The Challenges of MethicillinResistant Staphylococcus aureus MRSA as a Community Pathogen

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The Challenges of Methicillin-Resistant
Staphylococcus aureus (MRSA) as a Community
Pathogen
MRSA Surveillance Issues and Approaches
R. Monina Klevens, DDS, MPH Melissa Morrison,
MPH Division of Healthcare Quality Promotion
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"The findings and conclusions in this
presentation are those of the authors and do not
necessarily represent the views of the Centers
for Disease Control and Prevention/the Agency for
Toxic Substances and Disease Registry."
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Overview

• Challenges
• Changing epidemiology
• Confusing terminology
• Cost and resources
• Examples of surveillance activities that address
  challenges
• Antibiogram surveillance
• EmergeIDNet
• ABCs

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Challenges for Surveillance

• Changing epidemiology
• Tracking morbidity and mortality of a dynamic
  organism
• Confusing terminology, definitions
• Costs and resources
• Disproportionate frequency of disease compared
  with availability of resources

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Co-Resistance Among Methicillin-Resistant S.
aureus (MRSA) from Nosocomial Infections Among
Intensive Care Unit Patients, 1992-2003



plt.01
Klevens et al. CID 200642389-91
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Resistance of MRSA to Erythromycin Only Among
Nosocomial Infections Among Intensive Care Unit
Patients, 1992-2003
Plt0.001
Klevens et al. CID 200642389-91
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Percentage of Isolates of Invasive MRSA Cases,
Comparing Healthcare Risk Factors and
Pulsed-Field Type
16th Annual SHEA March 2006
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Challenges for Surveillance

• Changing epidemiology
• Tracking morbidity and mortality of a dynamic
  organism
• Confusing terminology, definitions
• Costs and resources
• Disproportionate frequency of disease compared
  with availability of resources

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Confusing, Non-standard MRSA Terminology

• Community-Onset
• Not hospital-associated
• Community-Acquired
• Community-Associated
• Community-Based
• Community-Adapted

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Challenges for Surveillance

• Changing epidemiology
• Tracking morbidity and mortality of a dynamic
  organism
• Confusing terminology, definitions
• Costs and resources
• Disproportionate frequency of disease compared
  with availability of resources

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What is adequate funding?

• 130 cases in 2005
• 133 cases in 2004

about 22,500 per case
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Burden of Invasive Bacterial DiseaseABCs cases
and U.S. projections 2003/2004
Preliminary estimates
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Spectrum of MRSA Surveillance Activities
Reportable
Outbreak response
Antibiogram surveillance
Active/passive
Sentinel populations
All sites/invasive
Isolate testing
Population-based
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Current Status of Surveillance for
Methicillin-resistant Staphylococcus aureus by
State 2004 2005








Active MRSA Passive MRSA Active and Passive
MRSA NONE


A
Michigan Massachusetts Washington Maine
Louisiana Missouri
Information collected from 1. Current U.S.
surveillance systems survey. April, 2005. 2.
http//www.cdc.gov/ncidod/dbmd/abcs/meth-surv.htm.
3. Updated January, 2006.
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Examples of surveillance activities

• Aggregate susceptibility patterns
• Louisiana antibiogram surveillance
• Restrict source location and syndrome
• EmergeID Net
• Restrict source of isolate
• ABCs Invasive MRSA disease

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Example of Antibiogram Surveillance Louisiana

• Antibiograms collected from 37 hospitals
  throughout the state in 2002
• Resistance data is compiled on a Microsoft Access
  database on a rolling basis as hospital
  antibiograms become available
• Purpose
• To track and monitor resistance patterns
  throughout the state
• To compare patterns across regions and with other
  states

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(No Transcript)
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Prevalence of MRSA as cause of SSTI in Adult ED
Patients EMERGEncy ID Net, Moran GJ, et al,
SAEM 2005
MRSA 59
PVL98
54
39
15
55
74
68
51
60
60
72
67
MSSA 17
PVL42
Slide courtesy of Rachel Gorwitz and Greg Moran
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Participants Total Population 16.3 million
Hospitalization or death
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Methods of Invasive MRSA Surveillance
Isolate from invasive site MRSA
MRSA Patients
Medical Record Review
Risk Factors
Community-associated
Healthcare-associated
Collection of isolates since 2005
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Number and Percentage of Invasive MRSA Cases
Without Healthcare-Related Risk Factors, by Site,
July - December 2005
98
34
62
26
81
Percent Without HRFs
25
43
5
12
Site
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Resources
http//www.cste.org
http//www.apic.org
Prevention Fact sheets community MRSA Campaign
to Prevent Resistance in Healthcare
http//www.cdc.gov/ncidod/hip/default.htm
Get Smart newsletter http//www.cdc.gov/drugresis
tance/community/news.htm