National survey of methicillin-resistantStaphylococcus aureus in Belgian hospitals: Detection methods, prevalence trends and infection control measures

Abstract

A questionnaire survey of Belgian acute care hospitals was conducted to determine the methods used for detection of methicillin-resistantStaphylococcus aureus (MRSA), to estimate the prevalence of this organism during the period 1989–1991 and to describe the infection control measures used locally for limiting its spread. Questionnaires were returned by 144 acute care hospitals, with a coverage of 41 to 72 % of hospitals by province. Methods used for detection of MRSA included disk diffusion (91 %), microdilution panels (8 %) and oxacillin agar screen (9 %). Only 34 % of laboratories performed disk diffusion testing under optimal conditions for detection of heterogeneous resistance. Among 36 hospitals reporting complete susceptibility data ofStaphylococcus aureus isolates tested during the study period (n=24,153), a mean MRSA prevalence of 14 % was found (range: 0–70 %). The median prevalence increased from 9.5 % in 1989 to 13.7 % in 1991 and showed a significant linear increase during this period in 30 % of these hospitals (p<0.01). Precautions used for controlling spread of MRSA included hand decontamination using either soap and water or antimicrobial preparations (68 % of hospitals), room decontamination (62 %), patient isolation (55 %) and various barrier precautions (24–49 %). Carrier screening was performed in 37 % of hospitals, but antibiotic decolonization was attempted in only 24 %. This survey identified areas for improvement in MRSA detection methods and underscored the need for multicentric surveillance of MRSA prevalence and a reappraisal of MRSA control strategies in Belgian hospitals.