Open Access Highly Accessed Research article

Successful reduction of hospital-acquired methicillin-resistant Staphylococcus aureus in a urology ward: a 10-year study

Manabu Tatokoro, Kazunori Kihara, Hitoshi Masuda*, Masaya Ito, Soichiro Yoshida, Toshiki Kijima, Minato Yokoyama, Kazutaka Saito, Fumitaka Koga, Satoru Kawakami and Yasuhisa Fujii

Author Affiliations

Department of Urology, Tokyo Medical and Dental University Graduate School, 1-5-45, Yushima, Bunkyo, Tokyo 113-8519, Japan

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BMC Urology 2013, 13:35  doi:10.1186/1471-2490-13-35

Published: 18 July 2013



To eradicate hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a stepwise infection control strategy that includes an avoidance of antimicrobial prophylaxis (AMP) based on surgical wound classification and an improvement in operative procedures in gasless single-port urologic surgery.


The study was conducted at an 801-bed university hospital. Since 2001, in the urology ward, we have introduced the stepwise infection control strategy. In 2007, surveillance cultures for MRSA in all urological patients were commenced. The annual incidence of MRSA was calculated as a total number of newly identified MRSA cases per 1,000 patient days. Trend analysis was performed using a Poisson regression.


Over the study period, 139,866 patients, including 10,201 urology patients, were admitted to our hospital. Of these patients, 3,719 patients, including 134 ones in the urology ward, were diagnosed with MRSA throughout the entire hospital. Although the incidence of MRSA increased throughout the entire hospital (p = 0.002), it decreased significantly in the urology ward (p < 0.0001). Of the 134 cases, 45 (33.6%) were classified as “imported,” and 89 (66.4%) as “acquired.” In the urology ward, the incidence of acquired MRSA decreased significantly over time (p < 0.0001), whereas the incidence of imported MRSA did not change over time (p = 0.66). A significant decrease (p < 0.0001) in the incidence of clinically significant MRSA infection over time was found.


Stepwise infection control strategy that includes a reduction or avoidance of antimicrobial prophylaxis in minimally invasive surgery can contribute to a reduction in hospital-acquired MRSA.

Trial registration

Current study has approved by the institutional ethical review board (No.1141).

Antibiotic prophylaxis; Hospital infections; Infection control; Methicillin-resistant Staphylococcus aureus; Minimally invasive surgery