Methicillin-Resistant Staphylococcus aureus in Saarland, Germany: A Statewide Admission Prevalence Screening Study

Abstract

BackgroundThe screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA) is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed.Methodology/Principal FindingsDuring a four-week period, all 24 acute care hospitals of the State of Saarland participated in admission prevalence screening. Overall, 436/20,027 screened patients revealed MRSA carrier status (prevalence, 2.2/100 patients) with geriatrics and intensive care departments associated with highest prevalence (7.6/100 and 6.3/100, respectively). Risk factor analysis among 17,975 admission patients yielded MRSA history (OR, 4.3; CI95 2.7–6.8), a skin condition (OR, 3.2; CI95 2.1–5.0), and/or an indwelling catheter (OR, 2.2; CI95 1.4–3.5) among the leading risks. Hierarchical risk factor ascertainment of the six risk factors associated with highest odd’s ratios would require 31% of patients to be laboratory screened to allow for detection of 67% of all MRSA positive admission patients in the State.Conclusions/SignificanceState-wide admission prevalence screening in conjunction with risk factor ascertainment yields important information on the distribution of the MRSA burden for hospitals, and allows for data-based decisions on local or institutional MRSA screening policies considering risk factor prevalence and expected MRSA identification rates.

Whole genome sequence typing and microarray profiling of nasal and blood stream methicillin-resistant Staphylococcus aureus isolates: Clues to phylogeny and invasiveness

“…Therefore we suggest that apart from the local t504 clade a second clade of local CC5 isolates evolved in the region of Saarland (t003 Clade 1) which has not been identified before by less discriminatory typing methods. In the present study both regional clades (t504 and t003 Clade 1) were detected in the local population during a hospital admission study (Herrmann et al, 2013) and not as a consequence of direct MRSA transmission in the same hospital (Leopold et al, 2014). The appearance of regional clades argues for MRSA spreading in regional health-care associated networks.…”

“…Using less discriminatory methods the provenience of the recently evolved regional spa-type t504 strains remained elusive (Herrmann et al, 2013;Ruffing et al, 2012). Based on WGS we can now prove that the t504 strains were of clonal origin with common ancestors to the highly abundant t003 group.…”

“…In outbreak settings discrimination by spa-typing is frequently limited by the clonal nature of the predominant organisms; yet, occasionally spa-typing could identify an emerging MRSA subclone such as the novel CC5 spa-type t504 detected in a hospital admission prevalence screening study in the State of Saarland in Southwest Germany (Herrmann et al, 2013).…”

Incidence of invasive meticillin-resistant Staphylococcus aureus infections in Germany, 2010 to 2014

“…In 2013, 12.8% (95% confidence interval (CI): [12][13][14] of Staphylococcus aureus isolates from blood culture in Germany were found to be resistant to meticillin in laboratories submitting data to the European antibiotic resistance surveillance network (EARS-Net), placing Germany below the European average of 18% [1]. The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia is now within the middle lower range of those reported in Europe.…”

Drei Jahre MRE-Netz Rhein-Main 2010 – 2013 – Evaluation der Angebote des Netzwerks durch die Mitglieder

“…Einige Netzwerke setzen auf neue Medien und haben MRSA-Apps zur Information der Bevölkerung oder beispielsweise der Pflegedienste entwickelt (Regio Rhein-Ahr; Saarland). Andere Netzwerke, wie Beispielsweise die MRE-Netzwerke in Brandenburg oder im Saarland, setzen noch intensiver auf Prävalenzstudien, auch um die Einrichtungen zur intensiveren Beschäftigung mit der MRE-Problematik zu sensibilisieren (Grabe et al 2010, Herrmann et al 2013, Pohle et al 2012. Wieder andere führen regelmäßige Befragungen zur MRE-Problematik durch (Popp et al 2009).…”