MRSA - surveillance, rapid screening and hospital hygiene

The origins and future perspectives about meticillin-resistant Staphylococcus aureus (MRSA) are outlined in a Review in this week's issue of The Lancet.

S aureus meticillin resistance was first reported in the early 1960s, but widespread resistance has only become a major public-health problem in recent decades. Hajo Grundmann (Projectleader of the European Antimicrobial Resistance Surveillance System) and colleagues outline the history and microbiological and genetic characteristics of MRSA; for example, the bacterium readily acquires resistance against all classes of antibiotics by one of two mechanisms: mutation of an existing bacterial gene or horizontal transfer of a resistance gene from another bacterium.

Also discussed are key issues such as the case for screening programmes to identify carriers of MRSA, and how community acquired MRSA - in addition to the management of MRSA in hospital settings - remains a critical public-health priority.

Professor Grundmann concludes: "If the new community-acquired MRSA clones are, however, sufficient to sustain endemic levels by transmission in the community, the MRSA situation in hospitals, which still remains out of control in many countries, could potentially become explosive. The onus is therefore on health-care authorities to develop not only surveillance systems that are able to monitor the clonal dynamics of MRSA over wide geographical areas, but also to provide the resources for early recognition of MRSA carriers through rapid screening. Hospital staff have a responsibility to implement, maintain, and adhere to strict contact precautions, should hospitals remain places where citizens can aspire to positive health-care outcomes with confidence."

A Comment highlights the dangers of ignoring community-aquired MRSA in preference to hospital-acquired MRSA. Professor Ian Gould (Aberdeen Royal Infirmary, UK) warns that outbreaks of MRSA in the community are occurring independantly from hospitals - not just taken from hospitals into the community - yet very little is being done to control the outbreaks in affected communities. He warns that this lack of action threatens to spoil any success in controlling hospital-acquired MRSA and asks: "Why are we doing nothing in the comunity, to contain this latest bout of staphylococcal agression, never mind that it might help us in our battle with hospital aquired MRSA." He concludes: "if we are going to act we should do it now before what is currently sporadic illness(and probably sporadic carriage) becomes epidemic and commonly used antibiotics become useless."

Review Professor Hajo Grundmann, Project Leader and Scientific Coordinator of the European Antimicrobial Resistance Surveillance System, Center for Infectious Disease Epidemiology, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9 PO BOX 1 3720 BA Bilthoven, The Netherlands

Comment Dr Ian M Gould, Dept of medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2AN, UK; T) +44 (0)1224 554954