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Current Opinion in Infectious Diseases. 17(4):317-322, AUG 2004

DOI: 10.1097/01.qco.0000136926.52673.cd,  ,  PMID: 15241075
Issn Print: 0951-7375
Publication Date: 2004/08/01

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Prevention and control of

methicillin-resistant Staphylococcus
aureus infections
Barry M Farr

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Abstract
Purpose of review
This article reviews many recent publications relevant to the prevention and control
of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.
Recent findings
Higher risk-adjusted costs and mortality have been found for MRSA infections than
for methicillin-susceptible S. aureus infections confirming their epidemiologic
importance. Staphylococcal cassette chromosome mec, the genetic basis for MRSA,
does not develop in methicillin-susceptible S. aureus exposed to antimicrobials.
Instead virtually all patients acquire MRSA via spread. Nevertheless, antibiotic
therapy provides a selective advantage for such spread, especially within healthcare
settings where antimicrobial therapy is most frequent. Several studies have
suggested better control of MRSA through antibiotic control, but far more studies
have reported control using surveillance cultures and contact precautions for
preventing spread (rather than just using standard precautions). More rapid
detection of MRSA (within 6 h) has been reported using polymerase chain reaction,
but studies using this method to reduce spread have not yet been published. A
structured survey of research methods used regarding MRSA control noted that
many studies had methodologic shortcomings (for example, none was a randomized
trial), but nevertheless concluded that active detection and isolation work should be
used. A Society for Healthcare Epidemiology of America guideline emphasized the
same approach noting that scores of studies on multiple continents had reported
success with this approach, with best results in several northern-European
countries where all facilities used it routinely.
Summary
Improved MRSA control is possible by detecting and isolating colonized patients.

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