Elsevier

The Lancet

Volume 350, Issue 9074, 2 August 1997, Pages 323-325
The Lancet

Articles
Resistance to methicillin and other antibiotics in isolates of Staphylococcus aureus from blood and cerebrospinal fluid, England and Wales, 1989–95

https://doi.org/10.1016/S0140-6736(97)12148-1Get rights and content

Summary

Background

Methicillin-resistant Staphylococcus aureus (MRSA) strains are colonising hospital patients in most areas of England and Wales, UK. The extent to which they cause invasive infection can be gauged from their presence in isolates from blood or cerebrospinal fluid.

Method

About 200 clinical laboratories reported the results of susceptibility testing of between 4501 and 6370 isolates of S aureus from blood or cerebrospinal fluid in each of the years 1989–95. We assessed the rate of resistance to methicillin and other antibiotics for each of these years.

Findings

Resistance to methicillin was stable at about 1·5% of isolates during 1989–91, but increased thereafter to 13·2% in 1995 (p<0·001). At the same time there was a significant increase in the percentage of isolates resistant to erythromycin, clindamycin, ciprofloxacin, gentamicin, trimethoprim, and rifampicin (p<0·001 for each)–resistance characteristics often seen in MRSA. Resistance to benzylpenicillin increased slightly but significantly (p<0·001); resistance to fusidic acid was stable (p>0·05); resistance to tetracycline decreased significantly (p<0·001).

Interpretation

Among cases of S aureus bacteraemia, the proportion due to MRSA has increased significantly. Bacteraemia due to MRSA has a poor prognosis, especially if not treated with suitable antibiotics. Therefore, these findings are important, especially for management of patients and the development of antibiotic policies.

Introduction

During the past few years in most developed countries there has been an increase in colonisation and infection of hospital patients by strains of Staphylococcus aureus resistant to methicillin and other antibiotics.1, 2 In England and Wales, UK, this increase has been reflected in the numbers of isolates referred to the Laboratory of Hospital Infection of the Central Public Health Laboratory, for bacteriophage typing.3 Opinions differ about the threat to health posed by methicillin-resistant S aureus (MRSA).1, 4, 5 Colonisation has commonly been found to exceed infection,6 and the incidence of documented bacteraemia in England and Wales has been low. However, bacteraemia caused by MRSA has a poor prognosis, especially if effective antibiotic treatment, generally with vancomycin, is not given.7 Since 1992, we have detected an increase in resistance to methicillin among S aureus strains causing bacteraemia in England and Wales.

Section snippets

Methods

Clinical laboratories in England and Wales are encouraged to report all clinically relevant isolations of S aureus from blood or cerebrospinal fluid, to the Public Health Laboratory Service Communicable Disease Surveillance Centre. Results are provided on a standard form, which includes relevant details of patients and clinical details.

Since 1989, the form has included a list of 30 antibiotics and laboratories have been asked to report the results of susceptibility testing as sensitive,

Results

During the period covered by this survey the National External Quality Assessment Scheme issued cultures of S aureus strains on several occasions. The median results for the percentage of laboratories obtaining the correct results were ⩾98·4% (JJS Snell, National External Quality Assessment Scheme, Public Health Laboratory Service, London, personal communication). The high median values indicate a good level of proficiency at detecting antibiotic resistance.

The number of reports of S aureus

Discussion

Surveillance, based on reports of routine diagnostic testing, has the advantage that data on many isolates can be collected, which allows investigation of significant trends in resistance. Our results show that, since 1992, the proportion of MRSA among cases of bacteraemia due to S aureus has increased substantially. The testing of S aureus isolates for susceptibility to methicillin seems to be almost universal in clinical microbiology laboratories, and we believe, therefore, that the increase

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