Screening for multidrug resistant HCAIs

There is growing concern, in the UK and abroad, about the number of clinically significant micro-organisms that have developed resistance to commonly prescribed antibiotics. Multi-drug resistant bacteria, such as meticillin-resistant Staphylococcus aureus (MRSA), extended spectrum ß-lactamase (ESBL)-producing organisms and vancomycin-resistant enterococci (VRE) are common causes of healthcare-associated infections (HCAIs) and are of particular concern to infection control teams. These organisms are a heavy burden on our health service. Not only do they cause prolonged hospital stays and increased morbidity and mortality in patients, but they also limit treatment options, so that clinicians are often forced to use more expensive (possibly toxic) antimicrobial agents. An expert European working group recently reported that very few antibacterial agents with new mechanisms of action are under development to meet the challenges of multi-drug resistant bacteria. In particular, they observed that new agents for the treatment of infections due to resistant Gram-negative bacteria (including ESBL-producers) are severely lacking.1 With treatment options running out, there is an even greater need for effective infection control measures. Furthermore, in order to ensure that such measures are instigated in a timely manner, rapid detection of the offending resistant bacteria is of major importance. MRSA, ESBL-producing organisms and VRE are among the most common multi-drug resistant bacteria isolated from blood cultures (and therefore with the potential to cause serious infections) in Europe.1

MRSA

In England, mandatory reporting since 2005 has shown that the number of MRSA bacteraemias reported to the Health Protection Agency (HPA) has more than halved in recent years – with 7,096 cases reported in 2005/2006 compared to 2,932 in 2008/2009 (Fig. 1).2,3 This reduction may be due to the intense scrutiny of individual hospitals, with highly publicised reports on performance, in addition to improved antibiotic prescribing policies and infection control practices. In addition, screening for MRSA carriage of all elective admissions has been compulsory in England since April 2009. Speed and accuracy of results are extremely important, allowing colonised patients to be quickly and accurately identified for isolation, decolonisation and appropriate treatment prior to admission.