Transmission Dynamics of Methicillin-Resistant Staphylococcus aureus in a Medical Intensive Care Unit in India

被引:19
作者
Christopher, Solomon [1 ]
Verghis, Rejina Mariam [2 ]
Antonisamy, Belavendra [1 ]
Sowmyanarayanan, Thuppal Varadachari [5 ]
Brahmadathan, Kootallur Narayanan [6 ]
Kang, Gagandeep [5 ]
Cooper, Ben Symons [3 ,4 ]
机构
[1] Christian Med Coll & Hosp, Dept Biostat, Vellore, Tamil Nadu, India
[2] Royal Hosp, NI Clin Res Support Ctr, Belfast, Antrim, North Ireland
[3] Mahidol Univ, Fac Trop Med, Mahidol Oxford Trop Med Res Unit, Bangkok, Thailand
[4] Univ Oxford, Nuffield Dept Clin Med, Ctr Clin Vaccinol & Trop Med, Oxford, England
[5] Christian Med Coll & Hosp, Dept Gastrointestinal Sci, Vellore, Tamil Nadu, India
[6] Christian Med Coll & Hosp, Dept Microbiol, Vellore, Tamil Nadu, India
关键词
INFECTION-CONTROL; COLONIZATION; PATHOGENS; HOSPITALS; ROUTES;
D O I
10.1371/journal.pone.0020604
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
070301 [无机化学]; 070403 [天体物理学]; 070507 [自然资源与国土空间规划学]; 090105 [作物生产系统与生态工程];
摘要
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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