The continuing problem of 'hospital staphylococci': why?

Nosocomial infections due to staphylococci continue to pose a serious health concern worldwide. Methicillin-resistant Staphylococcus aureus (MRSA) is an important and growing cause of staphylococcal infection. The incidence of MRSA varies throughout the world, but is particularly high in Japan where the incidence is four-times that seen in Europe. The emergence of coagulase-negative staphylococci (CNS) has increased as a significant pathogen in infections associated with prosthetic implants. Evidence suggests that hand carriage by hospital staff is one way in which CNS are introduced onto catheters, intravenous lines and other implant devices. Control measures in the UK have concentrated on the reservoirs of infection, with the aim of preventing infection and the resulting morbidity, mortality and economic burden. At the North Middlesex Hospital, London, UK, an aggressive prophylactic policy for MRSA has been employed since 1987. Data show that it is six times cheaper to treat a carrier than it is to treat an infected patient. Prophylaxis therefore provides a more cost-effective way of controlling the spread of MRSA infection. Such stringent control strategies, coupled with increased awareness and adequate funding, are necessary if the spread of resistant bacteria is to be limited.