title: Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007.
abstract: BACKGROUND
  Concerns about rates of methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections have prompted calls for mandatory screening or reporting in efforts to reduce MRSA infections.
  
  
  OBJECTIVE
  To examine trends in the incidence of MRSA central line-associated bloodstream infections (BSIs) in US intensive care units (ICUs).
  
  
  METHODS
  Data reported by hospitals to the Centers for Disease Control and Prevention (CDC) from 1997-2007 were used to calculate pooled mean annual central line-associated BSI incidence rates for 7 types of adult and non-neonatal pediatric ICUs. Percent MRSA was defined as the proportion of S aureus central line-associated BSIs that were MRSA. We used regression modeling to estimate percent changes in central line-associated BSI metrics over the analysis period.
  
  
  METHODS
  Incidence rate of central line-associated BSIs per 1000 central line days; percent MRSA among S. aureus central line-associated BSIs.
  
  
  RESULTS
  Overall, 33,587 central line-associated BSIs were reported from 1684 ICUs representing 16,225,498 patient-days of surveillance; 2498 reported central line-associated BSIs (7.4%) were MRSA and 1590 (4.7%) were methicillin-susceptible S. aureus (MSSA). Of evaluated ICU types, surgical, nonteaching-affiliated medical-surgical, cardiothoracic, and coronary units experienced increases in MRSA central line-associated BSI incidence in the 1997-2001 period; however, medical, teaching-affiliated medical-surgical, and pediatric units experienced no significant changes. From 2001 through 2007, MRSA central line-associated BSI incidence declined significantly in all ICU types except in pediatric units, for which incidence rates remained static. Declines in MRSA central line-associated BSI incidence ranged from -51.5% (95% CI, -33.7% to -64.6%; P < .001) in nonteaching-affiliated medical-surgical ICUs (0.31 vs 0.15 per 1000 central line days) to -69.2% (95% CI, -57.9% to -77.7%; P < .001) in surgical ICUs (0.58 vs 0.18 per 1000 central line days). In all ICU types, MSSA central line-associated BSI incidence declined from 1997 through 2007, with changes in incidence ranging from -60.1% (95% CI, -41.2% to -73.1%; P < .001) in surgical ICUs (0.24 vs 0.10 per 1000 central line days) to -77.7% (95% CI, -68.2% to -84.4%; P < .001) in medical ICUs (0.40 vs 0.09 per 1000 central line days). Although the overall proportion of S. aureus central line-associated BSIs due to MRSA increased 25.8% (P = .02) in the 1997-2007 period, overall MRSA central line-associated BSI incidence decreased 49.6% (P < .001) over this period.
  
  
  CONCLUSIONS
  The incidence of MRSA central line-associated BSI has been decreasing in recent years in most ICU types reporting to the CDC. These trends are not apparent when only percent MRSA is monitored.
authors.affiliation: Surveillance Branch, Division of Healthcare Quality Promotion, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dburton@cdc.gov
authors.forename: Deron C
authors.initials: DC
authors.lastname: Burton
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Edwards
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Horan
authors.forename: John A
authors.initials: JA
authors.lastname: Jernigan
authors.forename: Scott K
authors.initials: SK
authors.lastname: Fridkin
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000145:classification / Q000639:trends*; D055624:Methicillin-Resistant Staphylococcus aureus; D016012:Poisson Distribution; D011159:Population Surveillance / Q000379:methods; D012044:Regression Analysis; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D014481:United States / Q000453:epidemiology