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Healthcare-associated Infections (HAI)

Invasive Staphylococcus aureus (MRSA/MSSA) Infection Tracking

Staphylococcus aureus is a leading cause of healthcare-associated infections in the United States and an important cause of serious infections in the community. Methicillin-resistant S. aureus (MRSA) is one of the most important antibiotic resistant bacteria in the United States. Data from this project will help inform future policy and prevention strategies to reduce S. aureus disease, including MRSA. Invasive S. aureus is defined as isolated from a normally sterile body site. See the case definition for details.

The invasive S. aureus infection surveillance program is an active population- and laboratory-based surveillance system. Laboratories are specifically and regularly queried by surveillance staff for reports of results among patients in a specifically defined geographic area. This program is conducted through CDC’s Emerging Infections Program (EIP) Healthcare-Associated Infections Community Interface (HAIC). Data from the EIP S. aureus program are used to evaluate the incidence of invasive S. aureus infections in the population, characterize S. aureus strains associated with disease, and monitor trends in disease over time.

Additional Information

The EIP invasive S. aureus infection surveillance program was launched in 2004 as a part of EIP Active Bacterial Core surveillance (ABCs). Between 2004 and 2014, surveillance focused on invasive MRSA infections only in 9 EIP sites. In 2016 it officially became a part of the EIP HAIC activity and incorporated surveillance for both methicillin-resistant and methicillin-sensitive S. aureus. Invasive S. aureus surveillance currently operates in select counties in 7 EIP sites across the United States and has approximately 16 million people living in the surveillance area.

Specifically, the EIP invasive S. aureus surveillance project will:

  • Determine the frequency of invasive S. aureus disease among different patient subpopulations
  • Measure disease trends over time
  • Determine what strains of S. aureus are causing invasive disease

In addition, the project provides infrastructure for further projects, including studies to identify risk factors, determine who would most benefit from vaccines and other interventions in development, and monitor the effectiveness and impact of prevention strategies.

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Surveillance Objectives

  1. To monitor changes in incidence of hospital-onset (HO), healthcare-associated community-onset (HACO), and community-associated (CA) invasive infections with Staphylococcus aureus.
  2. To identify populations with invasive S. aureus that would benefit from improved prevention or treatment activities, and assess the impact of established prevention strategies, with a focus on community-onset infections.
  3. To describe the molecular and microbiologic characteristics of strains causing invasive S. aureus infections, with a focus on community-onset S. aureus isolates.

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Methods

Surveillance Population

Surveillance for invasive S. aureus/MRSA is conducted in seven EIP sites. In some surveillance areas, only invasive MRSA surveillance is conducted. As of July 2015, the total population under surveillance was 15,564,769, according to the U.S. Census Quick Facts population estimates accessed June 27, 2016.

 

Population Under Surveillance (as of January 2016)
State Population (Location)
CA 3,629,776
(3 county San Francisco Bay Area)
CT 3,590,886
(Entire state)
GA 3,701,359
(8 county Atlanta Area)
MD 1,452,977
(Baltimore County and Baltimore City)
MN 1,761,282
(2 metro Twin Cities Counties)
NY 749,600
(1 county Rochester Metro Area)
TN 678,889
(1 county Nashville Metro Area)
Total 15,564,769

 

Case Definition

To be considered a case, the following conditions must both be met:

  • S. aureus isolated from a normally sterile site, such as blood, cerebrospinal fluid (CSF), pleural fluid, peritoneal fluid, pericardial fluid, bone, joint/synovial fluid, or internal body site (e.g., lymph node, brain)
    and
  • Case patient must be a resident of one of the defined surveillance areas

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Annual Reports

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Publications

  • Johnson NB, Hayes LD, Hoo EC, Ethier KA. CDC National Health Report: Leading causes of morbidity and mortality and associated risk and protective factors – United States, 2005-2013. MMWR Supplements 2014; 63(04):3-27.
  • Nguyen DB, See I, Gualandi N, et al. Completeness of MRSA bloodstream infection reporting from outpatient hemodialysis facilities to the national healthcare safety network, 2013. Infect Control Hosp Epidemiol. 2016 Feb;37(2):205-7.
  • Epstein L, Mu Y, Belflower R, Scott J, Ray S, Dumyati G, et al. Risk factors for invasive methicillin-resistant Staphylococcus aureus infection after recent discharge from an acute-care hospitalization, 2011-2013. Clin Infect Dis. 2016;62(1):45-52.
  • Reno J, Doshi S, Tunali AK, Stein B, Farley MM, Ray SM, Jacob JT. Epidemiology of methicillin-resistant Staphylococcus aureus bloodstream co-infection among adults with candidemia in Atlanta, GA, 2008-2012. Infect Control Hosp Epidemiol. 2015 Nov;36(11):1298-304.
  • Fridkin SK, Cleveland AA, See I, Lynfield R. Emerging Infections Program as surveillance for antimicrobial drug resistance. Emerg Infect Dis. 2015 Sep;21(9):1578-1581.
  • Dantes R, Mu Y, Belflower R, Aragon D, Dumyati G, Harrison LH, Lessa FC, Lynfield R, Nadle J, Petit S, Ray SM, Schaffner W, Townes J, Fridkin S. Emerging Infections Program–Active Bacterial Core Surveillance MRSA Surveillance Investigators. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med. 2013;173(21):1970-8.
  • Duffy J, Dumyati G, Bulens S, Namburi S, Gellert A, Fridkin SK, Lessa FC. Community-onset invasive methicillin-resistant Staphylococcus aureus infections following hospital discharge. Am J Infect Control. 2013;41(9):782-6.
  • Iwamoto M, Mu Y, Lynfield R, Bulens, SN, Nadle J, Aragon D, Petit S, Ray SM, Harrison LH, Dumyati G, Townes JM, Schaffner W, Gorwitz RJ, Lessa FC. Trends in invasive methicillin-resistant Staphylococcus aureus infections. Pediatrics. 2013;132(40):e817-24.
  • Nguyen DB, Lessa FC, Belflower R, Mu Y, Wise M, Nadle J, Bamberg WM, Petit S, Ray SM, Harrison LH, Lynfield R, Dumyati G, Thompson J, Schaffner W, Patel PR; for the Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. Invasive methicillin-resistant Staphylococcus aureus infections among chronic dialysis patients in the United States, 2005-2011. Clin Infect Dis. 2013;57:1393-400.
  • Tosh PK, Bulens SN, Nadle J, Dumyati G, Lynfield R, Schaffner W, Ray S, Seema J, Fridkin SK, Sievert DM. Characterization of hospitalized community-onset Staphylococcus aureus lower respiratory tract infections among generally healthy persons 50 years of age or younger. Infect Dis Clin Prac.2013;21:359-65.
  • Bender JB, Waters KC, Nerby J, Olsen KE, Jawahir S. Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pets living in households with MRSA-infected children. Clin Infect Dis. February 2012;54(3):449-50.
  • Hadler JL, Petit S, Mandour M, Cartter ML. Trends in Invasive Infection with methicillin-resistant Staphylococcus aureus, Connecticut, 2001-2010. Emerg Infect Dis. 2012 June; 18(6):917-924.
  • Lessa FC, Mu Y, Ray SM, Dumyati G, Bulens S, Gorwitz RJ, Fosheim G, Devries A, Schaffner W, Nadle J, Gershman K, Fridkin SK for the Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. Impact of USA300 methicillin-resistant Staphylococcus aureus on clinical outcomes of patients with pneumonia or central line-associated bloodstream infections. Clin Infect Dis. 2012 Jul; 55(2): 232-41.
  • CDC. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2011 [PDF – 340 KB].
  • DeVries A, Lesher L, Schlievert PM, Rogers T, Gomez-Villaume L, Danila R, et al. Staphylococcal toxic shock syndrome 2000-2006: Epidemiology, clinical features, and molecular characteristics. PLoS One. 2011: 6(8):e22997.
  • Nerby JM, Gorwitz R, Lesher L, Juni B, Jawahir S, Lynfield R, Harriman K. Risk factors for household transmission of community-associated methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J. 2011;30(11):927-932.
  • Satola SW, Lessa FC, Ray SM, Bulens SN, Lynfield R, Schaffner W, Dumyati G, Nadle J, Patel JB. Clinical and laboratory characteristics of invasive infections due to methicillin-resistant Staphylococcus aureus isolates demonstrating a vancomycin MIC of 2 micrograms per milliliter: Lack of effect of heteroresistant vancomycin-intermediate S. aureus phenotype. J Clin Microbiol. 2011;49(4):1583-87.
  • Satola SW, Farley MM, Anderson KF, Patel JB. Comparison of detection methods for heteroresistant vancomycin-intermediate Staphylococcus aureus, with the population analysis profile method as the reference method. J Clin Microbiol. 2011;49(1):177-83.
  • CDC. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2010 [PDF – 342 KB].
  • Como-Sabetti KJ, Harriman KH, Fridkin SK, Jawahir SL, Lynfield R. Risk factors for community-associated Staphylococcus aureus infections: Results from parallel studies including methicillin-resistant and methicillin-sensitive S. aureus compared to uninfected controls. Epidemiol Infect. 2010;1:1-11.
  • Kallen A, Mu Y, Bulens S, Reingold A, Petit S, Gershman K, Ray SM, Harrison LH, Lynfield R, DumyatiG, Townes JM, Schaffner W, Patel PR, Fridkin SK for the Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. Healthcare-associated invasive MRSA infections, 2005-2008. JAMA 2010; 304(6):641-48.
  • Kempker RR, Farley MM, Ladson JL, Satola S, Ray SM. Association of methicillin-resistant Staphylococcus aureus (MRSA) USA300 genotype with mortality in MRSA Bacteremia. J Infect. 2010;61:372-81.
  • Lessa FC, Mu Y, Davies J, Murray M, Lillie M, Pearson A, Fridkin S for the Emerging Infections Program/Active Bacterial Core surveillance MRSA investigators and the Health Protection Agency Team. Comparison of incidence of bloodstream infection with methicillin-resistant Staphylococcus aureus between England and United States, 2006-2007. Clin Infect Dis 2010;51(8):925-28.
  • Shukla SK, Karow ME, Brady JM, Stemper ME, Kislow J, Moore N, Wroblewski K, Chyou PH, Warshauer DM, Reed KD, Lynfield R, Schwan WR. Virulence genes and genotypic associations in nasal carriage, community-associated methicillin-susceptible and methicillin-resistant USA400 Staphylococcus aureus isolates. J Clin Microbiol. 2010;48(10):3582-92.
  • CDC. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2009 [PDF -337 KB].
  • Limbago B, Fosheim GE, Schoonover V, Crane CE, Nadle J, Petit S, Heltzel D, Ray SM, Harrison LH, Lynfield R, Dumyati G, Townes JM, Schaffner W, Mu Y, Fridkin SK. Characterization of methicillin-resistant Staphylococcus aureus isolates collected in 2005 and 2006 from patients with invasive disease: a population-based analysis. J Clin Microbiol 2009;47(5):1344-51.
  • Lucero CA, Hageman J, Zell ER, Bulens S, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Schaffner W, Fridkin SK for ABCs MRSA Investigators. Evaluating the potential public health impact of a Staphylococcus aureus vaccine through the use of population-based surveillance for invasive methicillin-resistant S. aureus disease in the United States. Vaccine 2009;27(37):5061-68.
  • Buck JM, Harriman KH, Juni BA, Gall K, Boxrud DJ, Glennen A, Danila R, Lynfield R. No change in methicillin-resistant Staphylococcus aureus nasal colonization rates among Minnesota school children during 2 study periods. Infect Dis Clin Pract 2008;16(3):163-5.
  • CDC. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2008.
  • Tenover FC, McAllister S, Fosheim G, McDougal LK, Carey RB, Limbago B, Lonsway D, Patel JB, Kuehnert MJ, Gorwitz R. Characterization of Staphylococcus aureus Isolates from nasal cultures collected from individuals in the United States in 2001 to 2004. J Clin Microbiol 2008;46(9):2837-41.
  • Centers for Disease Control and Prevention. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2007.
  • Klevens MR, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK for ABCs MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298(15):1763-71.
  • CDC. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2006.
  • Klevens MR, Morrison MA, Fridkin SK, Reingold A, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati R, Townes JM, Craig AS, Fosheim G, McDougal LK, Tenover FC, for ABCs/EIP. Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infec Dis 2006;12:1991-3.
  • CDC. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Methicillin-Resistant Staphylococcus aureus, 2005.
  • Buck JM, Como-Sabetti K, Harriman KH, Danila RN, Boxrud DJ, Glennen A, Lynfield R. Community-associated methicillin-resistant Staphylococcus aureus, Minnesota, 2000-2003. Emerg Infect Dis. 2005; 11(10):1532-8.
  • Fridkin SK, Hageman JC, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, Harriman K, Harrison LH, Lynfield R, Farley MM for the Active Bacterial Core Surveillance Program of The Emerging Infections Program Network. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005;352:1436-44.
  • Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, Johnson SK, Vandenesch F, Fridkin S, O’Boyle C, Danila RN,
    Lynfield R. Comparison of community and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976-84.
  • Morin C, Hadler JL. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in four metropolitan areas in Connecticut, 1998. J Infect Dis 2001;184:1029-34.

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