Methicillin resistant staphylococcal infection: Clinical importance remains unevaluated

Abstract

EDITOR, - Though Georgia J Duckworth's article is a factually correct account about methicillin resistant Staphylococcus aureus,1 we do not agree with her recommendations. Firstly, the clinical importance of methicillin resistant S aureus has not been adequately documented as reports have tended to be of epidemics of carriage rather than infection.2 Also, when infection occurs, response to treatment with antibiotics is generally good.3 Methicillin resistant S aureus is not more virulent than methicillin sensitive S aureus,3 and many strains may be less virulent.2 Even when virulence is clinically important, multiple resistance in S aureus is no more important than that in other organisms, such as Pseudomonas or Enterococcus spp, which are often difficult to treat. There are no recommendations that these organisms should be screened for or eliminated. We do not know the importance of carriage in causing outbreaks of infection as information on infections (as opposed to carriage) is lacking. Evidence suggests that total elimination of methicillin resistant S aureus may not be possible even with rigorous intervention measures. 4 Such measures have also been shown to have little impact on endemic methicillin resistant S aureus.5 Finally, use of topical and systemic antibiotics to eliminate carriage is likely to cause additional bacterial resistance, thus further reducing the drugs available for use in clinically important infection. Indeed, changes in the use of antibiotics have been implicated in exacerbating or even causing the problem of methicillin resistant Saureus. Much remains to be done in evaluating the clinical importance of methicillin resistant S aureus and recommended control measures. In the interim, infection control should be based on strictly enforced measures to control hospital infection, encompassing good hygiene practices among staff, thorough cleaning of patients' environment, and a prescribing policy that restricts the use of antibiotics. 1. 1.↵1. Duckworth GJ .Diagnosis and management of methicillin resistant Staphylococcus aureus infection.BMJ 1993;307: 1049–52. [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Marples RR, 2. Reith S .Methicillin resistant Staphylococcus aureus in England and Wales.Communicable Disease Report Review 1993;2(3):R25–9. [OpenUrl][3] 3. 3.↵1. Meers PD, 2. Leong KY .The impact of methicillin and aminoglycoside resistant Staphylococcus aureus on the pattern of hospital acquired infection in an acute hospital.J Hosp Infect 1990;16: 231–9. [OpenUrl][4][PubMed][5] 4. 4.↵1. Cohen SH, 2. Morita MM, 3. Bradford M .A seven year experience with methicillin resistant Staphylococcus aureus.Am J Med 1991;91 (suppl 3B):233–7S. [OpenUrl][6][CrossRef][7][PubMed][8][Web of Science][9] 5. 5.↵1. Barrett SP, 2. Teare EL, 3. Sage R .Methicillin resistant Staphylococcus aureus in three adjacent health districts of south-east England 1986–91.J Hosp Infect 1993;24: 313–25. [OpenUrl][10][CrossRef][11][PubMed][12][Web of Science][13] # Infection spreads between hospitals {#article-title-7} EDITOR, … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DDuckworth%26rft.auinit1%253DG%2BJ%26rft.volume%253D307%26rft.issue%253D6911%26rft.spage%253D1049%26rft.epage%253D1052%26rft.atitle%253DDiagnosis%2Band%2Bmanagement%2Bof%2Bmethicillin%2Bresistant%2BStaphylococcus%2Baureus%2Binfection.%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.307.6911.1049%26rft_id%253Dinfo%253Apmid%252F8251781%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=PDF&journalCode=bmj&resid=307/6911/1049&atom=%2Fbmj%2F308%2F6920%2F57.2.atom [3]: {openurl}?query=rft.jtitle%253DCommunicable%2BDisease%2BReport%2BReview%26rft.volume%253D2%26rft.issue%253D3%26rft.spage%253D25R%26rft.atitle%253DMETHICILLIN%2BRESISTANT%2BSTAPHYLOCOCCUS%2BAUREUS%2BIN%2BENGLAND%2BAND%2BWALES.%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: {openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2Bhospital%2Binfection%26rft.stitle%253DJ%2BHosp%2BInfect%26rft.aulast%253DMeers%26rft.auinit1%253DP.%2BD.%26rft.volume%253D16%26rft.issue%253D3%26rft.spage%253D231%26rft.epage%253D239%26rft.atitle%253DThe%2Bimpact%2Bof%2Bmethicillin-%2Band%2Baminoglycoside-resistant%2BStaphylococcus%2Baureus%2Bon%2Bthe%2Bpattern%2Bof%2Bhospital-acquired%2Binfection%2Bin%2Ban%2Bacute%2Bhospital.%26rft_id%253Dinfo%253Apmid%252F1979573%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [5]: /lookup/external-ref?access_num=1979573&link_type=MED&atom=%2Fbmj%2F308%2F6920%2F57.2.atom [6]: {openurl}?query=rft.jtitle%253DThe%2BAmerican%2Bjournal%2Bof%2Bmedicine%26rft.stitle%253DAm%2BJ%2BMed%26rft.aulast%253DCappuccio%26rft.auinit1%253DF.%2BP.%26rft.volume%253D91%26rft.issue%253D3%26rft.spage%253D233%26rft.epage%253D238%26rft.atitle%253DAcute%2Band%2Bsustained%2Bchanges%2Bin%2Bsodium%2Bbalance%2Bduring%2Bnifedipine%2Btreatment%2Bin%2Bessential%2Bhypertension.%26rft_id%253Dinfo%253Adoi%252F10.1016%252F0002-9343%252891%252990121-D%26rft_id%253Dinfo%253Apmid%252F1832516%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [7]: /lookup/external-ref?access_num=10.1016/0002-9343(91)90121-D&link_type=DOI [8]: /lookup/external-ref?access_num=1832516&link_type=MED&atom=%2Fbmj%2F308%2F6920%2F57.2.atom [9]:...