MRSA rates have been increasing worldwide over the past decades write Hajo Grundman (National Institute for Public Health and the Environment, Bilthoven, the Netherlands) and colleagues. Even in Scandinavian countries and the Netherlands, where MRSA rates have been fairly low and stable for many years, the frequency is beginning to rise.
"Of the expected 2 billion individuals carrying S aureus worldwide, conservative estimates based on either Dutch or US prevalence figures would predict that between 2 million and 52 million carry MRSA," states Professor Grundmann.
In their Review the authors also warn of the threat of community acquired MRSA. Genetic changes in strains of community acquired MRSA have led to the evolution of 'fitter' strains that can combine antimicrobial resistance with transmissibility and virulence. If these strains are sufficiently fit to maintain a high prevalence in the community, the MRSA situation in hospitals could potentially become explosive, write the authors.
They conclude: "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."
Contact: Dr Hajo Grundmann, Project Leader, Scientific Coordinator, European Antimircrobial Resistance Surveillance System (EARSS), Center for Infectious Disease Epidemiology, National Institute for Public Health, Antonie van Leeuwenhoeklaan 9, PO BOX 1, 3720 BA Bilthoven, Netherlands. T) 31 30 274 4239 Hajo.Grundmann@rivm.nl / edine.tiemersma@rivm.nl
Journal
The Lancet