Control of Methicillin-Resistant Staphylococcus aureus Outbreaks
Methicillin-resistant Staphylococcus aureus (MRSA) is a term used to describe any strain of Staphylococcus aureus that shows resistance to methicillin, thus implying resistance to still-used isoxazolyl penicillins such as flucloxacillin and oxacillin. There are many different strains of MRSA, and one or several may be found in an intensive therapy unit (ITU). Various reasons are put forward for wishing to limit the spread of these organisms. Most convincing is that the spectrum of an empirical antibiotic treatment regime may fail to cover MRSA unless it includes a glycopeptide such as vancomycin or teicoplanin. Another concern is that we are compelled to use what is effectively our last option when we treat MRSA with a glycopeptide. Although it is usually possible to find some alternative drugs active against an MRSA, they tend to be infrequently used agents and there are no general principles of susceptibility to guide empiric therapy. The emergence of glycopeptide-resistant MRSA would undermine the whole of empiric antibiotic treatment and would be of major importance in areas such as the ITU. The recognition in recent years of MRSA with reduced sensitivity to glycopeptides and of enterococci that are frankly resistant shows this concern to be more than just theoretical. A further reason given for needing to control MRSA is that in most cases a patient with an MRSA will have acquired it while in hospital. Clearly, the MRSA will be only one of a wide range of organisms the patient will have acquired during a hospital stay. However, perhaps because they are readily identified and tend to be reported as though they were a single organism, MRSA have acquired a high profile and have entered the public consciousness. Fear of litigation therefore provides another reason for attempting control.
KeywordsStaphylococcus Aureus Infect Control Hosp Anterior Nare Intensive Therapy Unit Direct Physical Contact
Unable to display preview. Download preview PDF.
- 6.Working Party of the Hospital Infection Society and British Society for Antimicrobial Chemotherapy (1986) Guidelines for the control of epidemic methicillin-resistant Staphylococcus aureus. J Hosp Infect 7: 193–201Google Scholar
- 7.Vincent JL, Bihari DJ, Suter PM et al (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care ( EPIC) study. JAMA 274: 639–644Google Scholar
- 8.Working Party of the BSAC, HIS and ICNA (1998) Revised guidelines for the control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 39: 253–290Google Scholar
- 11.Farrington M, Redpath C, Trundle C et al (1998) Winning the battle but losing the war: methicillin-resistant Staphylococcus aureus ( MRSA) infection at a teaching hospital. Q J Med 91: 539–548Google Scholar
- 16.Clark B, Fryer J, Emslie A et al (1999) Why is something as important as screening for MRSA so difficult to achieve? P589 presented the 21st International Congress of Chemotherapy, July 4–7, BirminghamGoogle Scholar
- 19.Vanderbroucke-Grauls CM (1993) Control of methicillin-resistant Staphyloocccus aureus in the Netherlands. In: Coello R, Casewell MW (eds) Methicillin-resistant Staphylococcus aureus. Wells, Kent, pp 87–106Google Scholar
- 28.Hare R, Thomas CGA (1956) The transmission of Staphylococcus aureus. Br Med J ií: 840–846Google Scholar
- 33.Price DJE, Sleigh JD (1970) Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet ii: 1213–1215Google Scholar