Reporting of Severe Staphylococcus aureus Infections Effective July 1

Indiana Epidemiology Newsletter
May 2008

Jean Svendsen, RN, BS
ISDH Chief Nurse Consultant

Effective July 1, 2008, Indiana health care providers will be required to immediately report cases of severe Staphylococcus aureus infections in previously healthy people to local health departments (LHD). The LHDs will investigate these cases using case investigation forms provided by the Indiana State Department of Health (ISDH).

In response to political and public interest in methicillin-resistant Staphylococcus aureus (MRSA), the ISDH enacted a 90-day emergency rule requiring laboratory reporting of MRSA infections from January 1-March 30, 2008. A detailed report describing data from this surveillance will be posted in the near future on the ISDH Web site.

The laboratory surveillance data were consistent with what is already known about MRSA infections.  The laboratory data did not provide insight about several significant factors regarding the burden of MRSA infections. The study did not differentiate healthcare-acquired MRSA (HA-MRSA) from community-acquired MRSA (CA-MRSA), nor was severity of infection noted. Antimicrobial susceptibility patterns were not studied due to the low number of laboratories reporting. Additional resources would also be needed to sustain laboratory reporting.

The limitations of the laboratory surveillance data allowed for the development and implementation of a more useful way to study the burden of MRSA infections in Indiana. Most cases of MRSA infections identified in the laboratory surveillance data were skin and soft tissue infections, which are typically not life threatening, whereas invasive MRSA infections are life threatening.  While invasive HA-MRSA infections are typically already being addressed by health care professionals, most invasive CA-MRSA infections are not. These are the cases that are reported in the media and can cause concern. These issues can be addressed by specifically studying severe Staphylococcus aureus infections in the state while conserving public health resources.

Since severe infections can be caused by MRSA and methicillin-sensitive Staphylococcus aureus (MSSA), the reporting of severe Staphylococcus aureus in previously healthy people will allow for better data collection to:

  • Measure the burden and severity of staphylococcal infection
  • Provide information on antimicrobial susceptibility patterns
  • Identify populations at risk for severe infection
  • Provide information to formulate prevention and control measures
  • Utilize resources judiciously

The reporting rule, case investigation form, and detailed reporting instructions for health care providers and the LHDs will be posted on the ISDH Web site at by July 1, 2008.