MRSA is everybody's business, not only that of epidemiologists and politicians, the Lancet

Main Category: MRSA / Drug Resistance
Article Date: 22 Sep 2005 - 8:00 PDT

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MRSA (meticllin-resistant Staphylococcus aureus) is everybody's business, not only that of hospital epidemiologists and a few opinion leaders, conclude experts contributing to a global debate in the October issue of The Lancet Infectious Diseases.

The debate brings together viewpoints from across the world as MRSA experts share the challenges that individual countries face in trying to control the spread of MRSA. Despite extensive research, "uncertainty remains about the best approach to prevent and control this worldwide plague", conclude coauthors Stephan Harbarth and Didier Pittet from the Infection Control Program, University of Geneva, Switzerland.

Countries such as Finland, Denmark, and the Netherlands are some of the most successful at controlling MRSA. Finland's strict procedures include screening of patients and staff, strictly enforced contact precautions, and judicious use of antibiotics. They also have facilities to allow rapid identification and treatment of MRSA. Similarly, the Netherlands' "search, isolate, and destroy" strategy has allowed them to retain one of the lowest incidences of MRSA in Europe.

This approach is in stark contrast to countries like Japan, which, according to Harbarth and Pittet, "has more or less ignored this public-health problem for a long time, resulting in some of the highest MRSA incidence rates worldwide". "No mechanism to identify patients within hospitals currently exists in Japan", admits Satoshi Hori, (Department of Infection Control Science, Juntendo University, Japan) author of Japan's contribution to the debate. Antibiotic use in Japan has been strongly influenced by their pharmaceutical reimbursement system, which provides financial incentives for physicians to prescribe antibiotics. "This has only recently been adequately addressed at the policy level", say Harbarth and Pittet.

In the UK, the changing environment within hospitals has hampered implementation of effective MRSA control measures. Reduced numbers of hospital beds have resulted in increased inter-ward transfers of patients, which increase the spread of MRSA. Reduced lengths of stay have resulted in patients being discharged before their MRSA infection becomes apparent. "Inter-city transfer of patients has encouraged national MRSA spread", says Barry Cookson, of the Health Protection Agency.

However, MSRA is not only a problem within hospitals. The emergence of community-acquired MRSA is presenting a new challenge in many countries. This is a problem in Western Australia for example, where despite low levels of hospital MRSA infections, there is a high rate of community-acquired MRSA. Western Australia is now considering employing their effective hospital "search and destroy" policy within the community setting.

Harbarth and Pittet comment: "The situation with MRSA might become comparable to that observed for other infectious problems such as severe acute respiratory syndrome and mad cow disease--economic and political pressure may contribute to compliance and uniformity in control measures and to allocation of resources to improve patients safety."

Contact:

Dr Stephan Harbarth, Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, 1211 Geneva 14, Switzerland

Professor Didier Pittet, Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, 1211 Geneva 14, Switzerland

UK contributor: Dr Barry Cookson, Director of the Laboratory of Healthcare Associated Infection, Health Protection Agency, London, UK

Japanese contributor: Dr Satoshi Hori, Senior Lecturer, Department of Infection Control Science, Juntendo University, Graduate School of Medicine, Tokyo, Japan

Finnish contributor: Dr Jaana Vuopio-Varkila, Chief Physician, Hospital Bacteria Laboratory, Department of Bacterial and Inflammatory Diseases, National Public Health Institute, 00300 Helsinki, Finland

Dutch contributor: Dr Christina Vandenbroucke-Grauls, Department of Medical microbiology, academic Medical Centre, and Department of Medical Microbiology and Infection Control, VU University Medical Centre, Amsterdam, Netherlands

Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
http://www.thelancet.com

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