National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most prevalent multidrug-resistant organisms causing health care-associated infections. Limited data are available about how the prevalence of MRSA has changed over the past several years and what MRSA prevention practices have been implemented since the 2006 Association for Professionals in Infection Control and Epidemiology, Inc, MRSA survey. METHODS: We conducted a national prevalence survey of MRSA colonization or infection in inpatients at US health care facilities. The survey was developed, received institutional review board approval, and then was distributed to all US Association for Professionals in Infection Control and Epidemiology, Inc, members. Members were asked to complete the survey on 1 day during the period August 1 to December 30, 2010, reporting the number of inpatients with MRSA infection or colonization and facility- and patient-specific information. RESULTS: Personnel at 590 facilities indicated a state and responded to the survey. All states were represented, except for Alaska and Washington, DC (mean, 12 facilities per state; range, 1-38). Respondents reported 4,476 MRSA-colonized/infected patients in 67,412 inpatients; the overall MRSA prevalence rate was 66.4 per 1,000 inpatients (25.3 infections and 41.1 colonizations per 1,000 inpatients). Active surveillance testing was conducted by 75.7% of the respondents; 39.6% used nonselective media, 37.2% used selective media, and 23.3% used polymerase chain reaction. Detailed data were provided on 3,176 MRSA-colonized/infected patients. Of those in whom colonization/infection status was reported (1,908/3,086 [61.8%] were MRSA colonized and 1,778/3,086 [38.2%] were MRSA infected), most MRSA-colonized or infected patients (78.3%) were detected within 48 hours of admission; the most common site of infection was skin and soft tissue (42.9%); and, using the Centers for Disease Control and Prevention's definitions, approximately 50% would be classified as health care-associated infections. CONCLUSION: Our survey documents that the MRSA prevalence in 2010 is higher than that reported in our 2006 survey. However, the majority of facilities currently are performing active surveillance testing, and, compared with 2006, the rate of MRSA infection has decreased while the rate of MRSA colonization has increased. In addition, compared with 2006, the proportion of MRSA strains recovered from MRSA-colonized/infected patients that are health care-associated strains has deceased, and community-associated strains have increased.

National point prevalence of Clostridium difficile in US health care facility inpatients, 2008.

BACKGROUND: Recent published estimates of Clostridium difficile infection (CDI) incidence have been based on small numbers of hospitals or national hospital discharge data. These data suggest that CDI incidence is increasing. METHODS: We conducted a point prevalence survey of C difficile in inpatients at US health care facilities. The survey was developed, received Institutional Review Board approval, and was then distributed to all Association for Professionals in Infection Control and Epidemiology, Inc (APIC) members. They were asked to complete the survey on 1 day between May 7 and August 29, 2008, reporting the number of inpatients with CDI or colonization and facility-specific information. RESULTS: Personnel at 648 hospitals completed the survey; this represents approximately 12.5% of all US acute care facilities. All but 3 states and the District of Columbia were represented (mean, 14 facilities per state; range, 2-43). Eighty-two percent reported that their CDI rate had not decreased in the past 3 years. Respondents reported 1443 C difficile-colonized/infected patients among 110,550 inpatients; the overall C difficile prevalence rate was 13.1 per 1000 inpatients (94.4% infection). Detailed data were provided on 1062 (73.6%) patients. Of these, 55.5% were female, 69.2% were >60 years of age, 67.6% had selected comorbid conditions, 79% had received antimicrobials within 30 days, and 94.4% were detected by enzyme immunoassay. The majority of patients (54.4%) were diagnosed < or =48 hours of hospitalization, but 35% had been admitted to a long-term care facility within 30 days, and 47% had been hospitalized within 90 days; 73% met Centers for Disease Control and Prevention criteria for health care-associated CDI. Most facilities (>90%) used contact isolation for CDI patients. Bleach was used for environmental disinfection more commonly during CDI outbreaks than during nonoutbreak periods. CONCLUSION: Our survey documents a higher C difficile prevalence rate than previous estimates using different methodologies. The majority of inpatient CDI appears to be health care associated. Given that not all patients with diarrhea are tested for CDI and that most facilities use enzyme immunoassays with limited sensitivity to detect C difficile, these are minimum estimates of the US health care facility C difficile burden.