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Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control

Author
Anthony Harris, MD, MPH
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

Prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) infection is among the most important challenges of infection prevention. About 100,000 invasive MRSA infections occur annually, and the associated number of death is estimated to be 19,000 [1]. Factors in transmission include colonization, impaired host defenses, and contact with skin or contaminated fomites [2,3]. Further study of S. aureus pathogenesis is important for prevention optimization.

The success of MRSA control has varied substantially with different strategies [4,5]. Some European countries have managed to contain MRSA at a low prevalence using active surveillance cultures and contact precautions, with or without decolonization (examples include the Netherlands, Finland, and France) [6-10]. Other countries have struggled to control MRSA epidemics but have progressed over the last decade (examples include Germany and Canada) [11-14]. The countries with greatest MRSA prevalence include the United States and Japan [15-17]. In the last few years, the incidence of MRSA infections in the United States has plateaued and is decreasing [8,9]. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology".)

Many important clinical studies addressing control of MRSA have been in intensive care units, including studies on contact precautions, decolonization, and the role of active surveillance. The clinical approach to prevention of MRSA infection among patients in intensive care units, including universal decolonization with chlorhexidine bathing, is discussed separately. (See "Infections and antimicrobial resistance in the intensive care unit: Epidemiology and prevention".)

Issues related to prevention and control of MRSA outside intensive care units will be reviewed here. Issues related to infection control within intensive care units and the epidemiology of MRSA are discussed in detail separately. (See "Infections and antimicrobial resistance in the intensive care unit: Epidemiology and prevention" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology".)

IN HEALTHCARE SETTINGS

Basic infection prevention principles — Principles of infection prevention for reducing spread of methicillin-resistant S. aureus (MRSA) include attention to careful hand hygiene and adherence to contact precautions for care of patients with known MRSA infection.

            

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