MRSA burden and interventions
Introduction
Meticillin-resistant Staphylococcus aureus (MRSA) infections are a problem across the whole health economy, and have been shown to be associated with a poorer outcome than similar infections caused by meticillin-sensitive strains of S. aureus.1, 2 In England, the number of bloodstream infections rose during the 1990s, and in 2000 the Health Minister announced that reporting of certain healthcare-associated infections, which included MRSA bacteraemia, would become mandatory from April 2001.
The MRSA bacteraemia rates in England peaked in 2003 (Fig. 1). The Department of Health (DH) consequently set a target of reducing the number of MRSA bloodstream infections occurring in hospitals. The target was set at a 50% reduction in the national total of MRSA bacteraemias by 2008, against the 2003/04 baseline.
In 2005 the DH produced guidance for hospitals, which took the form of care bundles, entitled: Saving lives: reducing infection, delivering clean and safe care.3 These high-impact interventions initially focused on infection-control measures for central venous catheter care, peripheral intravenous catheter care, renal dialysis catheter care, urinary catheter care, MRSA screening, and a care bundle for ventilated patients. The introduction of the target and the high-impact interventions, and the support given to hospitals in England by the DH, resulted in a year-on-year decrease in the number of MRSA bloodstream infections (Fig. 2). The decrease was initially small, but increased rapidly during the period 2006-2008.4
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Antibiotic prescribing interventions
While infection-control interventions are necessary, interventions involving changes in antibiotic prescribing practices are also important. It is widely recognised that the use of antibiotics provokes collateral damage, i.e. colonisation and subsequent infection with antibiotic- or multidrug-resistant strains of bacteria.
Numerous studies have investigated the antibiotics patients received prior to developing an MRSA infection. Paterson reviewed the literature and concluded that the
Intervention study at the Queen Elizabeth Hospital, King's Lynn
Based on the above-mentioned studies and the SHEA recommendations, an educational intervention study discouraging the use of both intravenous ciprofloxacin and third-generation cephalosporins was performed at the Queen Elizabeth Hospital, King's Lynn National Health Service Trust.13 In this interrupted time series study, the time data were analysed by segmented regression.
An 80% decrease in intravenous ciprofloxacin use, together with a 75% decrease in third-generation cephalosporin use,
Antibiotic prescribing guidance
In 2007 the DH introduced a second clinical target – the reduction of Clostridium difficile infections – together with guidance on antibiotic prescribing, in which the use of fluoroquinolones and cephalosporins was discouraged. It is likely that this guidance, which Cooke and Holmes termed the ‘missing care-bundle’ was at least in part responsible for an accelerated decrease in MRSA bloodstream isolates, and the country meeting the 50% reduction target.14
References (14)
- et al.
Effect of reduction in ciprofloxacin use on prevalence of meticillin-resistant Staphylococcus aureus rates within individual units of a tertiary care hospital
J Hosp Infect
(2006) - et al.
Modification in prescribing practices for third-generation cephalosporins and ciprofloxacin is associated with a reduction in meticillin-resistant Staphylococcus aureus bacteraemia rate
J Hosp Infect
(2008) - et al.
The missing care bundle: antibiotic prescribing in hospitals
Int J Antimicrob Agents
(2007) - et al.
Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis
Clin Infect Dis
(2003) - et al.
Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis
Med J Aust
(2001) - National Health Service. Clean, safe care: reducing MRSA and other healthcare associated infections. Department of...
- HPA. Staphylococcus aureus bacteraemia past publications (mandatory surveillance). Health Protection Agency....
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2014, Journal of Hospital InfectionCitation Excerpt :One of the most successful reductions in MRSA bacteraemia has been achieved in the UK. The campaign was strongly outcome-based and focused on achieving a target of 50% reduction within five years, arbitrarily set by the political establishment.23 Such an approach, as well as the strategy methods adopted, were highly compatible with the UK's low UAI/high MAS national culture.
Funding: LL received an honorarium for writing this article from Wyeth Pharmaceuticals.
Competing interests: LL has received unrestricted educational grants from Aventis, Bayer, GlaxoSmithKline and Wyeth, and honoraria for lectures from Bayer and Bard.
Ethics approval: Not required.