Nosocomial Transmission: Methicillin-Resistant Staphylococcus aureus (MRSA)

Part of the Statistics for Biology and Health book series (SBH)


Nosocomial, or hospital-acquired , infections are an important cause of morbidity and mortality in health-care settings. Within hospitals, we find a gathering of patients with a weakened immune system, who receive all kinds of treatment that may even further weaken host defense mechanisms and that may break natural barriers against pathogens by surgery or by inserting intravascular lines. In such circumstances, even microorganisms that are generally considered harmless may cause fulminate infections.


Severe Acute Respiratory Syndrome Rapid Diagnostic Test Hand Hygiene Transmission Route Diagnostic Delay 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Austin DJ, Bonten MJM, Weinstein RA et al. (1999) Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs. Proc Natl Acad Sci USA 96:6908–6913CrossRefGoogle Scholar
  2. Bergstrom CT, Lo M, Lipsitch M (2004) Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals. Proc Natl Acad Sci USA 101:13285–13290CrossRefGoogle Scholar
  3. Boldin B (2007) Relative effects of barrier precautions and topical antibiotics on nosocomial bacterial transmission: results of multi-compartment models. Bull Math Biol 69:2227–2248MathSciNetMATHCrossRefGoogle Scholar
  4. Bonten MJM, Slaughter S, Ambergen AW et al. (1998) The role of "colonization pressure" in the spread of vancomycin-resistant enterococci. An important infection control variable. Arch Intern Med 158:1127–1132CrossRefGoogle Scholar
  5. Bonten MJM, Austin DJ, Lipsitch M (2001) Understanding the spread of antibiotic resistant pathogens in hospitals: mathematical models as tools for control. Clin Infect Dis 33:1739–1746CrossRefGoogle Scholar
  6. Bootsma MCJ, Diekmann O, Bonten MJM (2006) Controlling methicillin-resistant Staphylococcus aureus: Quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci USA 103:5620–5625CrossRefGoogle Scholar
  7. Bootsma MCJ, Bonten MJM, Nijssen S et al. (2007) An algorithm to estimate the importance of bacterial acquisition routes in hospital settings. Am J Epidemiol 166:841–851CrossRefGoogle Scholar
  8. Cepeda JA, Whitehouse T, Cooper B et al. (2005) Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 365:295–304Google Scholar
  9. Cooper BS (2007) Confronting models with data. J Hosp Infect 65(S2):88–92Google Scholar
  10. Cooper BS, Lipsitch M (2004) The analysis of hospital infection data using hidden Markov models. Biostatistics 5:223–237MATHCrossRefGoogle Scholar
  11. Cooper BS, Medley GF, Scott GM (1999) Preliminary analysis of the transmission dynamics of nosocomial infections: stochastic and management effects. J Hosp Infect 43:131–147CrossRefGoogle Scholar
  12. Cooper BS, Stone SP, Kibbler CC et al. (2003) Systematic review of isolation policies in the hospital management of methicillin-resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technol Assessment 7:1–194Google Scholar
  13. Cooper BS, Medley GF, Stone SP et al. (2004) Methicillin-resistant Staphylococcus aureus in hospitals and the community: Stealth dynamics and control catastrophes. Proc Natl Acad Sci USA 101:10223–10228CrossRefGoogle Scholar
  14. D’Agata EM, Horn MA, Webb GF (2005) A mathematical model quantifying the impact of antibiotic exposure and other interventions on the endemic prevalence of vancomycin-resistant enterococci. J Infect Dis 192:2004–2011CrossRefGoogle Scholar
  15. Dancer SJ (2008) Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infec Dis 8:101–113CrossRefGoogle Scholar
  16. Drovandi CC, Pettitt AN (2008) Multivariate Markov process models for the transmission of methicillin-resistant Staphylococcus aureus in a hospital ward. Biometrics. doi: 10.1111/j.1541–0420. 2007. 00933.xGoogle Scholar
  17. Forrester M, Pettitt AN (2005) Use of stochastic epidemic modeling to quantify transmission rates of colonization with methicillin-resistant Staphylococcus aureus in an intensive care unit. Infect Control Hosp Epidemiol 26:598–606CrossRefGoogle Scholar
  18. Grundmann H, Hori S, Winter B et al. (2002) Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 185:481–488CrossRefGoogle Scholar
  19. Harbarth S, Masuet-Aumatell C, Schrenzel J et al. (2006) Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 10:R25CrossRefGoogle Scholar
  20. Klevens RM, Edwards JR, Richards CL Jr et al. (2007a) Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 122:160–166Google Scholar
  21. Klevens RM, Morrison MA, Nadle J et al. (2007b) Invasive methicillin-resistant Staphylococcus aureus infections in the United States. J Am Med Assoc 298:1763–1771CrossRefGoogle Scholar
  22. Kuulasma K (1982) The spatial general epidemic and locally dependent random graphs. J Appl Prob 19:745–758CrossRefGoogle Scholar
  23. Lipsitch M, Bergstrom CT, Levin BR (2000) The epidemiology of antibiotic resistance in hospitals: Paradoxes and prescriptions. Proc Natl Acad Sci USA 97:1938–1943CrossRefGoogle Scholar
  24. MacDonald G (1957) The epidemiology and control of malaria. Oxford University Press, LondonGoogle Scholar
  25. McBryde ES, Bradley LC, Whitby M et al. (2004) An investigation of contact transmission of methicillin-resistant Staphylococcus aureus. J Hosp Infect 58:104–108CrossRefGoogle Scholar
  26. McBryde ES, Pettitt AN, McEwain DLS (2007) A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit: Predicting the impact of interventions. J Theor Biol 245:470–481CrossRefGoogle Scholar
  27. Mikolajczyk RT, Sagel U, Bornemann R et al. (2007) A statistical method for estimating the proportion of cases resulting from cross-transmission of multi-resistant pathogens in an intensive care unit. J Hosp Infect 65:149–55CrossRefGoogle Scholar
  28. Nijssen S, Bonten MJM, Weinstein RA (2005) Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis 40:405–409CrossRefGoogle Scholar
  29. Nijssen S, Bootsma MCJ, Bonten,MJM (2006) Potential confounding in evaluating infection control interventions in hospital settings: changing antibiotic prescription. Clin Infect Dis 43:616–623CrossRefGoogle Scholar
  30. Pelupessy I, Bonten MJM, Diekmann O (2002) How to assess the relative importance of different colonization routes of pathogens within hospital settings. Proc Natl Acad Sci USA 99:5601–5605CrossRefGoogle Scholar
  31. Raboud J, Saskin R, Simor A et al. (2005) Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 26:607–615CrossRefGoogle Scholar
  32. Robotham JV, Jenkins DR, Medley GF (2006) Screening strategies in surveillance and control of methicillin-resistant Staphylococcus aureus (MRSA). Epidemiol Infect 13:1–15Google Scholar
  33. Robotham JV, Scarff CA, Jenkins DR et al. (2007) Meticillin-resistant Staphylococcus aureus (MRSA) in hospitals and the community: model predictions based on the UK situation. J Hosp Infect 65(S2):93–99CrossRefGoogle Scholar
  34. Ross R (1911) The prevention of malaria (2nd edition). Murray, LondonGoogle Scholar
  35. Sébille V, Valleron A-J (1997) A computer simulation model for the spread of nosocomial infections caused by multidrug-resistant pathogens. Comput Biomed Res 30:307–322CrossRefGoogle Scholar
  36. Sébille V, Cheuret S, Valleron A-J (1997) Modeling the spread of resistant nosocomial pathogens in an intensive-care unit. Infect Control Hosp Epidemiol 18:84–92CrossRefGoogle Scholar
  37. Smith DL, Dushoff J, Perencevich E et al. (2004) Persistent colonization and the spread of antibiotic resistance in nosocomial pathogens: resistance is a regional problem. Proc Natl Acad Sci USA 101:3709–3714CrossRefGoogle Scholar
  38. Smith DL, Levin SA, Laxminarayan R (2005) Strategic interactions in multi-institutional epidemics of antibiotic resistance. Proc Natl Acad Sci USA 102:3153–3158CrossRefGoogle Scholar
  39. Stewart FM, Antia R , Levin BR et al. (1998) The population genetics of antibiotic resistance. II: Analytic theory for sustained populations of bacteria in a community of hosts. Theor Popul Biol 53:152–165MATHCrossRefGoogle Scholar
  40. Stone PW, Hedblom EC, Murphy DM et al. (2005) The economic impact of infection control: Making the business case for increased infection control resources. Am J Infect Control 2005 33:542–547CrossRefGoogle Scholar
  41. Wenzel RP (2003) Prevention and Control of Nosocomial Infections, 4th edition, Lippincott Williams & Wilkins, ChicagoGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Medical Microbiology and the Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Faculty of Science, Department of MathematicsUtrecht UniversityUtrechtThe Netherlands
  3. 3.Julius Center for Health Sciences and Primary Care University Medical Center UtrechtUtrechtThe Netherlands

Personalised recommendations