Prevalence of methicillin-resistant Staphylococcus aureus infections, or MRSA, is on the rise, and a new report on California hospitals indicates the largest jumps over the past decade are among children and infections acquired outside of healthcare settings.
Calif. sees cases skyrocket outside healthcare settings
The state of California released a report last week on the growing problem of MRSA, based on patient discharge data provided by hospitals statewide from 1999 to 2007.
MRSA cases increased more than fourfold over the eight-year period, and the increase was primarily attributed to cases among those 18 to 64 years old admitted from home with skin infections.
However, an astounding 1,663% increase occurred among children under age 18. In 1999, hospitals reported 188 cases of MRSA among children. In 2007, 3,315 cases were reported.
Meanwhile, the number of cases admitted from home also rose substantially. In 1999, hospitals reported 7,231 MRSA cases admitted from the home. But in 2007, that figure grew by 438% to 38,864 cases admitted from the home to California hospitals. The report indicated a higher rate of MRSA in California than the national average.
The report backs up recent studies on the rise of community-acquired MRSA nationwide. Total hospital admissions for patients with skin and soft-tissue infections rose 29% from 2000 to 2004, according to a study published by the Centers for Disease Control and Prevention in August. The greatest increase in infection admissions were among patients under age 65 in urban areas. Community-acquired MRSA increased 33% in outpatient settings from 1996 to 2006, according to research published by the CDC in early December.
Some encouraging news can be found in the California report on MRSA: Death rates, hospital charges and length of hospital stay were all down over the eight-year timeframe analyzed.
“Nevertheless, the increase in MRSA cases among hospital patients is a concern for infection control in hospitals as well as in the community,” state researchers wrote in the report, released by the California Office of Statewide Health Planning and Development.
Debby Rogers, vice president of quality and emergency services at the California Hospital Association, called the report troubling. “We definitely agree there is more MRSA now than in the past,” Rogers said.
State officials said the report’s findings offer a conservative estimate of the volume of MRSA in California hospital patients. That’s “because it is likely that not all of those found to be resistant were tested for antibiotic resistance and not all of these were reported as resistant in the patient records provided,” according to the report.
Indeed, it is possible that some cases categorized as community-acquired MRSA were in fact contracted in a hospital inpatient or outpatient setting because the coding provided to the state agency may not have reflected the exact source of infection, Rogers said. Also missing in the data is 30-day readmission information. So, if a patient contracts MRSA in the hospital, then is readmitted for treatment within 30 days, the data may show the infection was acquired at home, Rogers said.
“There were 3.2 million patient discharges (in California) last year,” Rogers said. “Coding is improving, but we don’t think it is good enough to look at the details of those 3.2 million discharges.”
Better data are coming soon to California. In January 2008, California became the fourth state to require hospitals to test high-risk patients for MRSA. Hospitals must report the data to the California Public Health Department on a quarterly basis, and the agency must post information online about infection rates at individual hospitals by January 2011.
Initial data on infection rates are expected to be released after March 2010, a spokesman for the health department said.
The law requiring the expanded surveillance and reporting was signed by Gov. Arnold Schwarzenegger in September 2008. Dubbed “Nile’s Law,” it was named for 15-year-old Nile Moss of Gavilan Hills, Calif., who died in 2006 from a MRSA infection after visiting a hospital for an MRI.
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