title: Trends in methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections: effect of the MRSA "search and isolate" strategy in a hospital in Italy with hyperendemic MRSA.
abstract: OBJECTIVE
  To evaluate the secular trends in MRSA BSIs after the introduction of a nosocomial MRSA control intervention.
  
  
  METHODS
  Before-after study.
  
  
  METHODS
  An 850-bed community hospital with an ICU and vascular surgery, neurosurgery, bone marrow transplantation, and AIDS units. MRSA is endemic at this hospital; the prevalence of methicillin resistance among patients with S. aureus infection is greater than 50%.
  
  
  METHODS
  Among all inpatients, MRSA BSI was identified, its origin defined, and incidence rates calculated by ward and origin.
  
  
  METHODS
  A MRSA control program was implemented based on active surveillance cultures to identify MRSA-colonized patients, followed by isolation using contact precautions. Incidence rates of MRSA BSI during the intervention (i.e., July 1, 1997, to December 31, 2001) and preintervention (i.e., January 1, 1996, to June 30, 1997) periods were compared.
  
  
  RESULTS
  Sixty-nine MRSA BSIs were identified. When compared with the preintervention period, the incidence rate of MRSA BSI was reduced from 0.64 to 0.30 per 1000 admissions (RR, 0.46; CI95, 0.25-0.87; P = .02) during the intervention period. The impact was greater in the ICU, with an 89% reduction (RR, 0.11; CI95, 0.01-0.98; P = .03), and for CVC-associated MRSA BSIs, with an 82% decrease (RR, 0.17; CI95, 0.05-0.55; P = .002). Methicillin resistance among S. aureus blood isolates decreased from 46% to 17% (RR, 0.36; CI95, 0.22-0.62; P = .0002).
  
  
  CONCLUSIONS
  A reduction in MRSA bacteremia is achievable through use of the MRSA "search and isolate" intervention even in a hospital with high rates of endemic MRSA.
authors.affiliation: Divisione di Malattie Infettive, Istituti Ospitalieri di Cremona, Cremona, Italy. ange.pan@tiscali.it
authors.forename: Angelo
authors.initials: A
authors.lastname: Pan
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Carnevale
authors.forename: Patrizia
authors.initials: P
authors.lastname: Catenazzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Colombini
authors.forename: Luciano
authors.initials: L
authors.lastname: Crema
authors.forename: Lucia
authors.initials: L
authors.lastname: Dolcetti
authors.forename: Lucio
authors.initials: L
authors.lastname: Ferrari
authors.forename: Placido
authors.initials: P
authors.lastname: Mondello
authors.forename: Liana
authors.initials: L
authors.lastname: Signorini
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.forename: Eugenia
authors.initials: E
authors.lastname: Quiros Roldan
authors.forename: Giampiero
authors.initials: G
authors.lastname: Carosi
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D006757:Hospital Units; D006764:Hospitals, Community; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007558:Italy / Q000453:epidemiology; D016106:Methicillin Resistance; D013203:Staphylococcal Infections / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification*