Stopping short the spread of methicillin-resistant Staphylococcus aureus.

A s described by Andrew Simor and colleagues 1 elsewhere in this issue (page 21), Canadian hospitals, like many hospitals elsewhere, have recently witnessed an increase in the proportion of Staphylococcus aureus isolates that are resistant to methicillin (known as methi-cillin-resistant S. aureus or MRSA). The rate has risen from 1% of all isolates in 1995 to 6% in 1999. 1 Despite the increase , Canada's rate of MRSA is much lower than those of many other countries, such as the United States (where 40% of strains are resistant), Japan (80%) and European countries such as Italy, Greece, France, Belgium and Spain (all of which have rates higher than those in Canada). 2 The Canadian rate is similar to those observed in Switzerland and the Scandinavian countries, but it is 5 times higher than in the Netherlands. 3 It is surprising that despite frequent cross-border traffic between the United States and Canada and between Canada and many European countries , there are still such great differences in rates of MRSA strains among these countries. The cause of such substantial differences between countries and between hospitals must relate to local differences in antibiotic policies and infection control measures. In the Canadian study 1 more than half of the isolates could be linked to an index case, and molecular techniques showed that 81% of the isolates were identical with 1 of only 4 epidemic strains. These findings suggest that even in a country as geographically vast as Canada, infection control measures can and should be centrally organized in the battle against MRSA. As discussed by Simor and colleagues , 1 there is an urgent need to implement better infection prevention and control measures to limit the spread of MRSA in the hospital setting. In the Netherlands both colonization and infection with MRSA occur in less than 1% of patients. This low rate can be attributed to hospitals' enforcement of the stringent infection control measures that were established by the Dutch Working Party on Infection Prevention almost 10 years ago. 4 The basis of those guidelines is a " search-and-destroy " strategy. For example, all patients transferred to our hospital (a 1042-bed teaching hospital that encompasses all major disciplines) from hospitals outside the Netherlands are kept in quarantine for at least 48 hours. During that time they receive medical care, and screening cultures are taken from the skin and mucous membranes of the …