Methicillin-resistant Staph increasing, California report says
By Kylie Reynolds
March 1, 2010 10:28 p.m.
A report published this winter indicates that methicillin-resistant Staphylococcus aureus has increased fourfold in California patients from 1999 to 2007.
Published by the California Office of Statewide Health Planning and Development, the report stated that the number of MRSA cases rose from about 13,000 in 1999 to about 52,000 in 2007. Rates of MRSA cases at UCLA, however, have remained low.
MRSA, a bacteria present on the skin and in the nose, is the cause of both skin infections and some potentially life-threatening infections, such as pneumonia.
For patients with diabetes, staph infections can be especially dangerous. Diabetic patients make up 20 percent of those who die after contracting MRSA, according to a Department of Public Health survey.
The infection often weakens those who are already sick but does not necessarily lead to death. The infection is most prevalent in 18- to 64-year-olds, according to the report.
“Twenty-five percent of us are walking around with Staph aureus in our noses,” said David Pegues, a UCLA professor of clinical medicine in infectious diseases.
Despite the severe implications that could arise with an increase in MRSA cases, mortality rates in California hospitals for MRSA-infected patients have actually decreased from 16 percent in 1999 to 8 percent in 2005, the report stated.
The dramatic rise in MRSA cases in the past decade can be attributed to greater exposure to staph in community settings, as well as hospitals, although there is no way to know between the two where an individual case arises, according to the report.
Community-acquired infections can come from homes, playgrounds and gyms, and they appear to be rising in numbers, according to a California Watch article.
To combat the increase in MRSA cases, Pegues said hospitals must screen patients for infections and take barrier precautions, such as wearing gloves and gowns, to prevent the spread of infections.
Recent legislation that requires public reporting will also help reduce MRSA cases in hospitals with high rates of infection.
Passed by the California Senate in October 2008, the legislation requires the reporting of selected health-care-associated infections to the California Department of Health Services, which includes blood stream infections associated with MRSA, Pegues said.
The legislation also requires patients deemed at high-risk for acquiring MRSA, including those who have been admitted to a hospital in the past 30 days or who were transferred from another health-care facility, to be screened for the culture upon admittance to a hospital.
Although legislation now mandates that hospitals report infections, UCLA has kept its rates of infection low the past decade by screening for infections in patients they consider at highest risk for MRSA or other drug-resistant infections based on local data they collected, even before legislation required them to do so, Pegues said.
The data from screening ensures that patients with infections get put in appropriate isolation, which includes emphasizing hand hygiene and the use of barrier precautions when treating a patient.
“We are very proud of our efforts in infection control here, both at Ronald Reagan and Santa Monica Orthopaedic Hospital,” Pegues said. “Our rates of infection remain, what we think, very low and continue to decline, but there is always room for improvement.”
While the increase in MRSA cases can seem alarming, studies may overestimate the severity of MRSA, Pegues said.
“MRSA infections in hospitals probably make up no more than 10 to 15 percent of all health-care-associated infections,” Pegues said. “It represents a relatively small proportion of all health-care-associated health infections, but a relatively large proportion of the words in printed articles are about MRSA.”
Rather than seeing an increase in infectious cases in hospitals, the number of Staph aureus cases has remained the same, with just a larger proportion of those being methicillin-resistant, Pegues said.
“If every year you had 10 Staph aureus infections in your hospital, 10 years ago 30 percent of those infections were methicillin-resistant, while this year 60 percent of those are methicillin-resistant,” Pegues said. “The burden of illness has remained unchanged; it’s just the proportion of cases that are methicillin-resistant that has changed.”
