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