MRSA rates in the community a concern: study

Hospital infection rates of Methicillin-resistant Staphylococcus aureus (MRSA) are improving but with most cases now occurring in the community, a shift in focus is needed, a new study has found.

The research team built on national data from previous studies and used pathology results from about 40,000 patients in the Hunter New England Local Health District, who provided specimens from 2008 to 2014.

Published in the Medical Journal of Australia, the study found hospital infection rates of the drug-resistant bacteria are improving, with decreased infections in two of the region's largest hospitals, but lead researcher Dr Jason Agostino, from the Australian National University, said most MRSA infections (56.9%) were picked up in the community.

"The problem of infections resistant to antibiotics in our community is not just a theoretical problem that will happen sometime in the future—it's happening right now,” Agostino said. “We need to really start thinking about infection control measures and antibiotic prescribing in the community.”

He seconded the findings of a recent narrative review, also published in the Medical Journal of Australia, that called for a national strategy to reduce antibiotic prescribing in general practice.

The authors, led by Bond University’s Professor Chris Del Mar, called for surveillance of antibiotic resistance rates in the community and to set targets to enable Australian GPs to reduce their antibiotic prescribing rates.

The authors said, in 2050, deaths from currently treatable infections will overtake all cancer deaths.

They suggested three items for surveillance and setting targets:

•  the background level of antibiotic resistance in the community, using sentinel general practices to systematically sample infections or even uninfected attending patients;
• rates of total antibiotic prescribing by GPs; and
• patient safety indicators, (serious infections admitted to hospital which might have been averted by earlier use of antibiotics).

The approaches put forward to support GPs to reduce their antibiotic prescribing included:

•  regulatory interventions, such as having electronic health records default to “no repeats”; restricting access to several antibiotics earmarked for special conservation, via the Authority Prescribing System; and the prescription of guideline-appropriate quantities;
• externally administered interventions, such as audit and feedback to clinicians about their prescribing habits; academic detailing including education of prescribers; and
• activities that GPs can choose to implement themselves, including delayed prescribing, shared decision making, “nudge” techniques, voluntary audit and feedback, and highlighting non-antibiotic symptom treatment.

Agostino's study also found that MRSA was predominantly acquired by young people, Aboriginal and Torres Strait Islander people, and residents of aged care facilities.

He suggested normal handwashing and good wound care practices and to avoid sharing personal items like towels and razors, and added that people should get areas of the body that look to be getting infected seen to.

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