Transmission dynamics of methicillin-resistant Staphylococcus aureus in a medical intensive care unit in India.
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a global pathogen and an important but seldom investigated cause of morbidity and mortality in lower and middle-income countries where it can place a major burden on limited resources. Quantifying nosocomial transmission in resource-...
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Main Authors: | , , , , , , |
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Format: | Article |
Language: | English |
Published: |
2015
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Subjects: | |
Online Access: | https://repository.li.mahidol.ac.th/handle/123456789/801 |
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Institution: | Mahidol University |
Language: | English |
Summary: | BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a global
pathogen and an important but seldom investigated cause of morbidity and
mortality in lower and middle-income countries where it can place a major burden
on limited resources. Quantifying nosocomial transmission in resource-poor
settings is difficult because molecular typing methods are prohibitively
expensive. Mechanistic statistical models can overcome this problem with minimal
cost. We analyse the transmission dynamics of MRSA in a hospital in south India
using one such approach and provide conservative estimates of the organism's
economic burden.
METHODS AND FINDINGS: Fifty months of MRSA infection data were collected
retrospectively from a Medical Intensive Care Unit (MICU) in a tertiary hospital
in Vellore, south India. Data were analysed using a previously described
structured hidden Markov model. Seventy-two patients developed MRSA infections
and, of these, 49 (68%) died in the MICU. We estimated that 4.2% (95%CI 1.0,
19.0) of patients were MRSA-positive when admitted, that there were 0.39 MRSA
infections per colonized patient month (0.06, 0.73), and that the ward-level
reproduction number for MRSA was 0.42 (0.08, 2.04). Anti-MRSA antibiotic
treatment costs alone averaged $124/patient, over three times the monthly income
of more than 40% of the Indian population.
CONCLUSIONS: Our analysis of routine data provides the first estimate of the
nosocomial transmission potential of MRSA in India. The high levels of
transmission estimated underline the need for cost-effective interventions to
reduce MRSA transmission in hospital settings in low and middle income countries. |
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