Hospital Pharmacist
Vol 10 No 1 p5
January 2003

News summary

Related websites
BMJ study (more)
Public Health Laboratory Service (www.phls.co.uk)

Deaths from methicillin-resistant Staphylococcus aureus infection are rising in England and Wales

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) seem to be an increasing cause of mortality in England and Wales, say researchers from the Office for National Statistics and the Public Health Laboratory Service, London.

The researchers say that the impact of MRSA infection on mortality has been unknown until now because the World Health Organization's international classification of diseases does not include a specific code for MRSA.

They have examined all death registrations in the Office for National Statistics's database that indicated staphylococcal infection on any part of death certificates issued between 1 January 1993 and 31 December 1998.

MRSA was mentioned on 1,387 out of 6,723 certificates that included a code for staphylococcal infection. The percentage of certificates mentioning MRSA increased from 7.5 per cent in 1993 to 25 per cent in 1998. In certificates that gave staphylococcal infection as the underlying cause of death, the proportion mentioning MRSA increased from 8 per cent in 1993 to 44 per cent in 1998.

MRSA accounted for all the increase in deaths due to staphylococcal infection in this period.

The researchers say that improved reporting is unlikely to explain the increase in deaths associated with MRSA infection.

They say: "Further improvements in surveillance, and control of health care associated infection and mortality, should be a priority if MRSA related deaths are to be prevented. Recent initiatives, such as the requirement since April 2001 for all NHS trusts to report Staphylococcus aureus bacteraemia, will help towards achieving this goal."

The study is published in the British Medical Journal (2002;325:1390-91).

Dr Crowcroft, one of the authors of the study, told Hospital Pharmacist that MRSA is now a problem for hospitals across the country, and also in many parts of the developed world, including Europe, the United States and Japan.

Dr Crowcroft said that tackling MRSA is largely about three factors. First, there needs to be good infection control in hospitals and health professionals need to ensure that they wash their hands between patient contacts. Secondly, careful antibiotic prescribing should be established to help slow the development of resistant organisms. Thirdly, new drugs need to be developed that are effective against antibiotic-resistant infections. Dr Crowcroft said: "Pharmacists have an important role to play in encouraging appropriate use of antibiotics."