MRSA rates down but other infections show increased drug resistance - HPSC

Published:

New figures released today (Thursday) by the Health Protection Surveillance Centre (HPSC) show that MRSA infections for the first six months of 2008 have fallen by 3.5% compared with 2007 and 7% when compared with 2006.

Commenting on the figures, HPSC consultant microbiologist Dr Robert Cunney said that he was pleased to see a reduction in both the proportion and number of MRSA bloodstream infections but urged caution in interpreting the findings as it is not yet clear whether or not this downward trend will continue. 

"Worryingly, a number of other infections are showing an increased resistance to drugs. These include Streptococcus pneumoniae - the most common cause of pneumonia outside of hospitals and an important cause of meningitis in young children - E. coli which causes kidney infections and is an important cause of wound-related and bloodstream infections in hospital, and vancomycin-resistant enterococcus (VRE).

"A number of new initiatives should help to address the issue of antibiotic resistance in Ireland including:

  • The recent appointment of additional infection prevention and control personnel, and clinical pharmacists with responsibility for promoting prudent antibiotic use, to a number of hospitals
  • A national education programme on prudent antibiotic prescribing for General Practitioners, along with antibiotic prescribing guidelines and a public information campaign, which are due to be launched in November 2008 (to coincide with a Europe-wide initiative to highlight the importance of using antibiotics wisely: the European Antibiotic Awareness Day)
  • National guidelines on developing programmes to promote prudent antibiotic use in hospitals are due to be launched in early 2009
  • The recent introduction of a new pneumococcal vaccine for children. This vaccine has helped to reduce the rate of infections caused by antibiotic-resistant strains of pneumococcus in other countries.

"However, even with these interventions, it is clear that a lot more still needs to be done to bring the rate of infections caused by antibiotic-resistant bacteria, including MRSA, down to the levels seen in other European countries. Investment in infection prevention and control structures, and in interventions to limit inappropriate antibiotic use, can bring major cost savings to the health service but, more importantly, will also save lives."

Full details and data on antimicrobial resistance and antibiotic consumption in Ireland can be found at:
http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/
http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanSurveillanceofAntimicrobialConsumptionESAC/

Note for editors:

MRSA
Although the downward trend may be significant, it is not yet known if it is due to improved implementation of infection prevention and control interventions, or due to strains of MRSA becoming less likely to cause infection, or some other explanation that is not yet apparent.

Improved infection prevention and control interventions are unlikely to fully explain the overall reduction in MRSA bloodstream infections because:

  • The number of infections caused by other antibiotic-resistant bacteria has not declined
  • The number of reported meticillin-sensitive Staph aureus (MSSA) infections has not declined
  • The level of hospital antibiotic use remains at a high level compared to other European countries.

Streptococcus pneumoniae
Levels of penicillin resistance in Ireland has been rising steadily since 2004 and 18% of reported pneumococcal bloodstream infections were caused by antibiotic resistant isolates in the first half of 2008. This is most likely due to the rising level of antibiotic use outside of hospitals in Ireland. 

E. coli
Levels of resistance to the fluoroquinolone group of antibiotics (commonly used to treat kidney infections and pneumonia) has increased from 12.6% in 2004 to 22.5% for the first half of 2008, while the proportion of multiple-drug resistant E. coli strains has increased from 5.6% in 2004 to 12.5% for the first half of 2008. Much of this increase is probably due to high levels of antibiotic use in hospitals.

VRE
Ireland has the second highest reported rate of VRE in Europe, at 33%. Antibiotic use in hospitals, and inadequate infection prevention and control resources, are the most likely explanations for this.