This study establishes the first national baseline by which future trends in invasive MRSA infections can be assessed.
"Based on 8,987 observed cases of MRSA and 1,598 in-hospital deaths among patients with MRSA, we estimate that 94,360 invasive MRSA infections occurred in the United States in 2005," the authors write.
"These infections were associated with death in 18,650 cases," according to the study by Klevens' team.
After adjusting for age, race and sex, they arrived at an incidence rate of invasive MRSA in 2005 of 31.8 per 100,000 persons.
"In conclusion, invasive MRSA disease is a major public health problem and is primarily related to health care but no longer confined to acute care. Although in 2005 the majority of invasive disease was related to health care, this may change," the researchers write.
Elizabeth Bancroft, MD, of the Los Angeles County Department of Public Health calls the 31.8 per 100,000 rate of invasive MRSA "astounding."
In an editorial published in the Journal of the American Medical Association to accompany the Klevens study, she estimates that this rate is higher than the combined rate for pneumococcal disease, invasive group A streptococcus, invasive meningococcal disease, and invasive H influenzas in 2005.
"Old diseases have learned new tricks," Bancroft writes. "Consequently, new collaborations between the public health and medical communities are needed to identify and control antimicrobial resistance."
MRSA has become the most frequent cause of skin and soft tissue infections among patients presenting to emergency departments in the United States, and can also cause severe, sometimes fatal invasive disease.
The study found about 85 percent of all invasive MRSA infections were associated with health care settings. Two-thirds of these infections surfaced in the community among people who were hospitalized, underwent a medical procedure or resided in a long-term care facility within the previous year.
By contrast, about 15 percent of reported infections were considered to be community-associated, which means that the infection occurred in people without documented health care risk factors.
The 2005 rates of invasive infection were highest among people 65 years of age or older. Black people were affected at twice the rate of whites, which could be due to higher rates of chronic illness among blacks.
"These numbers show that many families are being affected by these drug-resistant infections," said Denize Cardo, MD, director of CDC's Division of Healthcare Quality Promotion. "Healthcare facilities need to make MRSA prevention a greater priority. The closer we get to 100 percent compliance with CDC recommendations, the greater the impact on patient health and safety."
The Klevens team arrived at the new national estimate by projecting from the number of invasive MRSA cases from nine U.S. sites.
The sites included the state of Connecticut; the Atlanta metropolitan area; the San Francisco Bay area; the Denver metropolitan area; the Portland, Oregon metropolitan area; Monroe County, New York; Baltimore City, Maryland; Davidson County, Tennessee; and Ramsey County, Minnesota.
All the sites were part of CDC's Active Bacterial Core surveillance program, which actively tracks a number of pathogens in the United States representing a population of 38 million Americans.
Since 2002, school athletic teams in several states, including Massachusetts, have reported MRSA infections among wrestling, volleyball, and most frequently, football teams. Some colleges have reported MRSA infection cases in residential dormitories.
This staph infection first appears on the skin as a red, swollen pimple or boil that may be painful or have pus. It can be spread by skin-to skin contact or by touching contaminated surfaces.
The Centers for Disease Control and Prevention advises that people keep their hands free of staph bacteria by washing thoroughly with soap and water or using an alcohol-based hand cleaner.
Keep cuts and scrapes clean and covered with a bandage until healed, and avoid contact with other people's wounds or bandages.
And avoid sharing personal items such as towels or razors.
Doctors say staph infections can usually be treated with antibiotics. But over the decades, some strains of staph -- such as MRSA -- have become resistant to antibiotics that once destroyed it. MRSA was first discovered in 1961. It is now immune to methicillin, amoxicillin, penicillin, oxacillin, and many other antibiotics.
While some antibiotics still work, MRSA is constantly adapting. Researchers developing new antibiotics are having a difficult time keeping up.
Most MRSA infections are treated by good wound and skin care -- keeping the area clean and dry, washing hands after caring for the area, carefully disposing of any bandages, and allowing the body to heal.
Environment News Service and reprinted by special permission
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Albion Monitor October
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