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Title: MRSA improvement within a highly endemic hospital in Malta : infection control measures or clonal change?
Authors: Borg, Michael Angelo
Monecke, Stefan
Haider, Julie
Müller, Elke
Reißig, Annett
Ehricht, Ralf
Keywords: Staphylococcus aureus infections -- Prevention -- Malta
Methicillin resistance -- Malta
Drug resistance in microorganisms -- Malta
Nosocomial infections -- Prevention -- Malta
Medical screening -- Malta
Issue Date: 2021
Publisher: Elsevier
Citation: Borg, M. A., Monecke, S., Haider, J., Müller, E., Reissig, A., & Ehricht, R. (2021). MRSA improvement within a highly endemic hospital in Malta: infection control measures or clonal change? Journal of Hospital Infection, 110, 201-202.
Abstract: Malta has seen a significant reduction in the incidence of meticillin-resistant Staphylococcus aureus (MRSA) over the past decade. The primary contributor to this decline has been Mater Dei Hospital (MDH), a 1000-bed institution providing all tertiary and most secondary care in the country. Meticillin resistance in Staphylococcus aureus clinical isolates at MDH decreased from 51.4% [95% confidence interval (CI) 48.1–54.6%] in 2010 to 24.7% (95% CI 21.6–28.0%) in 2019. Over the same period, the incidence of healthcare-associated MRSA infections at MDH decreased from 1.1 to 0.18 cases per 1000 bed-days. This development runs contrary to the trend in European Union countries, where MRSA infections increased overall by 1.28% between 2007 and 2015. This is particularly the case in the Mediterranean region. The reduction in the incidence of MRSA at MDH corresponded with the introduction of a universal MRSA admission screening and decolonization strategy in 2014, wherein all patients admitted to adult hospital wards were screened by means of a nasal swab taken within 24 h of admission. If carriage was detected, they were decolonized with a 5-day combination of intranasal mupirocin and chlorhexidine body washes. The use of both agents has been substantial, with an average of 8.3% (interquartile range 6.8–9.6%) of admissions testing positive and requiring decolonization.
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