Is it time to stop searching for MRSA?

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7099.57 (Published 05 July 1997) Cite this as: BMJ 1997;315:57

Follow up screening within the community needs clarification

  1. R Philp, Public health nursea,
  2. R McCann, Consultant in communicable disease controla,
  3. P Rowland, Infection control nurseb
  1. a Salford and Trafford Health Authority, Eccles M30 0NJ
  2. b Salford Royal Hospitals NHS Trust, Hope Hospital, Salford M6 8HD
  3. c St James's and Seacroft University Hospitals NHS Trust, Leeds LS14 6UH
  4. d Department of Environmental and Occupational Medicine, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH
  5. e South Tyneside District Hospital, South Shields, Tyne and Wear NE34 0PL
  6. f Eastern General Hospital, Edinburgh EH6 7LN
  7. g Newham District Microbiology Laboratories, St Andrew's Hospital, London E3 3NT
  8. h Department of Pathological Sciences, University of Manchester, Manchester Healthcare Trust, Manchester M13 9WL
  9. i District General Hospital, Eastbourne, East Sussex BN21 2UD
  10. j Public Health Laboratory, Derriford Hospital, Plymouth PL6 8DH

    Editor—The articles by Barry Cookson and E L Teare and S P Barrett on methicillin resistant Staphylococcus aureus (MRSA)1 2 added to the nationwide debate between clinicians, infection control teams, trusts, and purchasers.

    Recently, after a large outbreak of MRSA in our local teaching hospital, all colonised patients were treated and followed up by screening within the community. Clearance of MRSA was defined as three consecutive negative cultures of swabs from the nose, throat, perineum, and any lesions and of urine if the patient had a catheter, starting five days after the completion of treatment.

    To determine whether this approach achieved clearance and prevented readmission of colonised patients we audited the records of 63 patients with MRSA who were discharged into the community over a period of six months. Fifty four patients were over the age of 60. Four were discharged to nursing homes, seven to residential homes, 45 to their own home, and seven to unknown destinations. Forty six were cleared of MRSA colonisation by the criterion defined above—34 after one treatment, two after two treatments, and 10 after three treatments. Eleven patients were readmitted to hospital during the study—seven were still negative for MRSA and four were recolonised.

    While acknowledging that bacteriological culture can lack sensitivity,2 we believe that this approach helped to prevent reintroduction of the organism into the acute hospital environment. We propose to follow up this cohort for another six months to examine this further.

    We look forward to commenting on the revised British guidelines for infection control, but we would welcome clarification on the need for follow up screening within the community. A recent publication on guidelines for the control of infection in residential and nursing homes3 states that treatment regimens started in hospital for MRSA should be completed but does …

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