Abstract
Aim
Nosocomial infections are an increasing risk worldwide, including in German hospitals. Methicillin-resistant Staphylococcus aureus (MRSA) infections are difficult to treat because of antibiotic resistances. The aim of this study is to gain insights into the relationship between MRSA and several characteristics of patients (individual level) and geographical regions (regional level).
Subjects and methods
Based on the German Diagnosis Related Groups Hospital Statistics (DRG Statistics), an analysis of secondary data relating to individual and regional predictors was conducted for the year 2011. The data set included 1.6 million cases (10 % sample), and the analysis was carried out using descriptive as well as inductive statistical methods including multilevel analysis.
Results
The variables age, male sex and length of hospital stay (individual level) as well as a higher prevalence of antibiotic prescriptions, a higher age structure in the population and a higher number of beds per hospital (regional level) are significantly associated with the probability of MRSA. The analysis does not reveal significant effects of the share of male population or the share of private hospitals.
Conclusion
The identified predictors related to MRSA will perhaps have an effect on the German health system in the future. Due to demographic changes, an increasing average age in the population may lead to a higher number of MRSA cases. Consequently, the financial burden on the insurance system will rise. Hence, MRSA prevention strategies and legal regulations should be taken more seriously in the next years.
Similar content being viewed by others
References
Albert S, Wichelhaus TA, Schäfer V (2000) Bedeutung des Methicillin-resistenten S. aureus (MRSA) in der Geriatrie-Epidemiologie. Therapie und Management Z Gerontol Geriat 33:367–373
Barbosa TM, Levy SB (2000) The impact of antibiotic use on resistance development and persistence. Drug Resist Updat 3:303–311
Becker K, Peters G (2009) Staphylococcaceae, Micrococcaceae und Dermacoccaceae. In: Neumeister B, Geiss HK, Braun RK, Kimmig P (eds) Mikrobiologische Diagnostik. Bakteriologie-Mykologie-Virologie-Parasitologie, vol 333–351. Thieme, Stuttgart
Behnke M et al. (2011) Deutsche Nationale Punkt-Prävalenzstudie zu nosokomialen Infektionen und Antibiotika-Anwendung. 2011. Abschlussbericht. http://www.nrz-hygiene.de/fileadmin/nrz/download/PPS-Abschlussbericht-Stand05-08-2013final.pdf. Accessed 28 November 2014
Bundesministerium für Gesundheit (BMG) (2011) DART Deutsche Antibiotika-Resistenzstrategie. http://www.bmelv.de/SharedDocs/Downloads/Broschueren/DART.pdf?__blob=publicationFile. Accessed 28 Nov 2014
Casewell M, Hill R (1986) The carrier state: methicillin-resistant Staphylococcus aureus. J Antimicrob Chemother Suppl A:1–12
Cosgrove SE, Qi Y, Kaye K, Harbarth S, Karchmer A, Carmeli Y (2005) The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26:166–174
Daschner F, Schumpelick V (2002) MRSA als Herausforderung an die klinische Organisation Chirurg 73:924–929
Dissemond J (2007) MRSA in der Dermatologie. In: Plewig G, Thomas P (eds) Fortschritte der praktischen Dermatologie und Venerologie. Springer, Heidelberg, pp 148–156
Engemann JJ et al (2003) Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 36:592–598
European Centre for Disease Prevention and Control (ECDC) (2013) Antimicrobial resistance surveillance in Europe. Annual Report of the European Antimicrobial Resistance Surveillance 2012. ECDC, Stockholm. doi:10.2900/93403
Forschungsdatenzentrum der statistischen Ämter des Bundes und der Länder (2014) Fallpauschalenbezogene Krankenhausstatistik (DRG-Statistik) 2008–2011.
Gastmeier P, Behnke M, Reichardt C, Geffers C (2011) Qualitätsmanagement zur Infektionsprävention im Krankenhaus. Die Bedeutung der Surveillance Bundesgesundheitsbl 54 doi:1007/s00103-010-1200-2
Gatermann S, Miksits K (2009) Staphylokokken. In: Hahn H, Kaufmann SHE, Schulze TF, Suerbaum S (eds) Medizinische Mikrobiologie. Springer, Heidelberg, pp 191-202
German Federal Bureau of Statistics (2011) Diagnosen der Krankenhauspatientinnen und -patienten. https://www.destatis.de/DE/Publikationen/Qualitaetsberichte/Gesundheitswesen/Krankenhauspatienten.pdf?__blob=publicationFile. Accessed 28 Nov 2014
German Federal Bureau of Statistics (2013) Verzeichnis der Krankenhäuser und Vorsorge- oder Rehabilitationseinrichtungen in Deutschland. Krankenhausverzeichnis, Wiesbaden
German Federal Bureau of Statistics (2014) Regionaldatenbank Deutschland. https://www.regionalstatistik.de/genesis/online/logon. Accessed 28 Nov 2014
Grobe TG (2005) Stationäre Versorgung-Krankenhausbehandlungen. In: Swart E, Ihle P (eds) Routinedaten im Gesundheitswesen. Handbuch Sekundärdatenanalyse: Grundlagen, Methoden und Perspektiven, vol 79–98. Verlag Hans Huber, Bern
Harbarth S, Pittet D (2005) Methicillin-resistant Staphylococcus aureus. Lancet Infect Dis 5:653–663
Harbarth S, Sax H, Frankhauser-Rodriguez C, Schrenzel J, Agostinho A, Pittet D (2006) Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 119:275.e215-275.e223
Hernández-Porto M, Castro B, Ramos MJ AA, Aguirre-Jaime A, Lecuona M (2014) Risk factors for development of methicillin-resistant Staphylococcus aureus-positive clinical culture in nasal carriers after decolonization treatment. Am J Infect Control 42:e75–79. doi:10.1016/j.ajic.2014.03.011
Hidron AI et al (2005) Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 41:159–166
Hiramatsu K (2001) Vancomycin-resistant Staphylococcus aureus: a new model of antibiotic resistance. Lancet Infect Dis 1:147–155
Hori S, Sunley R, Tami A, Grundmann H (2002) The Nottingham Staphylococcus aureus population study: prevalence of MRSA among the elderly in a university hospital. J Hosp Infect 50:25–29. doi:10.1053/jhin.2001.1130
Kinsman OS, McKenna R, Noble WC (1983) Association between histocompatability antigens (HLA) and nasal carriage of Staphylococcus aureus. J Med Microbiol 16:215–220
Kirov A (2013) Medizinische Mikrobiologie. In: Dülligen M, Kirov A, Unverricht H (eds) Hygiene und medizinische Mikrobiologie. Schattauer, Stuttgart, pp 3–161
Knoll T (2008) MRSA Killerbakterien aus dem OP. Tödliche Krankenhauskeime. Tredition, Hamburg
RKI (Robert Koch Institut) (2013) Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2012. http://www.rki.de/DE/Content/Infekt/Jahrbuch/Jahrbuch_2012.pdf?__blob=publicationFile. Accessed 26 Feb 2014
Korczak D, Schöffmann C (2010) Medizinische Wirksamkeit und Kosten-Effektivität von Präventions- und Kontrollmaßnahmen gegen Methicillinresistente Staphylococcus aureus (MRSA)-Infektionen im Krankenhaus. Deutsches Institut für Medizinische Dokumentation und Information (DIMDI), Cologne
Macy E, Contreras R (2014) Health care use and serious infection prevalence associated with penicillin “allergy” in hospitalized patients: A cohort study. J Allergy ClinImmunol 133:790–796. doi:10.1016/j.jaci.2013.09.021
Morgan M, Salmon R, Keppie N, Evans-Williams D, Hosein I, Looker DN (1999) All Wales surveillance of methicillin-resistant Staphylococcus aureus (MRSA): the first year’s results. J Hosp Infect 41:173–179
Morgan M, Evans-Williams D, Salmon R, Hosein I, Looker DN, Howard A (2000) The population impact of MRSA in a country: the national survey of MRSA in Wales, 1997. J Hosp Infect 44:227–239. doi:10.1053/jhin.1999.0695
MRSA-net (2014) Was ist der Unterschied zwischen Infektion und Besiedlung (Kolonisation)? http://www.mrsa-net.nl/de/personal/mrsa-allgemein-personal/definitionen-personal/460-was-ist-der-unterschied-zwischen-infektion-und-besiedlung-kolonisation. Accessed 14 Jan 2015
Nishikawa M et al (2009) Screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission to a geriatric hospital. Arch Gerontol Geriatr 49:242–245. doi:10.1016/j.archger.2008.08.012
Orendi J (2008) Health-care organisation, hospital-bed occupancy, and MRSA. Lancet Infect Dis 371:1401–1402. doi:10.1016/S0140-6736(08)60610-8
Pate AJ et al (2014) Antibiotics for methicillin-resistant Staphylococcus aureus skin and soft tissue infections: the challenge of outpatient therapy. Am J Emerg Med 32:135–138. doi:10.1016/j.ajem.2013.10.026
Peacock SJ, de Silva I, Lowy FD (2001) What determines nasal carriage of Staphylococcus aureus? Microbiology 9:605–610
Rink L, Kruse A, Haase H (2012) Immunologie für Einsteiger. Springer, Heidelberg
Sabuncu E et al. (2009) Significant Reduction of Antibiotic Use in the Community after a Nationwide Campaign in France, 2002–2007 PLoS Med 6:e1000084 doi:10.1371/journal.pmed.1000084
Simor AE, Ofner-Agostini M, Paton S, McGeer A, Loeb M, Bryce E, Mulvey M (2005) Canadian Nosocomial Infection Surveillance Program. 2005. Clinical and epidemiologic features of methicillin-resistant Staphylococcus aureus in elderly hospitalized patients Infect Control Hosp Epidemiol 26:838–841
Steindorff MM (2011) Untersuchungen zur Schleimhautbesiedlung durch Staphylococcus aureus und Identifizierung von Adhäsions-Inhibitoren mit einem neu entwickelten Hochdurchsatz-Screeningverfahren. Technische Universität Braunschweig, Fakultät für Lebenswissenschaften. Dissertation
Thüringer Landesamt für Verbraucherschutz (2012) MRE Netzwerk Thüringen. Jahresbericht 2012 über meldepflichtige MRSA-Nachweise in Blutkultur und Liquor gemäß § 7 Abschnitt 1 Satz 1 Infektionsschutzgesetz. (IfSG). https://www.thueringen.de/imperia/md/content/tllv/medizinaluntersuchung/mrenetzwerke/jahresbericht_mrsa_2012_finalversion.pdf. Accessed 28 Nov 2014
Unverricht H (2013) Isolierungsmaßnahmen. In: Dülligen M, Kirov A, Unverricht H (eds) Hygiene und medizinische Mikrobiologie, vol 6. Schattauer, Stuttgart, pp 242–256
van Belkum A et al (2007) The role of human innate immune factors in nasal colonization by Staphylococcus aureus. Microbes Infect 9:1471–1477
von Eiff C, Becker K, Machka K, Stammer H, Peters G (2001) Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 344:11–16
Acknowledgments
This research was conducted within the framework of the InnoMedTec project (no. 100098212). We would like to thank the European Social Funds of Germany and the state government of Saxony for funding.
We would also like to thank the reviewers for the feedback.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bellmann, M., Rößler, M., Scheibe, M. et al. Methicillin-resistant Staphylococcus aureus in German hospitals: individual- and regional-level predictors. J Public Health 23, 103–109 (2015). https://doi.org/10.1007/s10389-015-0660-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10389-015-0660-0