AND HOSPITAL EPIDHMIOLOGY May 2 0 0 3 ARE THERE REGIONAL VARIATIONS IN THE DIAGNOSIS, SURVEILLANCE, AND CONTROL OF METHICILLIN- RESISTANT STAPHYLOCOCCUS AUREUS} Herve M. Richet, MD; Mohamed Benbachir, PhD; Derek F. J. Brown, PhD; Helen Giamarellou, MD; Ian Gould, MD; Marija Gubina, MD; Piotr Heczko, MD; Smilja Kalenic, MD; Marina Pana, MD; Didier Pittet, MD; Saida Ben Redjeb, MD; Jiri Schindler, MD; Carlos Starling, MD; Marc J. Struelens, MD; Wolfgang Witte, MD; William R. Jarvis, MD; International Network for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR)* ABSTRACT OBJECTIVE: To assess the way healthcare facilities (HCFs) diagnose, survey, and control methicillin-resistant Staphylococcus aureus (MRSA). DESIGN: Questionnaire. SETTING: Ninety HCFs in 30 countries. RESULTS: Evaluation of susceptibility testing methods showed that 8 laboratories (9%) used oxacillin disks with antimi- crobial content different from the one recommended, 12 (13%) did not determine MRSA susceptibility to vancomycin, and 4 (4.5%) reported instances of isolation of vancomycin-resistant S. aureus but neither confirmed this resistance nor alerted public health authorities. A MRSA control program was reported by 55 (61.1%) of the HCFs. The following isolation precautions were routinely used: hospitalization in a private room (34.4%), wearing of gloves (62.2%), wearing of gowns (44.4%), hand washing by healthcare workers (53.3%), use of an isolation sign on the patient's door (43%), or all four. When the characteristics of HCFs with low incidence rates (< 0.4 per 1,000 patient-days) were com- pared with those of HCFs with high incidence rates (s= 0.4 per 1,000 patient-days), having a higher mean number of beds per infection control nurse was the only factor significantly associat- ed with HCFs with high incidence rates (834 vs 318 beds; P = .02). CONCLUSION: Our results emphasize the urgent need to strengthen the microbiologic and epidemiologic capacities of HCFs worldwide to prevent MRSA transmission and to prepare them to address the possible emergence of vancomycin-resistant S. aureus (Infect Control Hosp Epidemiol 2003;24:334-341). Drs. Richet and Jarvis are from the Investigation and Prevention Branch, Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia. Dr. Benbachir is from the Laboratoire de Microbiologie, Centre Hospitalier Ibn Rochd, Casablanca, Maroc. Dr. Brown is from the Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, United Kingdom. Dr. Giamarellou is from the 4th Department of Internal Medicine, Sismanoglio General Hospital, Maroussi Attikis, Greece. Dr. Gould is from Clinical Microbiology, Aberdeen Royal Hospitals, NHS Trust, Aberdeen, Scotland, United Kingdom. Dr. Gubina is from the Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. Dr. Heczko is from the Microbiology Department, Jagiellonian University Medical School, Krakow, Poland. Dr. Kalenic is from the Department of Clinical and Molecular Microbiology, Zagreb University School of Medicine, Zagreb, Croatia. Dr. Pana is from the Streptococcus National Reference Center, Institutul Cantacuzino, Bucarest, Romania. Dr. Pittet is from the Unite de Prevention et de Controle de I'Infection, Hopitaux Universitaires de Geneve, Geneve, Suisse. Dr. Redjeb is from the Laboratoire de Bacteriologie, Hopital Charles Nicolle, Tunis, Tunisie. Dr. Schindler isfromthe Department ofMedical Microbiology, 3rd Faculty ofMedicine, Charles University, Prague, Czech Republic. Dr. Starling is from Felicio Rocho, Vera Cruz and Sao Francisco Hospitals, Belo Horizonte, Brazil. Dr. Struelens is from the Department ofMicrobiology, Universite Libre de Bruxelles, Hopital Erasme, Bruxelles, Belgique. Dr. Witte is from the Robert-Koch Institut, Bunderinstitiit fur Infektionskrankheiten, Wernigerode, Germany. Address reprint requests to Herve M. Richet, MD, Laboratoire de Bacteriologie-Virologie-Hygiene Hospitaliere, Institut de Biologic des Hopitaux de Nantes, 9, quai Moncousu, BP1005, 44093 Nantes cedex 01, France. *INSPEAR MRSA survey participants—Argentina: Dr. Horacio Lopardo (Buenos Aires); Austria: Prof. Manfred Rotter (Vienna); Belgium: Prof. Marc Struelens (Bruxelles); Bosnia-Herzegovina: Dr. Maja Ostjic; Brazil: Dr. Jorge Saliba, Dr. Carlos Starling (Belo Horizonte, Minas Gerais); Bulgaria: Prof. Boyka Markova (Sofia); China: Prof. Kwok-Yung Yuen (Hong Kong); Cote dlvoire: Prof. Mireille Dosso (Abidjan); Croatia: Dr. Ines Bencic, Prof. Smilja Kalenic, Dr. Nastja Kucisec-Tepes, Dr. Jasenta Skrlin (Zagreb), Dr. Edita Susie (Sibenik), Dr. Maja Tomic (Slavonski Brod); Czech Republic: Dr. D. Burgetova (Brno), Dr. Jiri Schindler (Prague); France: B. Andre-Richet (Nantes), D. Barraud (Gonesse), Dr. Besnard (Mayenne), Dr. Edouard Bichier (Saumur), Mme. M. Bingen (Gonesse), Dr. Catherine Branger (Clichy), Mme. Anne Cirioni, Mme. Stephanie Clavel (Nogent le Rotrou), Dr. Simone Clevenot (Pithiviers), Dr. Andrea Collet (Port-Luois), Dr. Francois Coulomb (Dreux), Prof. Patrice Courvalin (Paris), Mme. Armelle David (Saint Gemmes), Prof. Francois Denis Dr. Marie Cecile Ploy (Limoges), Dr. Jean Yves Esvant (Paimpol), Dr. Ferrant (Lamembrolle sur choisille), Mme. Annick Genuis (La Ferte Bernard), Dr. Guir (Paimbeuf), Dr. Didier Jan (Mayenne), Mme. Francoise Jezequel (Roscoff), Dr. Jean Louis Laborie (Lannion), Dr. Florence Le Gallou (Nantes), Dr. Lemoign (Bayeux), Dr. Christine Rennes (Saint Lo), Dr. Pascale Richard (Morlaix), Mme. Yveline Ruellan (Vannes), Dr. Jacques Vaucel (Saint Brieux), Dr. Liliane Zbierski (Laval); Germany: Dr. Barbel Christiansen (Kiel), Dr. Julia Fitzner (Berlin), Dr. Mathias Hermann (Muenster), Dr. Michael Kramer (Bonn), Dr. Werner Mathys (Muenster), Dr. Sabine Schubert (Kiel), Dr. Stefan Weber (Hanover), Prof. Wolfgang Witte (Wernigerode); Greece: Prof. Helen Giamarellou (Maroussi Attikis), Dr. A. Katrachoura (Piraeus), Dr. E. A. Papafrangas (Maroussi Attikis), Dr. Danae Sofianou (Thessaloniki); Hungary: Dr. Anna Marton (Budapest); Israel: Dr. Nathan Keller, Prof. Ethan Rubinstein (Tel Hashomer); Italy: Dr. Giuseppe Cornaglia (Verona); Latvia: Dr. Jurjis Perevostikos, Dr. Ivonna Selga (Riga); Luxembourg: Dr. Robert Hemmer (Luxembourg); Morocco: Prof. M. A. Alaoui, Prof. A. Benouda-Benjilaji (Rabat), Prof. Mohamed Benbachir (Casablanca); Netherlands: Dr. J. H. T. Wagenvoort (Heerlen); Poland: Prof. Piotr Heczko, Dr. M. Pytlos (Cracaw), Prof. Waleria Hryniewicz (Warsaw); Romania: Dr. Manuela Anda Andrei, Dr. Dana Andries, Dr. Daniela Blana, Prof. Lucia Debeleac, Dr. Olga Dorobat, Dr. Antonia Medvetchi-Panatescu, Dr. Irina Nistor, Dr. Maria Pana, Dr. Raluca Papagheorge, Dr. Elena Silaghi, Dr. Daniela Tudorache (Bucuresti); Russia: Dr. Andrei Dekhitch, Prof. Leonid Stratchounski (Smolensk), Senegal: Prof. S. B. Cheikh Boye (Dakar); Slovenia: Prof. Marija Gubina, Dr. Katja Seme (Ljubljana); Spain: Dr. Javier Garau, Dr. Ferran Navarro, Prof. Guillem Prats, Dr. Antoni Trilla (Barcelona), Prof. Rafael Gomez-Lus (Zaragoza); Switzerland: Prof. Raymond Auckenthaler, Prof. Didier Pittet (Geneva), Dr. Enos Bernasconi, Prof. Jean Claude Piffaretti (Lugano), Dr. Reno Frei, Dr. Andreas Widmer (Basel); Tunisia: Prof. Assia Ben Hassen, Dr. Amel Kechrid, Prof. Saida Ben Redjob (Tunis); United Kingdom: Dr. Derek Brown, Dr. Nick Brown (Cambridge), Dr. Adam Fraise (Birmingham), Dr. Ian Gould (Aberdeen); United States: Dr. Krishna Agarwal, Dr. David Pegues (Los Angeles), Dr. Steven Gordon (Cleveland), Dr. William Jarvis, Dr. Herve Richet, Dr. Fred Tenover (Atlanta), Dr. Leonard Mermel (Providence), Dr. Louis Polish (Saint Louis). The authors thank Beatrice Andre-Richet, PharmD, MPH, and Elaine Miller, RN, MPH, for their assistance with data entry and analysis. https:/www.cambridge.org/core/terms. https://doi.org/10.1086/502216 Downloaded from https:/www.cambridge.org/core. University of Basel Library, on 11 Jul 2017 at 11:19:28, subject to the Cambridge Core terms of use, available at