Volume 188 - Issue 1
Methicillin-resistant Staphylococcus aureus in hospitals: time for a culture change
Authors: John K Ferguson and Helen Van Gessel
Med J Aust 2008; 188 (1): 61-64. || doi: 10.5694/j.1326-5377.2008.tb01516.x
Published online: 7 January 2008
Published online: 7 January 2008
To the Editor: The magnitude and distribution of the problem of health care-associated methicillin-resistant Staphylococcus aureus (MRSA) in Australia can be gauged from the report of a forum on MRSA control conducted at the Australasian Society for Infectious Diseases (ASID) in March 2007.1 This report contrasted approaches to control of health care-associated MRSA and quantified the population incidence rate of health care-associated MRSA bacteraemia across Australia from data derived from direct surveillance systems (Box). Reporting of MRSA infections is thought to be complete from all jurisdictions except Victoria and New South Wales. Figures for Victoria were extrapolated from accurate surveillance data representing 50%–60% of events. The degree of incompleteness of reporting in NSW could not be determined, and a range based on reports to NSW Health over 3 years was used. Overall morbidity of health care-associated MRSA in Australia is much higher, as only a minority of MRSA infections lead to bacteraemia.
The ASID report estimated that between 699 and 924 cases of bacteraemia would be prevented if other states and territories reduced their incidence of MRSA bacteraemia to that of Western Australia through implementation of more stringent infection control measures. The mortality of MRSA bacteraemia is 8%–50% (average, 29%).2 A recent study showed that more than half (59%) of such deaths were directly attributable to MRSA3 rather than other non-infective causes. These outcome proportions provide a minimum estimate of between 120 and 158 preventable deaths per annum in Australia directly caused by health care-associated MRSA — comparable to the annual South Australian road toll.
As identified recently in the Journal by Collignon and colleagues, there are significant structural barriers to achieving infection control — especially inadequate isolation resources and pressure on bed stock.4 Other dimensions of the MRSA problem include the high incidence of MRSA in many aged care facilities, the epidemic emergence of community strains of MRSA (best described in the recent report from WA on MRSA notification data up until 20025), the possibility of significant zoonotic reservoirs,6 and the role played by imprudent antibiotic use.
MRSA colonisation or infection needs to be made a nationally notifiable disease, with a system in place to enable typing of isolates. As in WA, such a system would enable more effective identification of MRSA carriers before hospital admission, the detection of emerging epidemic strains, and timely investigation of MRSA outbreaks occurring in community groups, such as in aged care facilities. Most importantly, all states and territories need to adopt, and provide resources for, consistent, stringent approaches to surveillance, prevention and control of health care-associated MRSA that are in keeping with internationally recommended approaches. Given the scale of preventable injury occurring in many states, MRSA control must be made one of the highest priorities for patient safety.
Relative burden of health care-associated MRSA morbidity across Australia1
References
- Ferguson JK. Healthcare-associated methicillin-resistant Staph. aureus (MRSA) control in Australia and New Zealand. Aust Infect Control 2007; 2: 60-66.
- Whitby M, McLaws ML, Berry G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001; 175: 264-267. 0_i1091918
- Shurland S, Zhan M, Bradham DD, Roghmann M. Comparison of mortality risk associated with bacteremia due to methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol 2007; 28: 273-279. 0_i1091920
- Collignon PJ, Grayson ML, Johnson PDR. Methicillin-resistant Staphylococcus aureus in hospitals: time for a culture change [editorial]. Med J Aust 2007; 187: 4-5. 0_i1091922
- Dailey L, Coombs GW, O’Brien FG, et al. Methicillin-resistant Staphylococcus aureus, Western Australia. Emerg Infect Dis 2005; 11: 1584-1590. 0_i1091924
- Juhász-Kaszanyitzky E, Jánosi S, Somogyi P, et al. MRSA transmission between cows and humans. Emerg Infect Dis 2007; 13: 630-632. 0_i1091927