European study: MRSA is primarily a hospital bug

A study in nine European countries has shown that MRSA rarely occurs in general practice. Methicillin-resistant Staphylococcus aureus (MRSA) is therefore primarily a hospital bacterium, according to a publication by researchers from the Universities of Maastricht, Nottingham and Antwerp and from the Netherlands Institute for Health Services Research (NIVEL) published in The Lancet Infectious Diseases.

The Staphylococcus aureus bacterium is present on the skin or in the nose of about a quarter of the population, without ever making them ill. However, a variant that is resistant to antibiotics (MRSA) can give rise to serious complications in severely weakened patients in hospitals, and can even be fatal. Hospitals in the Netherlands and Scandinavia therefore take strict precautions when there is an outbreak of MRSA: patients and sometimes entire wards are then quarantined.
 
GP surgeries
There seems to be no justification for the fear that MRSA is spreading beyond hospitals. Resistant strains of staphylococci are rarely encountered in GP surgeries, according to research in Austria, Belgium, Croatia, France, Hungary, Spain, Sweden, the UK and the Netherlands. At GP surgeries in these nine countries, a total of 32,206 samples were taken from the nasal mucosa of healthy subjects using cotton buds. The proportion of samples that were positive for Staphylococcus aureus varied from 12% to nearly 30%. Overall, methicillin-resistant staphylococci were found in an average of just 1.3% of the samples (91 samples).
 
Resistant subtype
Resistant staphylococci only appear sporadically in GP practices in countries where antibiotics are prescribed relatively often. It is striking that the rare cases of methicillin-resistant staphylococci that were found belong to different subtypes. There is therefore no single dominant subtype of MRSA found in GP surgeries. The resistant bacteria in the 91 positive samples belonged to 53 different subtypes.
 
Caution when prescribing
“This result means one less thing to worry about,” says Professor François Schellevis, a researcher at NIVEL. “Infections in general practice that are caused by Staphylococcus aureus can be treated effectively with antibiotics and we don’t yet have to start thinking about it being MRSA. But being cautious when prescribing antibiotics is still important. That’s the best way of stopping resistance from developing.”

Information
Drs. C.D.J. (Casper) den Heijer, Universiteit Maastricht University, phone. 0031(0)43-3876647, e-mail casper.den.heijer@mumc.nl

Cooperating partners
Maastricht University
University of Antwerp
The University of Nottingham
APRES