Journals Club - MRSA

Curriculum statement topical infectious diseases. Contributed by Dr Louise Newson, a GP in the West Midlands.

Key trials

  • Patients who have taken antibiotics have an almost two-fold increased risk of acquiring MRSA (either infection or colonisation) compared with people who have not taken antibiotics. The risk is almost three times greater for people who have taken quinolones (J Antimicrob Chemother 2008; 61: 26-38).
  • Treatment with topical mupirocin, chlorhexidine gluconate washes, oral rifampicin, and doxycycline for seven days is safe and effective in eradicating MRSA colonisation in hospitalised patients (Clin Infect Dis 2007; 44: 178-85).

Evidence base

  • Treatment of patients who are colonised with MRSA usually involves nasal antibiotic ointment and a daily antibacterial shampoo and body wash. The effectiveness is controversial (Cochrane Database Syst Rev 2003; (4):CD003340).
  • The NHS Clinical Knowledge Summary on MRSA in primary care has recently been produced.
  • The DoH has recently announced a 57 per cent reduction of MRSA in hospitals since 2004. The 2008 figures show continuing decline in MRSA bloodstream infections (Health Protection Agency)
  • MRSA screening for all patients going into hospital (other than in an emergency and a few other exceptions, eg day case endoscopy) is to be introduced by the end of March 2009 (The Health Act 2006: code of practice for the prevention and control of healthcare associated infections)

Guidelines

  • Guidelines have been developed by a Working Party convened on behalf of the British Society for Antimicrobial Chemotherapy. Their aim is to provide healthcare professionals with advice about when to suspect MRSA infection in the community, when and what cultures should be performed and what the management options should be (J Antimicrob Chemother 2008; 61: 976-94).
  • Recommendations are given for the treatment of common infections caused by MRSA, elimination of MRSA from carriage sites and prophylaxis of surgical site infection (J Antimicrob Chemother 2006; 57: 589-608).
  • The NHS introduced the 'clean your hands' campaign in a national initiative in England and Wales to improve the hand hygiene of healthcare workers and help reduce the spread of preventable healthcare-associated infections.
Key points
  • MRSA is an increasing problem in both the hospital and community setting.
  • The NHS Clinical Knowledge Summary on MRSA in primary care has recently been produced.
  • Treatment options for people colonised with MRSA are still debatable.
  • Screening for MRSA is likely to be introduced.

 

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