Prevention and control of methicillin-resistant Staphylococcus aureus infections

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Abstract
This article reviews many recent publications relevant to the prevention and control of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Higher risk-adjusted costs and mortality have been found for MRSA infections than for methicillin-susceptible S. aureus infections confirming their epidemiologic importance. Staphylococcal cassette chromosome mec, the genetic basis for MRSA, does not develop in methicillin-susceptible S. aureus exposed to antimicrobials. Instead virtually all patients acquire MRSA via spread. Nevertheless, antibiotic therapy provides a selective advantage for such spread, especially within healthcare settings where antimicrobial therapy is most frequent. Several studies have suggested better control of MRSA through antibiotic control, but far more studies have reported control using surveillance cultures and contact precautions for preventing spread (rather than just using standard precautions). More rapid detection of MRSA (within 6 h) has been reported using polymerase chain reaction, but studies using this method to reduce spread have not yet been published. A structured survey of research methods used regarding MRSA control noted that many studies had methodologic shortcomings (for example, none was a randomized trial), but nevertheless concluded that active detection and isolation work should be used. A Society for Healthcare Epidemiology of America guideline emphasized the same approach noting that scores of studies on multiple continents had reported success with this approach, with best results in several northern-European countries where all facilities used it routinely. Improved MRSA control is possible by detecting and isolating colonized patients.

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