This review examines the risk of infection in carriers of MRSA, and the outcomes of MRSA infection occurring in intensive care (ICU) patients in terms of mortality, length of stay and medical costs, by comparison to infection caused by sensitive strains. In the ICU, the risk of infection in MRSA carriers is much higher than in other wards, and averages 30 % to 50 % of carriers; it may reach 2/3 of carriers in specific high-risk groups. This risk is related to the intensity of colonization, and inversely with the time to acquisition; antibiotic also fosters infection by exerting a selective pressure while eliminating susceptible S.aureus strains. Although the attributable mortality associated with acquired MRSA infection is quite high (about 30 %), it does not appear superior to that incurred by MSSA infection (to the possible exception of infections occurring after major surgery), and the consequences of both infection in terms of length of stay and costs appear similar. Despite the lack of increased severity in comparison to infection caused by susceptible strains, the human cost and economic burden of MRSA acquisition is immense, when considering that MRSA acquisition in the ICU is mostly secondary to cross-transmission and is potentially avoidable. © 2002 Éditions scientifiques et médicales Elsevier SAS.
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