Staph Infections Still a Deadly Concern, per CDC

Although healthcare facilities have made some progress in preventing methicillin-resistant S aureus (MRSA) infections, the epidemiology of methicillin-susceptible S aureus(MSSA) infections is not well characterized.

The Centers for Disease Control and Prevention (CDC) used data from the Emerging Infections Program MRSA population surveillance during 2005 to 2016, and from the Premier and Cerner Electronic Health Record databases during 2012 to 2017, to examine trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and to estimate the overall US incidence and associated mortality of these infections. A second report describes MRSA and MSSA infection rates from 2005 to 2017 among inpatients at Department of Veterans Affairs medical centers (VAMCs), which had all begun a multifaceted MRSA prevention program by 2007.

Study Synopsis and Perspective

Infection control efforts in US hospitals have reduced rates of S aureus bloodstream infections, but progress has slowed in recent years, health officials with the CDC warned in a report released online ahead of print March 5 and in the March 8 issue of the CDC's Morbidity and Mortality Weekly Report.^[1]

"Staph infections are a serious threat and can be deadly. U.S. hospitals have made significant progress, but this report tells us that all staph infections must remain a prevention priority for healthcare providers," CDC Director Robert Redfield, MD, said in a news release.^[2]

"We call on all healthcare providers to step up prevention efforts and follow CDC guidelines to protect patients from staph. Inconsistent or declining adherence to these recommendations might be slowing our progress," Anne Schuchat, MD, CDC principal deputy director, said during a news briefing with reporters.

More than 119,000 people experienced S aureus bloodstream infections in 2017, and nearly 20,000 died as a result, Athena Kourtis, MD, PhD, from the CDC's Division of Healthcare Quality Promotion, and colleagues note in their report.^[3]

They analyzed electronic health record data from more than 400 acute care hospitals, as well as population-based surveillance data, to update estimates of MRSA and MSSA bloodstream infections.

Between 2005 and 2012, rates of MRSA infections in healthcare settings fell by 17.1% annually, according to Dr Kourtis and colleagues. But between 2012 and 2017, the rate of decline in hospital-onset MRSA infections slowed considerably (7.3% decline per year), the authors report. Community-onset MRSA infections declined by 6.9% per year between 2005 and 2016. The decrease was mostly related to declines in healthcare-associated infections.

Rates of hospital-onset MSSA infections did not decline substantially during the study period, whereas community-onset MSSA rates rose a significant 3.9% per year from 2012 to 2017, the authors report.

The ongoing opioid epidemic may be contributing to the rise in community-associated S aureus infections, Dr Schuchat said. She noted that in 2016, 9% of invasive MRSA cases occurred in persons who injected drugs, up from 4% in 2011.

"Healthcare providers should be aware that the people who inject drugs are 16 times more likely to develop a serious staph infection than those who do not," Dr Schuchat said during the briefing.

"The bottom line," she said, "is that while we've made important progress, our data show that more needs to be done to stop all types of staph infection."

VA Leads the Charge

Dr Schuchat noted that many healthcare systems in the United States are reducing staph infections by fully implementing current recommendations, continuously reviewing their data, and using additional interventions tailored to their facility if they are not meeting their infection reduction goals.

She cited VA medical centers as a "great success" story.

Beginning in 2005, in response to high rates of MRSA infections, 18 VA medical centers piloted a multifaceted MRSA infection prevention program, according to Makoto Jones, MD, and colleagues.^[1] Components of the program included admission screening for nasal MRSA carriage and use of contact precautions for patients found to be carriers. "By October 2007, all 153 VAMCs had implemented the MRSA infection prevention program," the authors write.

The overall rate of S aureus infections in VA medical centers decreased by 43% from 2005 to 2017. The decrease was driven primarily by decreases in MRSA infections, which went down by 55%, Dr Jones and colleagues report.

"CDC continues to fund academic and healthcare investigators working to reduce staph burden in their healthcare facilities through the antibiotic resistance solutions initiative. Collaborating with CDC, experts nationwide are studying innovative ways to prevent staph infections and are exploring promising strategies to stop the spread of staph and other germs in healthcare facilities," said Dr Schuchat.

"Without both renewed commitment to current infection control practices and innovations that identify additional opportunities to reduce infections, staph will kill more people," she added.

Morb Mortal Wkly Rep. 2019;68:214-224.

Clinical Implications

• S aureus infections account for significant morbidity and mortality in the United States, despite decreasing incidence of MRSA septicemia since 2005.
• Declines in MRSA were mostly responsible for significant reductions in S aureus infection after the VAMC intervention.
• Implications for the Healthcare Team: Healthcare facilities should fully implement and adhere to CDC recommendations to prevent device- and procedure-associated S aureus infections and to interrupt transmission. Health care professionals should use contact precautions in the care of patients known or suspected to be illnesses easily transmitted upon direct or indirect contact.