title: Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit in India.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) is a global pathogen and an important but seldom investigated cause of morbidity and mortality in lower and middle-income countries where it can place a major burden on limited resources. Quantifying nosocomial transmission in resource-poor settings is difficult because molecular typing methods are prohibitively expensive. Mechanistic statistical models can overcome this problem with minimal cost. We analyse the transmission dynamics of MRSA in a hospital in south India using one such approach and provide conservative estimates of the organism's economic burden.
  
  
  RESULTS
  Fifty months of MRSA infection data were collected retrospectively from a Medical Intensive Care Unit (MICU) in a tertiary hospital in Vellore, south India. Data were analysed using a previously described structured hidden Markov model. Seventy-two patients developed MRSA infections and, of these, 49 (68%) died in the MICU. We estimated that 4.2% (95%CI 1.0, 19.0) of patients were MRSA-positive when admitted, that there were 0.39 MRSA infections per colonized patient month (0.06, 0.73), and that the ward-level reproduction number for MRSA was 0.42 (0.08, 2.04). Anti-MRSA antibiotic treatment costs alone averaged $124/patient, over three times the monthly income of more than 40% of the Indian population.
  
  
  CONCLUSIONS
  Our analysis of routine data provides the first estimate of the nosocomial transmission potential of MRSA in India. The high levels of transmission estimated underline the need for cost-effective interventions to reduce MRSA transmission in hospital settings in low and middle income countries.
authors.affiliation: Department of Biostatistics, Christian Medical College, Vellore, India. solomon.christopher@gmail.com
authors.forename: Solomon
authors.initials: S
authors.lastname: Christopher
authors.forename: Rejina Mariam
authors.initials: RM
authors.lastname: Verghis
authors.forename: Belavendra
authors.initials: B
authors.lastname: Antonisamy
authors.forename: Thuppal Varadachari
authors.initials: TV
authors.lastname: Sowmyanarayanan
authors.forename: Kootallur Narayanan
authors.initials: KN
authors.lastname: Brahmadathan
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Kang
authors.forename: Ben Symons
authors.initials: BS
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D007362:Intensive Care Units / Q000191:economics*; D008297:Male; D008390:Markov Chains; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D018803:Models, Economic; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*