Methicillin-resistant Staphylococcus aureus infections: it's time to get tough.

In 1982 Boyce and Causey reported in Infection Control the results of a survey conducted to determine the magnitude of methicillin-resistant Staphylococcus aureus (MRSA) infections in the United States. From responses to that questionnaire, it was apparent that the number of hospitals reporting MRSA dramatically increased from 1975 to 1980, that larger hospitals were encountering the problem more frequently than smaller ones, and that it was more common in university and federal hospitals than community, community teaching, and municipal hospitals. In this issue of Infection Control, Preheim and colleagues have determined that the problem has not abated, at least in the Federal Veterans Administration system. Since 1980, the hospitals identifying the problem have continued to increase. This increase is geographically widespread and involves hospitals of all sizes. Federal hospitals in general have a high incidence of nosocomial infections compared with community hospitals. The reasons for this are not absolutely known but are probably multiple. VA hospitals provide care for primarily indigent patients, a group that may delay therapy longer and have more severe underlying conditions. The patients are frequently older and stay somewhat longer than those in other hospitals. Fixed hospital budgets often produce short-