National guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus--what do they tell us?

Guidelines to control and prevent methicillin-resistant Staphylococcus aureus (MRSA) infection are available in many countries. Infection control and prevention teams determine local strategies using such national guidelines, but not all guidelines involve a rigorous assessment of the literature to determine the strength of the recommendations. Available guidelines drafted by national agencies or prominent professional organisations in Germany, New Zealand, North America, The Netherlands, Ireland and the UK were reviewed. Significant literature reviews were a component of guidelines from the UK and North America. Recommendations were not graded on the strength of the evidence in guidelines from New Zealand and The Netherlands. The Netherlands, a country with a very low prevalence of MRSA, had the simplest set of guidelines. Few of the recommendations in any of the guidelines achieved the highest grading, i.e., based on well-designed, experimental, clinical or epidemiological studies, even though the logic of the proposed measures is clear. The onset of community-acquired MRSA is reflected in the recent publication of guidelines from North America. New developments, such as rapid testing and mathematical modelling, are of importance in helping to control MRSA in settings of both low and high endemicity. National guidelines are increasingly evidence-based, although good scientific studies concerning some aspects of MRSA control are lacking. However, general principles, e.g., early detection and isolation, are recommended by all guidelines. There is still a role for consensus and the opinion of experts in devising national guidelines.