Journal Article

Modeling the Invasion of Community-Acquired Methicillin-Resistant <i>Staphylococcus aureus</i> into Hospitals

Erica M. C. D'Agata, Glenn F. Webb, Mary Ann Horn, Robert C. Moellering and Shigui Ruan

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 48, issue 3, pages 274-284
Published in print February 2009 | ISSN: 1058-4838
Published online February 2009 | e-ISSN: 1537-6591 | DOI: https://dx.doi.org/10.1086/595844
Modeling the Invasion of Community-Acquired Methicillin-Resistant Staphylococcus aureus into Hospitals

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Background. Methicillin-resistant Staphylococcus aureus (MRSA) has traditionally been associated with infections in hospitals. Recently, a new strain of MRSA has emerged and rapidly spread in the community, causing serious infections among young, healthy individuals. Preliminary reports imply that a particular clone (USA300) of a community-acquired MRSA (CA-MRSA) strain is infiltrating hospitals and replacing the traditional hospital-acquired MRSA strains. If true, this event would have serious consequences, because CA-MRSA infections in hospitals would occur among a more debilitated, older patient population.

Methods. A deterministic mathematical model was developed to characterize the factors contributing to the replacement of hospital-acquired MRSA with CA-MRSA and to quantify the effectiveness of interventions aimed at limiting the spread of CA-MRSA in health care settings.

Results. The model strongly suggests that CA-MRSA will become the dominant MRSA strain in hospitals and health care facilities. This reversal of dominant strain will occur as a result of the documented expanding community reservoir and increasing influx into the hospital of individuals who harbor CA-MRSA. Competitive exclusion of hospital-acquired MRSA by CA-MRSA will occur, with increased severity of CA-MRSA infections resulting in longer hospitalizations and a larger in-hospital reservoir of CA-MRSA.

Conclusions. Improving compliance with hand hygiene and screening for and decolonization of CA-MRSA carriers are effective strategies. However, hand hygiene has the greatest return of benefits and, if compliance is optimized, other strategies may have minimal added benefit.

Journal Article.  4933 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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