Rapid spread of methicillin-resistant Staphylococcus aureus in a new hospital in the broad-spectrum antibiotic era
Introduction
Antimicrobial resistance in hospitals has been a serious problem and methicillin-resistant Staphylococcus aureus (MRSA) has been a major nosocomial pathogen as endemic organisms in many hospitals. According to the National Nosocomial Infections Surveillance system report, the proportion of MRSA in intensive care units in the United States hospitals increased from 35.9% in 1992 to 64.4% in 2003.1 The reports on S. aureus bacteremia in England and Wales also showed increase in the proportion of MRSA isolates from 2% in 1991 to 43% in 2002.2 In Korea, the proportion of MRSA in large university hospitals increased from 24.2% in 1988 to 74.2% in 1995, and has been reported about 70% in most hospitals since the mid-1990s.3, 4, 5 The spread of MRSA in hospitals is mainly attributable to person-to-person transmission by some MRSA clones.
Although community-acquired MRSA has been brought out as a recent hot issue, prevalence rates of MRSA in community are significantly lower than those in hospitals. Therefore, it would take a long time for MRSA to introduce and become endemic within a newly opened hospital. In a study from Taiwan, the prevalence rate of MRSA gradually increased from 14.1% in 1990 to 61.0% in 1998 over nearly 10 years since opening of the hospital.6 Similarly, in the intensive care units of a newly opened university hospital in Korea, the rate of MRSA causing hospital-acquired pneumonia increased from 15% in 1995 to 55% in 2000.7 During the last decade, increasing antimicrobial resistance has led to widespread use of broad-spectrum antibiotics. Such a big change in antimicrobial use in hospitals might have affected on the time required for MRSA strains to spread and become endemic in hospitals. However, there has been no report on this issue. We investigated how fast MRSA has spread and become endemic in a university hospital opened in the era of widespread use of broad-spectrum antibiotics.
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Infection control and antibiotic control policy
The study was performed at the Hallym University Sacred Heart Hospital, a 829-bed (including 60 ICU beds), secondary-care teaching hospital in Korea, which opened in February 1999. The Infection Control Committee of the hospital has been established at opening of the hospital. Antibiotic restriction program for vancomycin, teicoplanin, imipenem, and meropenem was applied from October 2001 through April 2003. The antibiotic restriction program was revised and approved by the infectious diseases
Antimicrobial susceptibility
The change of antimicrobial susceptibility rates (%) of major microorganisms for 6 years since opening of the hospital was as follows (Table 1). The susceptibility rate of Escherichia coli to ciprofloxacin decreased from 83% in 1999 to 76% in 2001 (P = .002) and maintained about 70% since 2002. The susceptibility rates of Klebsiella pneumoniae to ciprofloxacin and cefotaxime decreased from 94% in 1999 to 86% in 2001 (P = .003) and from 86% in 1999 to 81% in 2000 (P = .01) respectively, and both have
Discussion
Surprisingly, MRSA became rapidly endemic within only a few months in a university hospital opened in the era of widespread use of broad-spectrum antibiotics. The susceptibility rate of S. aureus to oxacillin reached its low (17%) in only 4 months since opening of the hospital and has maintained a low around 30% for 6 years thereafter (Fig. 1). The case was quite different with those of the hospitals in Taiwan and Korea, which opened in the early to mid-1990s.6, 7
What could make a rapid spread of
Acknowledgements
Financial Support: No.
Potential Conflicts of Interest: All authors: no conflicts.
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