title: Epidemiology of methicillin-resistant Staphylococcus aureus: results of a nation-wide survey in Switzerland.
abstract: OBJECTIVE
  To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Switzerland.
  
  
  METHODS
  One-year national survey of all MRSA cases detected in a large sample of Swiss healthcare institutions (HCI). Analysis of epidemiological and molecular typing data (PFGE) of MRSA strains.
  
  
  RESULTS
  During 1997, 385 cases of MRSA were recorded in the 5 university hospitals, in 33 acute care community hospitals, and 14 rehabilitation or long-term care institutions. Half of the cases were found at the University of Geneva Hospitals where MRSA was already known to be endemic (41.1 cases/10,000 admissions). The remaining cases (200) were distributed throughout Switzerland. The highest rates (>100 cases/10,000 admissions) were reported from non-acute care institutions. Rates ranged from 3.3 to 41.1 cases/10,000 admissions for university hospitals (mean 15.5); 0.67 to 90.4 for community hospitals (mean 4.8), and 28.2 to 315 for non-acute care institutions reporting MRSA (mean 85.7). Forty percent of MRSA patients were infected, while 60% were only colonised. The leading infection sites were skin and soft tissue (21%), surgical site (15%), and the urinary tract (26%). Whereas in Eastern Swiss HCI most MRSA cases occurred in acute care hospitals (n = 47, 98%), rehabilitation and long-term care institutions accounted for an important number of the identified cases (n = 107, 38%) in Western Switzerland.
  
  
  CONCLUSIONS
  Low rates of MRSA were still observed in Swiss HCI, despite one outlying acute care centre with endemic MRSA and some nonacute care institutions with epidemic MRSA. Rehabilitation and long-term care institutions contributed to a substantial proportion of cases in Western Switzerland and may constitute a significant reservoir. Overall, a national approach to surveillance and control of MRSA is mandatory in order to preserve a still favourable situation, and to decrease the risk of epidemic MRSA dissemination.
authors.affiliation: Division Autonome de Médecine Préventive Hospitalière, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Dominique.Blanc@chuv.hospvd.ch
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Blanc
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
authors.forename: Christian
authors.initials: C
authors.lastname: Ruef
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Widmer
authors.forename: Kathrin
authors.initials: K
authors.lastname: Mühlemann
authors.forename: Christiane
authors.initials: C
authors.lastname: Petignat
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Raymond
authors.initials: R
authors.lastname: Auckenthaler
authors.forename: Jacques
authors.initials: J
authors.lastname: Bille
authors.forename: Reno
authors.initials: R
authors.lastname: Frei
authors.forename: Reinhard
authors.initials: R
authors.lastname: Zbinden
authors.forename: Raffaele
authors.initials: R
authors.lastname: Peduzzi
authors.forename: Valeria
authors.initials: V
authors.lastname: Gaia
authors.forename: Huma
authors.initials: H
authors.lastname: Khamis
authors.forename: Enos
authors.initials: E
authors.lastname: Bernasconi
authors.forename: Patrick
authors.initials: P
authors.lastname: Francioli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013557:Switzerland / Q000453:epidemiology