Methicillin resistant staphylococcus aureus historical perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Staphylococcus aureus remains an important cause of nosocomial infection, especially nosocomial pneumonia, surgical wound infection, and bloodstream infection. Methicillin-resistant S aureus (MRSA) first emerged as an important clinical problem in the United Kingdom in the early 1960s, shortly after methicillin came into clinical use. Although MRSA was first recognized in the United States in 1961, it was not until the late 1960s that reports of outbreak investigations began to appear in the U.S. medical literature.

Most of the sources of data on the prevalence and distribution of MRSA in the United States are reports of outbreak investigations and surveys of hospitals and laboratories, including pediatric and Veterans Affairs hospitals. MRSA outbreaks have been reported from all U.S. geographic regions, although a wide variation in the geographic distribution of MRSA isolates appear to exist.

Several reports also have suggested an increasing prevalence of MRSA in U.S. hospitals. However, some of these reports provide no information on current trends. The most recent report by Boyce was based on a questionnaire survey of U.S. hospital epidemiologists during 1987-1989. In addition, all these reports covered relatively limited time periods.

The National Nosocomial Infections Surveillance (NNIS) System, which began in 1970, is the only source of national information on nosocomial infections in the United States. One of the objectives of the NNIS System is to identify changes in nosocomial pathogens and antimicrobial resistance. To determine whether the proportion of S aureus resistant to methicillin has increased over a 17-year period, 1975 through 1991, we analyzed NNIS data in which S aureus was associated with a nosocomial infection.

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