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Saturday, March 20, 2010: 11:15 AM
Regency VI-VII (Hyatt Regency Atlanta)
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant bacterium often responsible for healthcare-associated infections (HAI). Recent encouraging trends in MRSA HAI have been observed in France for 15 years, but incidence remains high and infection control (IC) programs should be actively pursued; since 2005, MRSA data are collected through a mandatory public reporting system.
Objective: Using public reporting data, to describe MRSA incidence in French healthcare-facilities (HCF) from 2005 to 2008; to assess temporal trends at national, regional level or by HCF type, and regional variations.
Methods: Each HCF reported to the Health Ministry the total number of patients (excluding day care) having at least one MRSA isolate recovered from any clinical specimen during a year (MRSA case). The total number of patient-days (pd) was obtained from national statistics. The analysis targeted teaching acute care (TH), general acute care (GH), local hospitals (LH), private acute-care facilities (PF), cancer centers (CC), rehabilitation and long term care (RLT). Temporal trends and regional variations were assessed using negative binomial regression models adjusting for HCF type and region.
Results: Data from an average of 1,880 HCF each year (81% of all targeted HCF) were analyzed, accounting for 441,201,222 pd and 217,361 MRSA cases. The overall MRSA incidence was 0.49 per 1,000 pd, and was higher in TH and GH, and lower in PF and RLT. From 2005 to 2008, it significantly decreased from 0.55 to 0.44 cases per 1,000 pd, a 12% decrease after adjusting for HCF type and region (adjusted incidence rate ratio [IRR]: 0.88; 95% confidence interval [CI]: 0.84-0.93). This temporal trend was not homogeneous, MRSA incidence significantly decreasing mostly in TH (-9.6% per year, p<0.001), GH >=300 beds (-7.1%; p<0.001), GH <300 beds (-5.5%; p=0.002) or RLT (-4.1%; p=0.036). Moreover, huge regional variations were observed, from 0.19 to 0.80 MRSA cases per 1,000 pd. The highest yearly incidences were regularly observed in 3 regions: Limousin, Picardie and Nord-Pas-de-Calais; the lowest were observed in Pays-de-Loire and all overseas districts but Martinique. Regional temporal trends were more difficult to ascertain: most of the regions had decreasing trends but only 6 were significant. Last, no region or HCF type had increasing trends.
Conclusions: French public reporting data are simple but robust, and produce frequency estimates of MRSA HAI consistent with those from other national surveillance systems (BMR-Raisin, repeated prevalence surveys, French data submitted to EARSS). The decrease in MRSA incidence in France is confirmed using this fourth, independent data source. However, MRSA incidence and trends vary by type of HCF or regions, which suggests the need to study these variations further in order to better target IC programs.
Objective: Using public reporting data, to describe MRSA incidence in French healthcare-facilities (HCF) from 2005 to 2008; to assess temporal trends at national, regional level or by HCF type, and regional variations.
Methods: Each HCF reported to the Health Ministry the total number of patients (excluding day care) having at least one MRSA isolate recovered from any clinical specimen during a year (MRSA case). The total number of patient-days (pd) was obtained from national statistics. The analysis targeted teaching acute care (TH), general acute care (GH), local hospitals (LH), private acute-care facilities (PF), cancer centers (CC), rehabilitation and long term care (RLT). Temporal trends and regional variations were assessed using negative binomial regression models adjusting for HCF type and region.
Results: Data from an average of 1,880 HCF each year (81% of all targeted HCF) were analyzed, accounting for 441,201,222 pd and 217,361 MRSA cases. The overall MRSA incidence was 0.49 per 1,000 pd, and was higher in TH and GH, and lower in PF and RLT. From 2005 to 2008, it significantly decreased from 0.55 to 0.44 cases per 1,000 pd, a 12% decrease after adjusting for HCF type and region (adjusted incidence rate ratio [IRR]: 0.88; 95% confidence interval [CI]: 0.84-0.93). This temporal trend was not homogeneous, MRSA incidence significantly decreasing mostly in TH (-9.6% per year, p<0.001), GH >=300 beds (-7.1%; p<0.001), GH <300 beds (-5.5%; p=0.002) or RLT (-4.1%; p=0.036). Moreover, huge regional variations were observed, from 0.19 to 0.80 MRSA cases per 1,000 pd. The highest yearly incidences were regularly observed in 3 regions: Limousin, Picardie and Nord-Pas-de-Calais; the lowest were observed in Pays-de-Loire and all overseas districts but Martinique. Regional temporal trends were more difficult to ascertain: most of the regions had decreasing trends but only 6 were significant. Last, no region or HCF type had increasing trends.
Conclusions: French public reporting data are simple but robust, and produce frequency estimates of MRSA HAI consistent with those from other national surveillance systems (BMR-Raisin, repeated prevalence surveys, French data submitted to EARSS). The decrease in MRSA incidence in France is confirmed using this fourth, independent data source. However, MRSA incidence and trends vary by type of HCF or regions, which suggests the need to study these variations further in order to better target IC programs.