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Original Investigation |

National Burden of Invasive Methicillin-Resistant Staphylococcus aureus Infections, United States, 2011

Raymund Dantes, MD, MPH1,2; Yi Mu, PhD2; Ruth Belflower, RN, MPH2,3; Deborah Aragon, MSPH4; Ghinwa Dumyati, MD5; Lee H. Harrison, MD6; Fernanda C. Lessa, MD2; Ruth Lynfield, MD7; Joelle Nadle, MPH8; Susan Petit, MPH9; Susan M. Ray, MD10; William Schaffner, MD11; John Townes, MD12; Scott Fridkin, MD2; for the Emerging Infections Program–Active Bacterial Core Surveillance MRSA Surveillance Investigators
[+] Author Affiliations
1Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia
2Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
3Atlanta Research and Education Foundation, Atlanta, Georgia
4Colorado Department of Public Health & Environment, Denver
5Department of Medicine, Division of Infectious Diseases, University of Rochester, Rochester, New York
6Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
7Minnesota Department of Health, St Paul
8California Emerging Infections Program, Oakland
9Connecticut Department of Public Health, Hartford
10Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine and Georgia Emerging Infections Program, Atlanta
11Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
12Department of Medicine, Division of Infectious Diseases, Oregon Health & Science University, Portland
JAMA Intern Med. 2013;173(21):1970-1978. doi:10.1001/jamainternmed.2013.10423.
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Importance  Estimating the US burden of methicillin-resistant Staphylococcus aureus (MRSA) infections is important for planning and tracking success of prevention strategies.

Objective  To describe updated national estimates and characteristics of health care– and community-associated invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in 2011.

Design, Setting, and Participants  Active laboratory-based case finding identified MRSA cultures in 9 US metropolitan areas from 2005 through 2011. Invasive infections (MRSA cultured from normally sterile body sites) were classified as health care–associated community-onset (HACO) infections (cultured ≤3 days after admission and/or prior year dialysis, hospitalization, surgery, long-term care residence, or central vascular catheter presence ≤2 days before culture); hospital-onset infections (cultured >3 days after admission); or community-associated infections if no other criteria were met. National estimates were adjusted using US census and US Renal Data System data.

Main Outcomes and Measures  National estimates of invasive HACO, hospital-onset, and community-associated MRSA infections using US census and US Renal Data System data as the denominator.

Results  An estimated 80 461 (95% CI, 69 515-93 914) invasive MRSA infections occurred nationally in 2011. Of these, 48 353 (95% CI, 40 195–58 642) were HACO infections; 14 156 (95% CI, 10 096-20 440) were hospital-onset infections; and 16 560 (95% CI, 12 806-21 811) were community-associated infections. Since 2005, adjusted national estimated incidence rates decreased among HACO infections by 27.7% and hospital-onset infections decreased by 54.2%; community-associated infections decreased by only 5.0%. Among recently hospitalized community-onset (nondialysis) infections, 64% occurred 3 months or less after discharge, and 32% of these were admitted from long-term care facilities.

Conclusions and Relevance  An estimated 30 800 fewer invasive MRSA infections occurred in the United States in 2011 compared with 2005; in 2011 fewer infections occurred among patients during hospitalization than among persons in the community without recent health care exposures. Effective strategies for preventing infections outside acute care settings will have the greatest impact on further reducing invasive MRSA infections nationally.

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Figures

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Figure 1.
Distribution of Weeks Between Previous Hospitalization and Current Admission Date, Stratified by Long-term Care Facility Residence

Data are given for nondialysis cases of health care–associated community-onset (HACO) invasive methicillin-resistant Staphylococcus aureus (MRSA) infectiona with hospitalization in the prior year in 2011 (n = 1622b).aDefined as MRSA isolated from a normally sterile source.bA total of 399 cases of HACO infections in nondialysis patients who had no prior hospitalization date in the prior year are not represented in this figure.

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Figure 2.
National Estimated Incidence Rates of Invasive MRSA Infections, Stratified by Epidemiologic Categorya

Data are given for methicillin-resistant Staphylococcus aureus (MRSA) infections reported to the Emerging Infections Program–Active Bacterial Core surveillance (United States, 2005-2011).aDefined as MSRA isolated from a normally sterile source.

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