Recently, there have been news reports in the media about a feared bacterium, which is resistant to many of the antibiotics that are used for treatment of common infections. Its professional name is Methicillin-resistant Staphylococcus aureus (MRSA).
The carrier of MRSA is infected by a sick person who has no clinical symptoms of the infection. MRSA most commonly colonizes in nasal mucosa, skin and less often in the nasopharynx. Not every carrier is a source of infection. An increased spread of the infection is due to its acute infection. The biggest threat is posed by a chronic carrier that was colonized or suffered an infection during a stay in hospital, especially in the intensive care unit. Invasive procedures, treatment with antibiotics, diabetes, hemodialysis and skin diseases increase the risk. The bacteria are usually transferred from the hands of hospital staff to patient to patient. Less often it can be transmitted by surgical devices. Transmission via air, especially in contaminated air (e.g. opened wounds at burn centers) cannot be eliminated.
The risk of occurrence is not the same in each hospital’s department. Departments with a high risk include the intensive care unit, burn and transplant centers, cardiovascular surgery, neurosurgery, orthopedics, and traumatology. The category of middle risk is presented in the surgery, neonatology, urology, ENT, gynecology and obstetrics wards. There’s a low risk in the standard internal departments, pediatrics and neurology. Specific situations exist in psychiatric departments and long-term care hospitals, where chronic and long-term hospitalized patients can move freely within different departments of the hospital.
It is important to know that the origin of resistant bacteria is associated mainly with taking too many antibiotics which can lead to the antibiotics no longer working against bacteria. For a long time it was assumed that the cases of MRSA are only hospital-associated, so-called nosocomial infections. But MRSA has been isolated in some communities out of hospitals.
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MRSA presents a worldwide problem. The number of invasive infections has been tracked since 2000 by a worldwide system, EARSS (European Antimicrobial Resistance Surveillance System.) The largest number is in the USA (around 60%) and in Japan (more than 70%). There are significant differences among European countries in MRSA infections.
Greta Britain, Ireland, France, Portugal, Croatia, Italy, Greece, Romania and Bulgaria report MRSA occurrences between 25 - 50%. Central European countries and Spain 10 - 25%; northern countries have traditionally low occurrences of MRSA, the best situation is in the Netherlands, Denmark and Sweden (< 1%.)
The Czech Republic, from 2000 – 2005, saw an increasing trend in MRSA infections; from 3.8% in 2000 to 9% in 2004 and 14.3% in 2005.
The MRSA incidence rate from 100,000 patient hospital days in 2006 was: the Czech Republic 1.6; Great Britain 12.5; France 8.6; Germany 1.1; Italy 7.2; Austria 1.5; Holland 0.5; Sweden 0.3; Finland 0.8; Spain 6.3; Denmark 0.2; Hungary 17.0; Portugal 26.9; Turkey 9.4 (see table.)
The most common diagnosis associated with MRSA in the Czech Republic are malign disease (26%), traumas (21%), low respiratory tract infections (16%) and diabetes mellitus (7%.) The increase of MRSA transfer in the Czech Republic was slowed by implementing strict measures. These include isolation of the patient with MRSA in a single bedroom, his/her treatment and decolonization with the help of tested suitable antibiotics, precautionary measures by all who come in contact with the person and increased medical control and regime measures until a third negative bacteriological examination was verified. Separation of the staff (nurses) for the MRSA patient, as well as a bacteriological examination of newly received patients and of attending staff (testing from the throat, nose and armpit) measures were also introduced, as was the usage of personal protective devices by the medical staff (face masks, gloves, shoe coverings, head cover). Hospitals introduced a strict barrier treatment that included the individualization of all devices that are necessary for the treatment and examination of the patient with MRSA and proper disinfection and sterilization of these devices. The most important measures are hand washing and hand disinfection by hospital staff; including wearing gloves and frequently changing them between different procedures for the patient. The selection of antibiotics and disinfection agents is decided upon with a microbiologist and epidemiologist depending on the current state.
| MRSA incidence from 100,000 patient days in 2006, for different countries | |||
| Country | MRSA incidence from 100,000 patient days in 2006, for different countries | Country | MRSA incidence from 100,000 patient days in 2006, for different countries |
| Austria | 1.5 (1.3 - 1.8) | Italy | 7.2 (6.5 - 8.1) |
| Belgium | 3.8 (3.2 - 4.4) | Latvia | 0.8 (0.5- 1.3) |
| Bulgaria | 1.4 (1.1 - 1.8) | Luxembourg | 3.1 (1.9 - 4.9) |
| Cyprus | 5.8 (3.8 - 8.2) | Lithuania | 1.8 (1.3 - 2.5) |
| Czech Republic | 1.6 (1.4 - 1.8) | Malta | 17.0 (14.3 - 19.4) |
| Germany | 1.1 (0.8 - 1.6) | Netherlands | 0.5 (0.3 - 0.8) |
| Denmark | 0.2 (0.1 - 0.5) | ||
| Estonia | 0.3 (0.1 - 0.8) | Poland | 1.0 (0.7 - 1.3) |
| Spain | 6.3 (5.7 - 6.9) | Portugal | 26.9 (25.4 - 28.4) |
| Finland | 0.8 (0.6 - 1.2) | ||
| France | 8.6 (8.0 - 9.3) | Sweden | 0.3 (0.2 - 0.5) |
| Croatia | 4.6 (4.0 - 5.3) | Slovenia | 1.3 (0.9 - 1.9) |
| Ireland | 14.6 (13.7 - 15.5) | Turkey | 9.4 (8.6 - 10.3) |
| Iceland | 14.1 (12.7 - 15.7) | Great Britain | 12.5 (11.6 - 13.4) |
| IS | <0.9# | Median | 3.8 |
In spite of a slightly raised trend of MRSA occurrence from 2000 to 2005, the Czech Republic is one of many countries with a low number of MRSA infections compared to USA, Japan, Great Britain, Ireland and Italy. As mentioned above, departments with a greater risk of infection are intensive care units, burn and traumatology centers. The risk of MRSA infection at the private clinics of plastic surgeries is very low.
It is necessary to emphasize that it is possible to prevent MRSA infection by appropriate epidemiologic measures and if symptoms have begun to appear, it is treatable. Luckily there are antibiotics and disinfecting agents that can fight against this feared and insidious bacterium.