Stalled Progress on Staph Infections a Deadly Concern, CDC Says

Megan Brooks

March 06, 2019

Infection control efforts in US hospitals have reduced rates of Staphylococcus aureus bloodstream infections, but progress has slowed in recent years, health officials with the Centers for Disease Control and Prevention (CDC) warned in a report released Tuesday.

"Staph infections are a serious threat and can be deadly. US 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.

"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, of the CDC's Division of Healthcare Quality Promotion, and colleagues note in their report.

They analyzed electronic health record data from more than 400 acute care hospitals as well as population-based surveillance data to update estimates of methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA) bloodstream infections.

From 2005 to 2012, rates of MRSA infections in healthcare settings fell by 17.1% annually. But from 2012 to 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 from 2005 to 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, while community-onset MSSA infection 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, 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," 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

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 Veterans Affairs (VA) medical centers as one "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. 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 VA medical centers had implemented the MRSA infection prevention program.

The overall rate of S aureus infections in VA medical centers decreased by 43% from 2005 to 2017. The decline was driven primarily by decreases in MRSA infections, which decreased by 55%, John Jernigan, MD, of the CDC, and colleagues state in a companion report released Tuesday.

"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 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.

MMWR Morb Mortal Wkly Rep. Published online March 5, 2019. Report 1, Full text; Report 2, Full text

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