Epidemiology and control of the ‘modern’ methicillin-resistant Staphylococcus aureus

Problems with methicillin-resistant staphylococci emerged again in the latter half of the 1970s and the last decade is the era of the ‘modern’ MRSA.

Abstract

One’s perception of the problems caused by the ‘modern’ methicillin-resistant Staphylococcus aureus (MRSA) depends on one’s historical and geographical viewpoint. The observation that ‘sizeable outbreaks due to methicillin-resistant staphylococci have occurred in British hospitals, but until recently such outbreaks seem to have been rather uncommon . . .’ seems an accurate comment on the present situation in the south-east of England until one realises that this was written in 1968 (Leading article, 1968). The concept of a ‘modern’ MRSA may imply that the present problems are new and this may hinder the appraisal of the practical information gained from studies of ‘hospital’ staphylococci conducted more than 20 years ago. The above quotation from a Lancet leading article was in response to the earliest outbreaks of MRSA that occurred in the mid-1960s, soon after the introduction of methicillin in 1959 (Editorial, 1960). By 1968 there had been geographically separated reports of methicillin-resistant strains which accounted for 17.3% of staphylococcal infections in Zurich (Benner & Kayser, 1968), 4.1% of isolates at the Middlesex Hospital in London (Colley, McNicol & Bracken, 1965) and 10% of Staph. aureus bacteraemia in Denmark (Ericksen, 1967). In France there were unsuccessful attempts to treat methicillin-resistant infections with methicillin (Chabbert et al., 1965; Bastin, Worms & Acar, 1967). The first report of an outbreak in the USA came from Boston City Hospital in 1968 (Barrett, McGehee & Finland, 1968). In the early 1970s there was, internationally, a general decline in the incidence of MRSA (Shanson, 198 1) and until 1976 there had been only two detailed reports of hospital outbreaks from the USA (Barrett et al., 1968; O’Toole et al., 1970). In Birmingham in the UK, for example, the percentage of patients carrying MRSA in their noses declined from 8.5% in 1970 to 0% in 1977 (Ayliffe, Lilly & Lowbury, 1979). Problems with methicillin-resistant staphylococci emerged again in the latter half of the 1970s and the last decade is the era of the ‘modern’ MRSA. The strains are usually resistant to gentamicin and chloramphenicol,