MRSA Conference - Woodbridge

From left to right: Dr. Bresnitz, Suzanne Lutwick (Hospital Infections Project Co-Director), Dr. Kreiswirth, Dr. Venezia, Dr. Lowy, and Dr. Karchmer.

Methicillin resistant Staphylococcus aureus (MRSA) causes more hospital-acquired infections than any other organism. Now, ominously, it is appearing in the community as well as in hospitals. The community MRSA has clinical and microbiological features that are unlike the hospital version. This emergence poses new challenges for healthcare professionals both in the hospital and in the community.

On June 20, 2003, PHRI brought together nationally recognized experts in the fields of infectious diseases, infection control, and microbiology to provide up to date information to 175 healthcare professionals to help them deal with this emerging pathogen. The symposium was held at the Woodbridge Hilton in Woodbridge, New Jersey.

The Infectious Disease Society of New Jersey and the Northern New Jersey and Southern New Jersey chapters of the Association for Professionals in Infection Control and Epidemiology promoted the symposium to their members. Funding support was provided by Hoffman-LaRoche Inc., the F.M. Kirby Foundation, and the Graham Frost Memorial Fund.

Dr. Eddy Bresnitz, the New Jersey State Epidemiologist and Assistant Commissioner of Health, moderated the morning session. The distinguished speakers were:

• Dr. Frank Lowy, Columbia University College of Physicians and Surgeons.
  
• Dr. Scott Fridkin, Centers for Disease Control and Prevention.
  
• Dr. Richard J. Venezia, University of Maryland School of Medicine.
  
• Dr. Tobi Karchmer, Wake Forest University Health Systems.
  

Dr. Lowy, who is Professor of Medicine and Pathology at Columbia, presented a lecture on the pathogenesis of Staphylococcus aureus. His presentation was an extremely comprehensive discussion of the S. aureus genome, mechanisms of resistance and the relevance of specific genetic markers as they relate to nosocomial versus community onset strains. This talk was very important in that it set the scientific tone for the symposium.

Dr. Fridkin

Dr. Fridkin, a Medical Epidemiologist at CDC's National Center for Infectious Diseases, presented a talk titled 'Evolving Epidemiology of Community-Associated MRSA.' He discussed the changing trends observed in the prevalence of MRSA in the USA and focused on the need to reassess the MRSA that is found within the hospital setting. He detailed the chronology of reports of community onset MRSA and cautioned the audience that to date the literature has deficiencies related to how community onset MRSA is defined, and that the methodology has primarily relied on medical records for gathering risk factor data. This methodology neglects to take into consideration many of the potential community exposures that could influence the number of cases being identified. He concluded by presenting data from a large well-controlled multi-state prospective study that evaluated the epidemiology of community associated MRSA. Based on the data available, it appears that MRSA is continuing to increase and emerge outside traditional settings and we must be prepared to observe continual change in the disease epidemiology as the community strains proliferate.

Dr. Venezia, Director of Microbiology at the University of Maryland School of Medicine, focused on two specific resistance issues: the emergence of extended spectrum beta lactamase resistance; and the increasing amount of quinolone resistance in S. aureus. He explained the resistance mechanisms and then went on to demonstrate how in these two particular issues, antibiotic usage patterns play a major role. His talk was important because it emphasized the need for a multi-step approach to controlling emerging resistance patterns. Of particular interest for the attendees was discussion of the economic benefits that can be derived from aggressive antibiotic control practices.

Dr. Karchmer, Associate Professor of Infectious Diseases and Hospital Epidemiologist at Wake Forest University Health Systems, centered her presentation on the infection control implications of MRSA in the hospital setting. Her discussion revolved around how MRSA is acquired, description of, the risk factors associated with acquisition and an overview of the outcomes associated with MRSA infection. She used a study at her own facility to demonstrate the fine points involved in using the CDC's contact isolation precautions, making the participants aware of some of the pitfalls that can occur when patients are colonized and remain undetected in the hospital environment. She discussed control measures, including the impact of antibiotic management and ongoing surveillance for MRSA. This talk was a strong reinforcement to attendees controlling the spread of MRSA in the hospital requires an approach that is aggressive, multifaceted and relentless.

In the afternoon, Dr. Barry Kreiswirth, PHRI Hospital Infections Program Co-Director, moderated a panel to discuss why MRSA is emerging in the community and how New Jersey physicians should address the issues. Dr. Lowy, Dr. Peter Wenger of the University of Medicine and Dentistry of New Jersey, Dr. Henry Fraimhow of Cooper Health System, and Dr. Venezia were panelists for this forum. Dr. Kreiswirth set the stage for the panel by presenting data to explain why we are viewing the changes in S. aureus resistance. He presented up to date information on the different clones that PHRI has observed in New Jersey and New York cases. The discussion was opened to the audience to ask questions.




Symposium Attendees

The occupations of the 175 attendees break down into the following categories:

• 34.3% infection control professionals
  
• 14.5% microbiologists, including laboratory directors and laboratory technicians
  
• 13% nursing professionals not designated infection control
  
• 10% physicians, including community physicians, infectious disease specialists, internists, and university affiliated faculty
  
• 7.2% employed in public health or research
  
• 4% employed in the pharmaceutical industry, including members of scientific research teams as well as the clinical liaison personnel;
  

The majority of the participants (70.5%) are employed in acute care hospitals. However, there were also representatives from rehabilitation centers, chronic care facilities, nursing homes, psychiatric centers, public health agencies, and home care agencies. The New Jersey Department of Health and Senior Services was represented, as were six major pharmaceutical companies. Ninety-six percent of the attendees were from new Jersey.