1952 first report of internal survival of staph* Tompsett MD et al*

Reflects the growing impact of medical interventions, older age and comborbidities of patients

he literature on the costs of MRSA and its control is sub- stantial, but unsatisfactory. Nevertheless, there is a consis- tent message from these studies that admission surveillance cultures and barrier precautions for MRSA-positive patients are both efficacious in its control and are also likely to be highly cost-effective. The more screening there is, the larger the reduction in MRSA that is likely to be achieved, and the higher the prevalence of MRSA, the greater the impact of screening will be. Moreover, from a clinical viewpoint, con- trol of MRSA is highly worthwhile, not only from the point of view of reducing the substantial clinical burden of MRSA, but also for improving the treatment of other infections by being able to avoid the use of glycopeptides. Future research should concentrate on more methodical, well-designed and robust intervention studies rather than the largely observa- tional, uncontrolled studies that fill the existing literature.

The public concern about this organism, fuelled by politics and media interest, has led to additional costs resulting from litigious cases. Although there are no comprehensive figures for the costs to hospitals from litigation, as to date these have been out-of-court settlements, there have been a number of high- profile cases. The first of these in the UK resulted in an out- of-court settlement in the region of £400 000 (BBC website report: http://news.bbc.co.uk/1/hi/health/6148546.stm (last accessed 15 July 2010)).

The burden on healthcare services is highly significant, in particular because MRSA has not replaced susceptible staphylococcal infection but is an additional problem

Annually in the EU, MRSA infections have been estimated to result in 1 million extra days of hospitalization and an attrib- utable additional hospital cost of €380 million European Centre for Disease Prevention and Control, European Medicines Agency. ECDC/EMEA Joint Technical Report—The bacterial challenge: time to react. Stockholm: ECDC & EMEA, 2009

n some countries, most notably the UK, MRSA has become an important political issue. The UK has among the highest rates in Europe, and during the 2005 General Elec- tion it was even suggested that concern about MRSA was a barometer for concern about the state of the country in general

Boyce T, Murray E, Holmes A. What are the drivers of the UK media coverage of meticillin-resistant Staphylococcus aureus, the inter- relationships and relative influences? J Hosp Infect 2009; 73: 400–407.
4.

MRSA carriers in long-term care facilities have a 1.4-fold increased risk for mortal- ity within 36 months
Suetens C, Niclaes L, Jans B, Verhaegen J, Schuermans A, Van Eldere J, et al. Methicillin-resistant Staphylococcus aureus colonization is associated with higher mortality in nursing home residents with impaired cognitive status. J Am Geriatr Soc. 2006;54(12):1854-60.
33.

The majority of HA-MRSA strains isolated in European countries have emerged from the introduction of the staphylococcal cassette chromosome mec (SCCmec) harbouring the methicillin-resistance gene mecA, into five S. aureus clonal complexes (CC), as defined by multi–locus sequence typing (MLST): CC5, CC8, CC22, CC30 and CC45

Deurenberg RH, Vink C, Kalenic S, Friedrich AW, Bruggeman CA, Stobberingh EE. The molecular evolution of methicillin- resistant Staphylococcus aureus. Clin Microbiol Infect. 2007;13(3):222-35.
4.

The European Centre for Disease Prevention and Control (ECDC) has calculated that HAIs involve 4.1 million patients annually in the European Union (EU) Member States and that such infections directly result in approximately 37,000 deaths [1].

Council of the European Union. Council recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare-associated infections (2009/C151/01). Official Journal of the European Union. 3 Jul 2009. Available from: http://ec.europa.eu/health/patient_safety/docs/ council_2009_en.pdf

Within the healthcare setting alone, MRSA infections are estimated to affect more than 150,000 patients annually in the European Union (EU), resulting in attributable extra in-hospital costs of EUR 380 million for EU healthcare systems

the past five years, the MRSA bacterae- mia rates have decreased significantly in 10 EU coun- tries with higher endemic rates of MRSA infections. In addition to healthcare-associated infections, new MRSA strains have recently emerged as community- and livestock-associated human pathogens in most EU Member States. The
( new reservoirs of pathogens)

The prevention and control of MRSA have therefore been identified as public health priori- ties in the EU.

Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe.

MRSA have been dubbed livestock-associated methicillin-resist- ant Staphylococcus aureus (LA-MRSA) [4].
Nemati M, Hermans K, Lipinska U, Denis O, Deplano A, Struelens M, et al. Antimicrobial resistance of old and recent Staphylococcus aureus isolates from poultry: Antimicrob Agents Chemother. 2008

In addition to healthcare-associated infections, new MRSA strains have recently emerged as community, expanding to further ecological niches and livestock-associated human pathogens in most EU Member States. The( new reservoirs of pathogens)

Deurenberg RH, Vink C, Kalenic S, Friedrich AW, Bruggeman CA, Stobberingh EE. The molecular evolution of methicillin- resistant Staphylococcus aureus. Clin Microbiol Infect. 2007;13(3):222-35.

CA-MRSA strains have been distinguished from their health care-associated MRSA (HA-MRSA) counterparts by molecu- lar means. HA-MRSA strains carry a relatively large staphy- lococcal chromosomal cassette mec (SCCmec) belonging to type I, II, or III. These cassettes all contain the signature mecA gene, which is nearly universal among MRSA isolates. They are often resistant to many classes of non-?-lactam antimicro- bials. HA-MRSA strains seldom carry the genes for the Pan- ton-Valentine leukocidin (PVL). In contrast, CA-MRSA iso- lates carry smaller SCCmec elements, most commonly SCCmec
type IV or type V. These smaller elements also carry the mecA gene and are presumably more mobile, although few explicit data support this notion (61). They are resistant to fewer non- ?-lactam classes of antimicrobials and frequently carry PVL genes. In addition to these genotypic characteristics, CA-MRSA
strains affect a population distinct from those affected by HA- MRSA and cause distinct clinical syndromes. CA-MRSA in- fections tend to occur in previously healthy younger patients. They have been associated predominantly with SSTIs (105, 642, 654) but have also been linked to several severe clinical syndromes such as necrotizing pneumonia and severe sepsis. In contrast, HA-MRSA strains have been isolated largely from people who are exposed to the health care setting; the patients are older and have one or more comorbid conditions. HA- MRSA strains tend to cause pneumonia, bacteremia, and in- vasive infections.
Community-associated methicillin-resistant Staphylococcus aureus: Epidemiology and clinical consequences of an emerging epidemic