Should focus more on patients bringing strains to hospital on readmission

Two papers in this week's BMJ consider from different perspectives the limitations of England's mandatory surveillance system for methicillin resistant Staphylococcus aureus (MRSA) bacteraemia.1 2 This surveillance became compulsory in April 2001 in response to the rise in MRSA bacteraemias from less than 2% of all S aureus bacteraemias in 1990 to 42% in 2000.3 The Department of Health publishes the results for each English NHS acute trust every six months.4 In 2004 the secretary of state for health announced that these infections would be halved by 2008 and monitored by the Healthcare Commission.5

The paper by Wyllie and colleagues focuses on the high proportion of MRSA bacteraemias among patients on admission to hospital.1 These bacteraemias were not necessarily acquired in the community, however, since nearly all these patients had previously stayed in hospital, where they could have been exposed to MRSA and some were known to have had MRSA on a previous admission. Indeed, in England most MRSA infections among patients entering hospital are caused by strains that have been exported from hospitals and have created …