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Methicillin resistant Staphylococcus aureus (MRSA) in the Nordic countries

Methicillin resistant Staphylococcus aureus (MRSA) in the Nordic countries. Petter Elstrøm Advisor Norwegian Institute of Public Health. Objective. Prevent establishment of MRSA in hospitals Increased rate of MRSA enforce changes in empiric treatment of S. aureus -infections

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Methicillin resistant Staphylococcus aureus (MRSA) in the Nordic countries

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  1. Methicillin resistant Staphylococcus aureus (MRSA) in the Nordic countries Petter Elstrøm Advisor Norwegian Institute of Public Health

  2. Objective Prevent establishment of MRSA in hospitals • Increased rate of MRSA enforce changes in empiric treatment of S.aureus-infections • Changes in antibiotic-guidelines will lead to more resistant bacteria and increase the cost

  3. Historical overview • Penicillin G introdused in 1941 • Penicillin resistant (-lactamase prod.) S.aureus isolated in 1942 • Meticillin introdused in 1959 as the first -lactamase resistant penicillin • Meticillin resistant S.aureus first described in 1961 • In late sixties MRSA was identified as a nosokomial pathogen • In late nineties reduced sensitivity against Vancomycin (VISA) was reported • Vancomycin resistant S.aureus (VRSA) isolated in 2002

  4. Historical overview First ”MRSA-wave” • Meticillin resistant first described in 1961 • Worldwide spread of a single arcaic clone Second “MRSA-wave” • Outbreaks in hospitals • 5 dominant clones Third “MRSA-wave” • CA-MRSA • Evolution of ”old” clones • Continually new MRSA-strains discovered

  5. CA-MRSA • Both epidemiological and microbiological definition • Increased incidence among people outside hospitals • Young people with no known risk factors for MRSA • Differ genetically from strains inside hospitals • SCCmec IV, PVL • Less resistant • Mainly skin- and soft tissue infections Occasionally severe infections (necrotizing pneumonia)

  6. Changed epidemiology • Earlier: • Imported cases • Related to hospital admission or employment • Now: • Most domestic cases • Increasing rate of cases not related to hospitals • Often no known risk factors for MRSA • Outbreaks in nursing homes

  7. MRSA in western Europe Proportion of invasive isolates resistant to methicillin 2003 Source: www.earss.rivm.nl

  8. MRSA in England og Wales Proportion (%) of MRSA i blood culture, 1989-2002

  9. MRSA in the Nordic countries *Estimated for 2005 Source: http://www.srga.org/SSAC/doc/2005/SSAC_MRSAreport_2004.pdf

  10. MRSA in Denmark Distribution by place of transmission Source: Robert Skov, State serum institute, Sept. 2005

  11. MRSA i Danmark Distribution by age group, 2003 Source: Robert Skov, State serum institute, Sept. 2005

  12. MRSA in Sweden Distribution by place of transmission 2003 2004 Source: Otto Cars, Smittskyddsinstitutet, sept. 2005

  13. MRSA in Norway No. of cases, 1995 – 15.nov. 2005

  14. MRSA in Norway Proportion by county, 2004 - 2005

  15. MRSA in Norway Distribution by place of transmission

  16. MRSA in Norway Distribution by place of infection onset Hospitalized:

  17. MRSA in Norway Reported outbreaks in health care institutions

  18. 2003: 2 hospitals, 3 nursing homes 2004: 2 hospitals, 4 nursing homes 2005: 8 nursing homes

  19. Challenges • Increasing incidence of MRSA • Changing epidemiology • Bacterial evolution • Laboratorial methods are not optimal • Lack in knowledge • Differs in national and regional guidelines • Compliance of infection control measures are not optimal

  20. Actions • Coordinate the guidelines in the Nordic countries • Discuss and coordinate advices and guidelines in Norway • Better survey through genotyping of all isolates • Continue rational use of antibiotics • Science • High quality in hygiene and other infection control measures

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