| Sub-title | |
| Author | M A Borg |
| Abstract | Methicillin resistant Staphylococcus aureus (MRSA) infections remain a major infectious disease challenge within the Maltese Islands. From the first outbreak with St Luke's Hospital in 1995, cases have continued to increase in the past decade to reach a situation whereby more than 45% of Staphylococcus aureus isolates from blood cultures are methicillin resistant, one of the highest in Europe. In addition there is evidence of an ever increasing prevalence of community MRSA. Several factors undoubtedly play a role in the local endemicity of MRSA. Overcrowding within St Luke's Hospital (St Luke's Hospital) has already been identified to be a major instigator behind MRSA incidence especially in medical wards. Antibiotic consumption is recognised as a major driver of resistance and indications are that antibiotic use in Malta is also on the high side. Furthermore studies of hand hygiene compliance, a cornerstone of nosocomial infection prevention, suggest a need for major improvement. Targeting these three risk factors is vital to achieve a successful outcome but will not necessary reverse the situation. Isolation of positive MRSA cases remains critical to ultimate control. Recent mathematical modelling data suggests that a comprehensive search and destroy policy is the only effective solution to eradicate MRSA. In high endemicity situations this will require a comprehensive programme of patient screening both on admission as well as of all contacts of cases diagnosed during the hospital stay, both patients and staff. The availability of sufficient isolation beds is a prerequisite and even if this were to be done, the modelling data suggests that based on current prevalence in St Luke's Hospital, 15 – 20 years will need to elapse before full control is achieved. |
Published in: | |
| Journal | Malta Medical Journal |
| Volume | 18 Supplement |
| Page | |
| Date | 01/12/2006 |
| Link to journal | |
| Key words | antibiotics, community MRSA, MRSA, overcrowding, screening |