SURVEILLANCE MRSA

Asymptomatic colonization with methicillin-resistant Staphylococcus aureus (MRSA) has been described as a risk factor for subsequent MRSA infection. MRSA is an important nosocomial pathogen but has currently been reported in patients without typical risk factors for nosocomial acquisition.(Davis et al. 2004). Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent causes of hospital- and community-associated infections. Resistance to the entire class of β-lactam antibiotics, such as methicillin and penicillin, makes MRSA infections difficult to treat. (Otto 2012).  Epidemiological data of methicillin resistant Staphylococcus aureus (MRSA) carriage in Indonesian hospitals are still scarce. These data are required for health management of infectious diseases in order to control hospital MRSA. The carriage rate of MRSA in nose and throat of patients on admission to Dr Soetomo Hospital Surabaya, Indonesia was 8.1% of 643 patients, 5.4% from throat, 3.9% from nose and 1.2% from both sites. Prevalence of MRSA among patients admitted to surgical and non-surgical ward was not different (8.2% and 8.0%, respectively).(Lestari and Juliette Astrid Severin 2009).

Research from Malaysia, Male gender and patient >50 years of age (p < 0.0001) were significantly associated with the increased risk of MRSA acquisition. The prevalence of PVL gene among 2011 MRSA strains was 5.3% and no PVL gene was detected in 2012 MRSA strains. All of the strains were sensitive to vancomycin. However, vancomycin MIC creep phenomenon was demonstrated by the increased number of MRSA strains with MIC ≥1.5 μg/mL (p = 0.008) between 2011 and 2012. Skin disease (p = 0.034) and SCCmec type III (p = 0.0001) were found to be significantly associated with high vancomycin MIC. Forty-four percent of MRSA strains from blood, were further subtyped by MLST and PFGE. (Sit et al. 2017)

In Japan, sentinel disease surveillance systems may underestimate the actual number of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection because they do not include information about patients who visit nonsentinel medical facilities, according to a study published in Epidemiology and Infection. In this study, we evaluated the representativeness of a methicillin-resistant Staphylococcus aureus (MRSA) surveillance system using health insurance claim (HIC) data, (TANIHARA and SUZUKI 2016). The study results suggested that health insurance claims data for MRSA cases were more useful for determining the incidence of MRSA cases in Japan from 2011 to 2012. For example, of the 2,052 eligible hospitals with 200 or more beds in 2011, roughly one-quarter (495, 23.8%) participated in the Japan Nosocomial Infections Surveillance system. Data from this relatively low percentage of eligible facilities most likely underestimated the true number of MRSA patients in Japan.  Experienced from japan, the investigators noted three major advantages of using health insurance claims data for infection surveillance. Firstly, information from health insurance claims data is not affected by health care providers’ notifications to surveillance systems. Secondly, data on patients with MRSA can be collected at low cost because of Japan’s uniform and computerized health insurance system, and the data are easy to access. Lastly, health insurance claims data prevent the duplication of patient information, as insurers can determine if a patient was treated at multiple medical facilities for the same disease.

BIBLIOGRAPHY

Davis, K. A., J. J. Stewart, H. K. Crouch, C. E. Florez, and D. R. Hospenthal. 2004. “Methicillin-Resistant Staphylococcus Aureus (MRSA) Nares Colonization at Hospital Admission and Its Effect on Subsequent MRSA Infection.” Clinical Infectious Diseases 39 (6):776–82. https://doi.org/10.1086/422997.

Lestari, Endang Sri, and Juliette Astrid Severin. 2009. Antimicrobial Resistance in Indonesia Prevalence , Determinants and Genetic Basis.

Marimuthu, Kalisvar, Didier Pittet, and Stephan Harbarth. 2014. “The Effect of Improved Hand Hygiene on Nosocomial MRSA Control.” Antimicrobial Resistance and Infection Control 3:34. https://doi.org/10.1186/2047-2994-3-34.

Otto, Michael. 2012. “MRSA Virulence and Spread.” Cellular Microbiology 14 (10):1513–21. https://doi.org/10.1111/j.1462-5822.2012.01832.x.

Sit, Pik San, Cindy Shuan Ju Teh, Nuryana Idris, I-Ching Sam, Sharifah Faridah Syed Omar, Helmi Sulaiman, Kwai Lin Thong, Adeeba Kamarulzaman, and Sasheela Ponnampalavanar. 2017. “Prevalence of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection and the Molecular Characteristics of MRSA Bacteraemia over a Two-Year Period in a Tertiary Teaching Hospital in Malaysia.” BMC Infectious Diseases 17 (1). BMC Infectious Diseases:274. https://doi.org/10.1186/s12879-017-2384-y.

TANIHARA, S., and S. SUZUKI. 2016. “Estimation of the Incidence of MRSA Patients: Evaluation of a Surveillance System Using Health Insurance Claim Data.” Epidemiology and Infection 144 (11):2260–67. https://doi.org/10.1017/S0950268816000674.

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