Methicillin-Resistant Staphylococcus aureus (MRSA), 2012
Strains of Staphylococcus aureus that are resistant to methicillin and beta lactam antibiotics are referred to as methicillin-resistant S. aureus (MRSA). Traditional risk factors for healthcareassociated (HA) MRSA include recent hospitalization or surgery, residence in a long-term care facility, and renal dialysis. In 2005, as part of the EIP Active Bacterial Core surveillance (ABCs) system, we initiated populationbased invasive MRSA surveillance in Ramsey County. In 2005, the incidence of invasive MRSA infection in Ramsey County was 19.8 per 100,000 and was 19.4, 18.5 and 19.9 per 100,000 in 2006, 2007, and 2008, respectively. Surveillance was expanded to include Hennepin County in 2008. The incidence rate for MRSA infection in Ramsey and Hennepin Counties was 17.0, 14.0,18.2, and 14.0 per 100,000 in 2009, 2010, 2011, and 2012, respectively (2012: Ramsey 17.6/100,000 and Hennepin 12.5/100,000). In 2012, MRSA was most frequently isolated from blood (65%), and 10% (24/233) of the cases died. The rate of invasive MRSA infection acquired in hospitals (hospitalonset or nosocomial) decreased from 5.4 per 100,000 in 2005 to 1.8 in 2011, and increased to 2.2 in 2012. Seventeen percent (39/233) of cases reported in 2012 had no reported healthcare-associated risk factors in the year prior to infection. Please refer to the MDH Antibiogram for details regarding antibiotic susceptibility testing results (pp. 26-27). Vancomycin-intermediate (VISA) and vancomycin-resistant S. aureus (VRSA) are reportable in Minnesota, as detected and defi ned according to Clinical and Laboratory Standards Institute approved standards and recommendations: a Minimum Inhibitory Concentration (MIC)=4-8 ug/ml for VISA and MIC≥16 ug/ml for VRSA. Patients at risk for VISA and VRSA generally have underlying health conditions such as diabetes and end stage renal disease requiring dialysis, previous MRSA infections, recent hospitalizations, and recent exposure to vancomycin. There have been no VRSA cases in Minnesota. We confi rmed 1 VISA case in 2000, 3 cases in 2008, 3 cases in 2009, 2 cases in 2010, and 5 VISA cases in 2011. No VISA cases were reported in 2012. Critical illnesses or deaths due to community-associated (CA) S. aureus infection (both methicillin-susceptible and -resistant) are reportable in Minnesota. From 2005-2012, 125 cases of critical illness or death due to community-associated S. aureus infection were reported: 8 (2005), 14 (2006), 16 (2007), 19 (2008), 20 (2009), 20 (2010), 13 (2011), and 15 (2012); 60 (48%) were MRSA and 65 (52%) MSSA. Twenty-eight (47%) MRSA cases were male and the median age was 35 years (12 days-88 years); 34 (52%) MSSA cases were male and the median age was 16 years (1 day-78 years). Multifocal infections occurred in 29 cases; 18 MRSA, 11 MSSA. Pneumonia was most frequent with 33 MRSA and 21 MSSA cases, and accounted for 21 (66%) deaths. Three MRSA and 18 MSSA had TSS; 4 MRSA and 11 MSSA had endocarditis (6/15 fatal); 21 MRSA and 11 MSSA had skin structure infections. Death occurred in 17 (28%) MRSA and 18 (28%) MSSA cases. PFGE typing and toxin PCR were performed on 50 MRSA and 52 MSSA isolates. Most MRSA isolates belonged to clonal groups associated with CA USA types (78% USA300). There was no change in the number of USA300 MRSA cases over time. MSSA isolates were in clonal groups associated with CA and healthcare-associated USA types.
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