Intended for healthcare professionals

Clinical Review

Meticillin resistant Staphylococcus aureus in the hospital

BMJ 2009; 338 doi: (Published 12 February 2009) Cite this as: BMJ 2009;338:b364
  1. Jan Kluytmans, consultant microbiologist and head of infection control1, professor of medical microbiology2,
  2. Marc Struelens, head of the department of microbiology3, director of Laboratoire de Référence des Staphylocoques4, professor of medical microbiology5
  1. 1Laboratory for Microbiology and Infection Control, Amphia Hospital Breda, 4800 RK Breda, Netherlands
  2. 2Department of Medical Microbiology and Infection Control, VU University Medical Center Amsterdam, 1081 HV Amsterdam, Netherlands
  3. 3Department of Microbiology Hopital Erasme, 1070 Brussels, Belgium
  4. 4Laboratoire de Référence des Staphylocoques, Hopital Erasme, 1070 Brussels, Belgium
  5. 5Department of Microbiology and Immunology, Faculté de Médecine, Université Libre de Bruxelles, 1070 Brussels, Belgium
  1. Correspondence to: J Kluytmans jankluytmans{at}

    Summary points

    • Meticillin resistant Staphylococcus aureus (MRSA) is now a major cause of disease—in the US in 2005 more deaths were caused by MRSA than by HIV

    • In addition to the well established hospital associated MRSA strains, new virulent strains have recently appeared in the general population

    • Molecular technologies can rapidly detect MRSA but their cost effectiveness is unclear

    • MRSA can be controlled by strict adherence to multifaceted strategies, including screening and transmission based precautions

    • Clinicians must be aware of MRSA in community infections of skin and soft tissues and use a low threshold for microbiological testing

    • Vancomycin is the standard treatment for serious MRSA infections. Alternative new drugs include linezolid, daptomycin, and tigecycline, which should be used with specialist advice

    The burden of disease from meticillin resistant Staphylococcus aureus (MRSA) infections is high. Around 100 000 invasive MRSA infections occurred in 2005 in the United States, and the number of associated deaths was about 19 000—more than that for HIV.1 The epidemiology of MRSA has changed recently—infections are no longer confined to the hospital setting, but also appear in healthy people in the community with no established risk factors for acquiring MRSA. These community associated MRSA strains differ from hospital associated strains.2 Mathematical models show that MRSA has a high potential to become endemic in the community.3 The recent emergence of community acquired MRSA in skin and soft tissue infections calls for increased awareness among general and emergency room practitioners and a lower threshold for microbiological testing. Strategies to control hospital associated MRSA work in lower prevalence settings and may work in settings with medium to high endemic levels of hospital associated MRSA.4

    Sources and selection criteria

    We used our personal archives and also searched PubMed and the Cochrane Library (1 January 2002 to 1 July 2008) using the terms “MRSA” or “methicillin …

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