New guidance to stem waves of MRSA epidemics in hospitals

Methicillin resistance during the novel coronavirus pandemic Staphylococcus aureus The Health Epidemiology Society of America (SHEA) said in its latest guidelines that MRSA infections in acute-care hospitals have surged, despite a decline in infections before the pandemic.

“It is unclear whether the reduction in the use of contact precautions for MRSA-colonized or MRSA-infected patients played a significant role in this increase,” said David Kalfee, M.D., of Weill Cornell Medical School in New York City. bottom. Infection control and hospital epidemiology.

According to the authors, about 10% of US hospital infections are due to MRSA. In the first year of the pandemic, Progress against deadly antibiotic-resistant infections reversedAccording to CDC data.

“The heavy burden placed on healthcare during the pandemic may have contributed to some of the observed increases in hospital-acquired infections. There are data that show an increase in MRSA infections,” Calfee said. said in a press release issued by SHEA.

In their updated guidelines, Calfee and co-authors recommend active surveillance to detect asymptomatic MRSA, especially among certain vulnerable patient populations, especially if precautions in hospitals have changed. He noted that patients need to be evaluated continuously if they are being treated or if they are on treatment. has changed.

The bacteria that cause MRSA infections are resistant to many of the antibiotics used to treat common staphylococcal infections. MRSA infections are common after surgery and after using hospital equipment such as central venous catheters. This bacterium is easily spread within hospitals via patients, healthcare providers, equipment, and contaminated surfaces.

For all recommendations, the authors reviewed the quality of the evidence. Recommendations considered to have moderate or high quality evidence and recommended as essential practice include:

• Promote adherence to CDC or World Health Organization (WHO) hand hygiene recommendations
• Take contact precautions (and assess whether they are effective) for patients with colonized and MRSA-infected patients
• Ensuring cleaning and disinfection of equipment and the environment

Additional approaches with moderate or high quality evidence include:

• Implementation of an MRSA active surveillance program in selected patient populations as part of a multipronged strategy to control and prevent MRSA
• Active surveillance for MRSA combined with decolonization of the target population prior to surgery to prevent postoperative MRSA infection
• Active surveillance for MRSA throughout the hospital, in conjunction with contact precautions to reduce the incidence of MRSA infection

“Basic infection prevention practices such as hand hygiene, cleaning and disinfection of healthcare environments and medical equipment remain the cornerstones of MRSA prevention,” said Kalfee in a press release. “These basic practices can also help prevent the spread of other pathogens.”

Contact precautions and the use of gowns and gloves when caring for patients with colonized or infectious MRSA remain mandatory practices in the new guidelines.

“The evidence that informs these recommendations shows that we can successfully prevent transmission and infection,” he added. “A return to pre-2020 interest rates could be even better.”

Despite the low-quality evidence, the guidelines point out that “an antimicrobial control program is an important part of many quality and safety measures, including MRSA prevention,” and that antibiotic treatment is recommended for different infections. Patients receiving the infection may be at higher risk of developing MRSA, he added, and pass it on to other susceptible patients.

The authors also noted that active surveillance with Contact Precautions is inferior to universal decolonization in reducing MRSA clinical isolates in adult intensive care units.

The guideline authors, last updated in 2014, evaluated the literature from January 2012 to August 2021. Representatives from the SHEA, the Infectious Diseases Society of America, the Professional Association for Infection Control Epidemiology, the American Hospital Association, and the Joint Commission attended. , the CDC attended the panel. Panel members reviewed and approved the document and its recommendations.