MRSA--past, present, future
摘要
MRSA-past, present, futureInfections with methicillin-resistant staphylococci (MRSA) remain a major concern.A Medline search reveals 175 publications in the past eight weeks and the BMJ has produced two editorials in the space of a year. 1,2For the reason, readers need look no further than the article by Dr David Thompson on p. 521. 3 In the intensive care unit (ICU) of his hospital, MRSA were present for 16.9% of available bed-days.The introduction of methicillin in 1960 4 heralded a period when staphylococcal infections were readily treatable.Such was the confidence in methicillin that the agent was sometimes sprayed into ward air to reduce staphylococcal infection and carriage amongst the newborn in hospital nurseries-with success. 5The occasional methicillin-resistant isolates, reported quite early on, 6 were not notably troublesome.Methicillin is no longer made (having been replaced in the UK by flucloxacillin) but the term MRSA lives on.In the 1970s, nosocomial infection was not regarded as a high priority.Although the hospital building programme included isolation units (largely to replace the old 'fever hospitals'), these were often not commissioned.In East Anglia, for example, 50% of the isolation beds in the new teaching hospital became a haematology ward, and in some of the 'best buy' hospitals some isolation beds were converted to other uses.Thus when major outbreaks of the 'epidemic MRSA' (EMRSA) occurred-such as that at Kettering 7 -isolation was impracticable and the strategy was to cohort infected patients and use a costly 'search and destroy' approach.Since then, EMRSA has affected most hospitals in the UK.A thoughtful article by Farrington et al. 8 describes the Cambridge experience.Over 100 introductions of MRSA into the hospital between 1985 and 1995 were safely contained by a strategy of isolation and search and destroy, together with ward closures for cleaning; contacts were nursed in isolation until screened.However, in 1994 the isolation faci