Newborn dies from MRSA infection, UK

Main Category: MRSA / Drug Resistance
Article Date: 22 Mar 2005 - 11:00 PDT

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Luke Day died when he was just 36 hours old from the superbug MRSA at Ipswich Hospital, UK on 2nd February. His parents initially refused to sign his death certificate because it had no mention of MRSA. The coroner eventually did include (in the death certificate) MRSA infection as the cause of death.

Many are asking why the mention of MRSA in the death certificate was omitted in the first place. According to 'official' statistics, only one in 2,000 newborn deaths in the UK are due to MRSA infection. Are there any more death certificates out there that 'omitted' MRSA as the cause of death.

Luke was born at Ipswich Hospital's maternity unit and died the following day.

Health experts are investigating the source of the superbug - so far they have found nothing.

1. What is MRSA?

MRSA stands for methicillin-resistant Staphylococcus aureus. It is a strain of Staphylococcus aureus, bacteria that can cause infections. MRSA has become resistant to methicillin, a powerful antibiotic drug, hence its name.

However, the term is slightly misleading because MRSA is also resistant to other powerful antibiotics. In fact, around 40% of cases of Staphylococcus aureus in the UK are resistant to methicillin and other antibiotics.

2. What does MRSA do?

MRSA does not normally pose a risk to healthy adults or children. In fact, around one third of people are thought to carry it in their noses or on their skin, often referred to as being 'colonised'. But those who are healthy and carry it do not have any symptoms.

The bacteria only becomes a problem if the bacteria gets into the body for example through burns, surgical wounds, or the entry point for catheters or intravenous drips.

MRSA and SA can cause boils and abscesses, the skin infection impetigo, septic wounds, heart-valve infections, food poisoning, pneumonia and toxic shock syndrome.

3. How is MRSA passed on?

MRSA is mainly passed on via the hands of healthcare workers, from surfaces to patients or between patients.

4. What measures can stop MRSA?

There is no one simple solution to stop MRSA.

One of the most important measures, though, is getting healthcare staff to wash their hands more frequently. International studies show that infection rates are reduced by between 10% and 50% if staff regularly clean their hands.

Other measures include:

-- changing dressings using disposable gloves;

-- isolating infected patients;

-- pre-planning visits of infected patients to other departments;

-- placing infected patients in the last slot for operations or X-rays.

5. How many people pick up MRSA in hospitals?

There were 7,647 MRSA bloodstream infections from 2003 to 2004, an increase of 3.6% in England over the last year.

But this represents only part of the total picture. There are also, for example, surgical site infections, ulcers and other wound infections. However, the Health Protection Agency does not currently collect these figures.

6. How do MRSA rates in the UK compare to those in other countries?

The prevalence of hospital acquired infections and MRSA in hospitals varies widely within the EU.

The rate of HCAI is 9% in England compared with 7% in the Netherlands, and 8% in Spain and Denmark. Rates in France are between 6-10% and 5-10% in the United States.

There has been a significant increase of MRSA in Austria, Belgium, Germany and the UK during 1998-2003. The rate of MRSA increased most quickly in Germany (8% to 18% and Austria (5% to 14%). The rate in the UK is stable following a fast rise of MRSA in the 1990s.

There are countries with very low rates of MRSA, such as the Netherlands, which has the lowest rate of MRSA in Europe. Earlier this year, Chief Medical Officer Sir Liam Donaldson visited the country on a fact-finding mission.

MRSA has become more of a problem in the UK for a number of interrelated reasons. These include the fact that the strains responsible for most infections in the UK are well adapted to spreading between patients. Also, we have a higher proportion of patients who are susceptible to this infection.

7. How many have patients have died of MRSA in England?

National Audit Office (NAO) estimates there have been 5,000 deaths a year attributable to hospital-acquired infections.

However, this figure has to be treated with caution because it is based on US figures from the 1980s.

The Office for National Statistics (ONS) study found that MRSA was mentioned as a contributory factor in 800 death certificates in 2002.

But it is worth remembering that some 70 million people went to hospital from 2002 to 2003 including 11.4 million in-patients.

And there were 539,200 deaths in England and Wales in 2003 from all causes.

8. How much does MRSA cost the NHS?

It is estimated that 100,000 people a year pick up some form of infection while in hospital, costing around £1 billion a year.

9. Why can't the Government provide better statistics on MRSA deaths?

Patients who die with MRSA are often already seriously ill with another medical condition. Therefore, it is difficult to say with any certainty if they would have recovered if they had not caught MRSA.

Death certificates ask for the 'underlying cause of death'. It is up to the doctor how many conditions, other than the underlying cause, he or she thinks should be recorded. MRSA may contribute to death, but it is unlikely to be the first event in the sequence.

However, the Chief Medical Officer's report Winning Ways called for an audit of deaths from healthcare associated infections which will be introduced from 2006, and therefore, better data should be available in the future.

Proposed changes should enable death certification to be done electronically. Information from patient records will be linked electronically to the registration, with the consent of a family member, registering the death. This will help identify cases where MRSA or other hospital acquired infections played a role.

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