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In their editorial describing the study of the use of co-trimoxazole
as prophylaxis after percutaneous endoscopic gastrostomy, Kurien and
Sanders state that the incidence of MRSA and Clostridium difficile is
increasing (1). In England this is no longer true. The quarterly number of
MRSA bacteraemias has fallen by 75% from the period 2003-04 (quarterly
average for that year) to the quarter January-March 2010 and the quarterly
number of C difficile infections has fallen by 54% from 2007-08 (quarterly
average) to the quarter January-March 2010 (2).
Prevention of healthcare-associated infection is important and more
can be done. Use of co-trimoxazole would be beneficial in this respect as
the risk of C difficile infection is lower with this agent compared to
cephalosporins which is the point made by Blomberg and colleagues in their
paper (3). Much work has already been done in the UK to improve antibiotic
use and the fall in number of MRSA and C difficile infections is probably
in part related to this. This should have been highlighted in more detail
in the editorial rather than the incorrect generalisation about MRSA and C
difficile incidence.
References
1.Kurien M, Sanders DS. Antibiotic prophylaxis after percutaneous
endoscopic gastrostomy. BMJ 2010; 340:c2898 doi 10.11136/bmj.c2898.
2. Quarterly epidemiological commentary: mandatory MRSA bacteraemia
and Clostridium difficile infection (up to Janury-March 2010). Health
Protection
Agency.http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1274091661838
accessed 11th July 2010.
3.Blomberg J, Lagergren P, Mattsson F, Lagergren J. Novel approach to
antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG):
randomized controlled trail. BMJ 2010;340:c3115 doi:10.11111136/bmj.c3115
Incidence of MRSA and Clostridium difficile is decreasing
In their editorial describing the study of the use of co-trimoxazole
as prophylaxis after percutaneous endoscopic gastrostomy, Kurien and
Sanders state that the incidence of MRSA and Clostridium difficile is
increasing (1). In England this is no longer true. The quarterly number of
MRSA bacteraemias has fallen by 75% from the period 2003-04 (quarterly
average for that year) to the quarter January-March 2010 and the quarterly
number of C difficile infections has fallen by 54% from 2007-08 (quarterly
average) to the quarter January-March 2010 (2).
Prevention of healthcare-associated infection is important and more
can be done. Use of co-trimoxazole would be beneficial in this respect as
the risk of C difficile infection is lower with this agent compared to
cephalosporins which is the point made by Blomberg and colleagues in their
paper (3). Much work has already been done in the UK to improve antibiotic
use and the fall in number of MRSA and C difficile infections is probably
in part related to this. This should have been highlighted in more detail
in the editorial rather than the incorrect generalisation about MRSA and C
difficile incidence.
References
1.Kurien M, Sanders DS. Antibiotic prophylaxis after percutaneous
endoscopic gastrostomy. BMJ 2010; 340:c2898 doi 10.11136/bmj.c2898.
2. Quarterly epidemiological commentary: mandatory MRSA bacteraemia
and Clostridium difficile infection (up to Janury-March 2010). Health
Protection
Agency.http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1274091661838
accessed 11th July 2010.
3.Blomberg J, Lagergren P, Mattsson F, Lagergren J. Novel approach to
antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG):
randomized controlled trail. BMJ 2010;340:c3115 doi:10.11111136/bmj.c3115
Competing interests:
None declared
Competing interests: No competing interests