Evaluation of California's Mandated Methicillin-Resistant Staphylococcus aureus Active Surveillance Testing for High Risk Patients at the University of California, San Francisco, 2009

During the last two decades, health care associated infections (HAI) especially antibiotic resistant infections have increased dramatically (Hidron AI, 2008). It has been estimated that HAI affects 1.7 million patients yearly in the United States, resulting in infection or death (Klevens RM E. J., 2007); more than half of HAI are due to antibiotic-resistant pathogens (Hidron AI, 2008). In 2008, the State of California enacted two Senate Bills (SB)---SB 158 [Chapter 294, Statutes of 2008] (Assembly, Bill SB 158, 2008) and SB 1058 [Chapter 296, Statutes of 2008] (Assembly, Bill SB 1058, 2008)---to "implement various measures relating to disease surveillance and prevention of HAI" following in the wake of SB 739 [Chapter 526, Statutes of 2006] (Assembly, Bill SB 739, 2006).;In late 2008, the new Active Surveillance Testing (AST) for methicillin-resistant Staphylococcus aureus (MRSA) (MRSA AST) program was implemented at the University of California, San Francisco (UCSF) Medical Center and Children's Hospital. We conducted an analysis and evaluation of how the MRSA demographics have changed and if the mandated bills have improved screening and identification of MRSA cases at UCSF. Analysis of the prospectively identified MRSA cases---colonized and infected---was used to identify demographic characteristics, risk factors and infection types for the patient population at UCSF during the 12 month period from January 1, 2009 to December 31, 2009. In 2009, there were 2,375 MRSA AST screens preformed, identifying 96 colonized patients, while 636 clinical isolates collected identified infected patients at UCSF. Of the 96 colonized patients, 90 patients had community-acquired MRSA (CA-MRSA) and 6 patients had hospital-acquired MRSA (HA-MRSA). Of the 636 infected patients, 553 patients had CA-MRSA infections and 83 had HA-MRSA infections. Skilled nursing transfers were considered the most prevalent risk group for CA-MRSA colonization and admission to an ICU was considered the most prevalent risk group for HA-MRSA colonization. The infection type classification was highly significant (p=0.0014) in predicting CA-MRSA and HA-MRSA infections and 364 (57.23%) of the total infections were classified as wound or soft tissue. Of the 26 patients identified as colonized and subsequently infected 15 (57.69%) were transferred from skilled nursing facilities. The most prevalent infection type classification for those colonized and subsequently infected was classified as "other" accounting for 14 (53.84%) of the infections from those patients previously colonized.