title: Using mandatory data collection on multiresistant bacteria for internal surveillance in a hospital.
abstract: OBJECTIVE
  Multiresistant pathogens cause major clinical problems and considerably increase treatment costs. Since 2001 the Protection Against Infection Act (PIA) obligates hospitals in Germany to the documentation of multiresistant bacteria. We analyzed the use of these data for routine internal surveillance.
  
  
  METHODS
  We used standard data collected for the mandatory documentation and studied consecutive diagnoses of Methicillin-resistant Staphylococcus aureus (MRSA) in a 893-bed tertiary level hospital in North Rhine-Westphalia in Germany. Based on the Poisson distribution for the cumulative yearly incidence of MRSA, we defined a threshold level for an outbreak.
  
  
  RESULTS
  During a 12-month time period 80 patients were diagnosed with MRSA. The time structure and spatial distribution of different MRSA phenotypes (defined through specific antibiotic resistance patterns) were consistent with the within-hospital transmission. In the two preceding time periods of 12 months each, 15 respectively 8 patients with MRSA were found. The defined alert threshold level for cumulative yearly incidence was crossed in the beginnings of the outbreak.
  
  
  CONCLUSIONS
  Monitoring the mandatory data collected on multiresistant bacteria allows the early detection of accumulations suspect for the within-hospital transmission. This knowledge can be used for a fast reaction and breaking off the transmission chains.
authors.affiliation: Institut für Mikrobiologie und Infektionsepidemiologie, Krankenanstalten Gilead/Mara, Remterweg 2, 33617 Bielefeld, Germany. mikrobiologie@gilead.de
authors.forename: U
authors.initials: U
authors.lastname: Sagel
authors.forename: R T
authors.initials: RT
authors.lastname: Mikolajczyk
authors.forename: A
authors.initials: A
authors.lastname: Krämer
mesh_terms: D003625:Data Collection; D018432:Drug Resistance, Multiple; D005858:Germany; D006801:Humans; D016106:Methicillin Resistance; D012308:Risk Management; D013211:Staphylococcus aureus / Q000187:drug effects