering by facility. Department of Health and Human Services.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U. CDC is not responsible for the content of pages found at these sites. This conversion might result in character translation or format errors in the HTML version. But if the skin is damaged or cut, it can cause infection. MRSA, the more dangerous antibiotic-resistant staph infection, can be spread by bed linens, medical equipment or health care workers if they don't wash their hands properly between patients.

MRSA can cause life-threatening pneumonia and bloodstream infections, which can lead to sepsis and death. The World Health Organization recommends that all patients be screened for the Staph aureus bacteria before surgery.

Staph infections can be reduced and even eliminated. Chart abstraction was performed by 2 independent reviewers with no access blinded to laboratory data. Each new hospital admission was categorized as a new episode of bacteremia; the first positive blood culture was used as the index infection.

We defined the number of days to clearance of bacteremia as the date of first positive MRSA culture subtracted from the date of first negative culture for all patients for whom this information was available. Episodes of bacteremia ended on the date of death or on the date of the first negative blood culture that was not followed by a positive culture within 7 days. We did not study subsequent episodes during the same hospitalization. Empirically prescribed therapy was defined as appropriate if MRSA were susceptible to the antimicrobial drug used according to in vitro susceptibility testing and if therapy was started within 48 hours of the blood culture result.

We defined an episode as community associated if the patient was bacteremic within 48 hours of hospitalization and lacked health care—associated risk factors such as dialysis, nursing home residence, or history of MRSA infection. We divided health care—associated MRSA cases into community onset or hospital onset. Cases were health care—associated community onset if the patient had such risk factors and was found to be bacteremic within 48 hours of hospital admission; cases were of health care—associated hospital onset if the bacteremia occurred after 48 hours of hospitalization, consistent with the schema of Klevens et al.

We used the Duke criteria to define endocarditis Severity of bacteremia at onset of infection was determined by use of vasopressors, elevation of serum creatinine levels from baseline renal insufficiency , and admission to an intensive care unit after positive MRSA blood culture result. The major patient outcome measure was day all-cause mortality rate. Data regarding death after hospital discharge were not available for analysis.

MRSA-attributable deaths were not included because of the difficulty in assessing exact cause of death. We used SAS version 9. Model building was guided first by conceptual models of likely effect and informed by our bivariate analysis results. Guided by the rule for stability of estimates established by Peduzzi et al.

Our model predicting death has a c-score of 0. Although we also present the more familiar adjusted odds ratios, our primary measures of impact are adjusted risk measures adjusted risk ratio and adjusted risk difference , which we derived from regression risk analysis, an enhancement over the usual presentation of logistic regression MRSA, methicillin-resistant Staphylococcus aureus. VISA, vancomycin-intermediate S.

Each year during —, the annual number of hospital admissions in this study were , 77, , , and , respectively; through May 31, , another 76 patients were hospitalized equivalent to annual hospitalizations.

The geometric mean MIC of vancomycin was 1. In , the MIC 50 of vancomycin was 1. Key patient characteristics are shown in Table 3. Recent medical care seemed to be associated with type of strain. Average length of stay for patients with all infection types was The day all-cause mortality rate was For the episodes of bacteremia, mortality rates were Our data did not enable us to determine the extent to which switching, or not switching, antimicrobial drugs contributed to survival. The adjusted risk difference represents the absolute difference in risk for that given characteristic, all else held equal.

Cirrhosis of the liver and central venous catheter infections nearly doubled the risk for hVISA infection. The effect of various clinical characteristics on risk for death within 90 days is summarized in Table 2. For patients with concomitant MRSA bacteremia, older age increased the risk of dying. Risk for death was independently associated with lower risk for death among those who had diabetes mellitus or who had had a vascular graft as the source of the infection. A subanalysis of vancomycin MICs for strains infecting patients who died in the hospital found that the mean MIC was 1.

The idealized model for the treatment of patients with infectious diseases incorporates the triad of host, organism, and drug. Organisms and drugs are more easily classified and hence more accessible for systematic study.

Our study of the 5-year experience with MRSA infections in adults at a major New York City medical center illustrates why such a dyadic approach might be insufficient. For example, the MIC, which characterizes the major intersection between organism and drug, was overshadowed by a constellation of clinical factors when predicting risk for death. Vancomycin MICs from isolates from most persons who died indicated nominal susceptibility. Several other studies have shown vancomycin MIC to not be a predictor of death 10 , 12 , Unlike others, who considered concurrent conditions by using scales such as the Charlson Index 15 , 24 , we investigated the association between specific patient characteristics, organisms, drugs, and outcomes.

Not all concurrent conditions were alike in either magnitude or direction of effect. Hospitalized patients with colonized MRSA may be particularly vulnerable to developing an infection during a hospital stay or after discharge. Wounds, surgical incisions and use of medical devices, such as catheters, may also lead to MRSA infection among carriers. For the study, which appears in the Journal of the American Board of Family Medicine , researchers analyzed data from the National Health and Nutrition Examination Survey, a large, nationally representative study that combines survey questions with laboratory testing, including nasal swabs to test for the presence of MRSA.

The researchers linked data on participants ages with data from the National Death Index to track deaths over an year period. Researchers adjusted for factors including gender, race and ethnicity, health insurance, poverty-income ratio, hospitalization in the previous 12 months, and doctor diagnosis of heart disease, diabetes and asthma.

Participants who carried staph bacteria on their skin, but not MRSA, did not have an increased risk for premature death. Some states and hospital systems require MRSA testing for patients before hospital admission, but policies for testing and treatment of colonized MRSA, which may include use of topical or oral antibiotics, are highly variable from hospital to hospital, Mainous said.

In addition to Mainous, the study team included Benjamin J. Rooks, M. Carek, M. Media contact: Ken Garcia at kdgarcia ufl. She is responsible for developing public relations and communications strategies to promote the