Author: Thomas Rosenthal
Staph infections were associated with almost 20,000 deaths in health care and community settings in 2017, according to the CDC.
An estimated 119,247 people suffered from methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MssA), with a total of 19,832 associated deaths from both infections, according to a new CDC Vital Signs report released by the agency (MMWR Morb Mortal Wkly Rep 2019 Mar 5.
According to electronic health record data from more than 400 acute care hospitals and CDC surveillance data, MRSA bloodstream infections in health care settings decreased nationally by approximately 17% each year between 2005 and 2012. The report also showed an almost 4% increase in MssA infections in the community each year from 2012 to 2017. The decline in staph infections in U.S. hospitals stalled in 2017 for the fifth straight year, whereas staph infections in the community have increased for the sixth year in a row, the CDC said.
“In health care settings, MRSA bloodstream infections decreased by approximately 17% each year between 2005 and 2012, but our progress slowed after that with no significant change during 2013 through 2016,” and the decline plateaued in 2017, said Anne Schuchat, MD (RADM, USPHS), the CDC principal deputy director, in a teleconference.
Hospital-onset MssA has not significantly changed during this period, she said.
“With infections that start outside of the health care setting, we found that MssA that begins in the community may be on the rise,” Dr. Schuchat said. “Our data show a 3.9% increase in community-onset MssA infections each year from 2012 through 2017.”
However, community-onset MRSA declined 6.9% annually from 2005 to 2016, which was mostly related to the declines in health care–associated infections, the CDC said.
The risk for serious staph infection is greatest during a hospital stay or surgical procedure, especially those that involve implants, as well as when people come into close contact with someone who has staph or when they inject drugs.
Dr. Schuchat said the rise in community-onset staph infections may be linked to the opioid crisis. The CDC reported last year that 9% of serious MRSA infections in 2016 happened among people who inject drugs, an increase from 4% in 2011.
“Health care 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. “When health care providers are aware of this connection, they can make sure that all appropriate infection prevention and control measures are in place.”
Dr. Schuchat said the steady rate of staph-associated fatalities also may be related to a drop-off in following the CDC’s intensive recommendations, and called on health care professionals to step up their staph infection prevention and control efforts.
“Staph remains as fatal as it has ever been,” she said.
As an example of attainable success in preventing staph infections, Dr. Schuchat pointed to the Veterans Affairs medical centers, which reduced staph infections by 43% from 2005 through 2017 after initiating a prevention program.
She specifically noted that in all health systems, pharmacists played a crucial role in contributing to the decline through their use of antibiotic stewardship, which curtailed specific prescriptions to reduce antimicrobial resistance. “Pharmacists play a very important role in the whole health care ecosystem,” she said.
Dr. Schuchat said health care providers and administrators need to review their data regularly to decide when to add additional staph prevention and intervention procedures recommended by the CDC and tailored to their facility if they are not meeting their reduction goals.
Staph prevention must be a priority. This includes implementing CDC recommendations, including the use of contact precautions (gloves and gowns), continually reviewing their facility infection data available from the CDC’s National Healthcare Safety Network, and considering other interventions if they are not meeting infection reduction goals.
Depending on the facility, additional prevention measures could include screening patients at high risk, or decolonization at high-risk periods or for certain types of procedures. Several health care systems in the United States have reported success after tailoring their approach to staph.
“We know infection prevention and control works, but it’s not one-size-fits-all. Additional strategies, including decolonization, for example, may be needed in certain circumstances and patients, to ensure optimal prevention and the best outcome for the patients,” said Athena Kourtis, MD, PhD, MPH, the associate director for Data Activities in the CDC’s Division of Healthcare Quality Promotion.
“The bottom line is this: We have prevented many staph infections, but while we’ve made important progress, our data show that more needs to be done to stop all types of staph infection,” Dr. Schuchat said. Without renewed commitment to current infection control practices and innovation, “staph will kill more people.”
The Vital Signs report is based on electronic health record data from more than 400 acute care hospitals and population-based surveillance data from the CDC’s Emerging Infections Program, the agency said.