Since 1 July 2009 in accordance with the statuary order based on the German law for
infectious diseases (Infektionsschutzgesetz), MRSA in blood and liquor must be notified to the public health authorities. The aim of extension of the notification to report is to improve the surveillance of
nosocomial infections and the prevention of nosocomial MRSA
infections. In addition to MRSA detection, data on symptoms and risk factors, e.g., medical devices, must also be reported. In this report, data of bloodstream MRSA
infections in hospitals in Frankfurt/Main, Germany, for the first complete year (2010)were evaluated. In 2010, 58 MRSA-positive
bloodstream infections were reported by the 17 hospitals in Frankfurt to the health protection authorities, i.e., 0.0360 MRSA/1,000 patient-days (range: 0- 0.109/1,000 patient-days). However, 10 of these
infections initially had not been reported to the public health department in charge for the hospitals, but to the health departments according to the patient's addresses. Although most of the
infections were reported from large hospitals (>100,000 patient-days/year), the highest incidences (0.0416/1,000 patient-days) were reported from small hospitals (<50,000 patient-days/year). Of the blood specimen, 13 (22.4%) were drawn on the first day of
hospital stay, thus, indicating an
imported infection. While 90% of the patients with MRSA in the bloodstream suffered from
fever, 80% had
sepsis and 34.5% suffered from
pneumonia. Medical devices, such as
central venous catheters and PEG, were reported from 60% of the patients. In the MRE network Rhine-Main region, the public health authorities asked for some more detailed information, such as risk factors for MRSA colonization (history for MRSA, recent
hospital stay or
antibiotic therapy, skin disorders, dialysis, residence in a retirements home), and for screening results as well as for the MRSA management, i.e., isolation of the patient and, if necessary, the contact patient. In 55% of the cases, the patients were identified by the clinics themselves as being patients with MRSA risk factors, mainly because of a history of MRSA (29%), recent
hospital stay (71%), and
antibiotic therapy during the last 6 months (52%). Screening was performed in 31 (53%) of the patients, most of them (71%) with positive MRSA nose swab. If the patients were screened, significantly fewer contact patients had to be screened and isolated later. Thus, to improve surveillance data on MRSA
bloodstream infections, the notification route to the public health authorities responsible for the clinic hosting the patient must be strictly obeyed in order to avoid underreporting und underassessment of
nosocomial infection. Although asking for clinical symptoms may be useful to validate the result in some cases, focus should be placed on risk factors and risk management, including screening and isolation. Only then can the aim of improving surveillance and reduction of nosocomial MRSA
infection be achieved.