title: Estimation of methicillin-resistant Staphylococcus aureus transmission by considering colonization pressure at the time of hospital admission.
abstract: Our objective was to evaluate the accuracy of a methicillin-resistant Staphylococcus aureus (MRSA) rate using the imported MRSA reservoir identified at the time of hospital admission. Two indicators were used: the number of imported MRSA patient-days/total number of patient-days [representing colonization pressure (CP) at the time of admission] and the incidence of hospital-acquired MRSA isolated from clinical samples expressed as density/100 patient-days for carriers identified at the time of admission [representing the incidence taking CP into account (ICP)]. The variations of these indicators were analysed and compared with two more common indicators: percentage of MRSA acquired in our hospital and the incidence of hospital-acquired MRSA isolated from clinical samples expressed as density/1000 patient-days within three four-month periods during 2002. Common indicators varied similarly, with marked decline during the third period; first-period CP was twice that of other periods (P<10(-6)) and the highest (>two-fold) ICP was seen in the summer (second) period (P<0.001) when the personnel/patient ratio was the lowest. Thus, comparison of different indicators within four-month periods underlines important differences between common and novel indicators. Despite several limitations, ICP should be helpful in the interpretation of MRSA surveillance data, particularly for estimating the extent of MRSA transmission.
authors.affiliation: Department of Microbiology and Hygiene, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, 178 rue des Renouillers, F 92700 Colombes Cedex, France. mathieu.eveillard@lmr-hop-paris.fr
authors.forename: M
authors.initials: M
authors.lastname: Eveillard
authors.forename: E
authors.initials: E
authors.lastname: Lancien
authors.forename: N
authors.initials: N
authors.lastname: Hidri
authors.forename: G
authors.initials: G
authors.lastname: Barnaud
authors.forename: S
authors.initials: S
authors.lastname: Gaba
authors.forename: J A
authors.initials: JA
authors.lastname: Benlolo
authors.forename: M-L
authors.initials: ML
authors.lastname: Joly-Guillou
mesh_terms: D015982:Bias; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D003627:Data Interpretation, Statistical; D005602:France / Q000453:epidemiology; D006301:Health Services Needs and Demand; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods* / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data*; D008403:Mass Screening; D016106:Methicillin Resistance; D010343:Patient Admission / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment; D012307:Risk Factors; D012621:Seasons; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D013211:Staphylococcus aureus