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The latest MJA has this editorial: Staphylococcus aureus: a guide for the perplexed
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Staphylococcus aureus is one of the most important bacterial pathogens globally. About a quarter of us carry one or other strain at any one time, and, if we develop an infection, our own colonising strain is likely to be responsible. All clinicians, from urban general practitioners to remote-area nurses, encounter S. aureus infections. In hospitals, S. aureus is responsible for most surgical-site infections, and their control poses a major challenge.
We have no effective vaccine against S. aureus, so for 50 years we have depended on the safe and affordable β-lactam antibiotics. However, in many large Australian hospitals, patients run the risk of becoming colonised with a hospital strain of S. aureus, many of which are β-lactam resistant — “golden staph” in the vernacular. As β-lactam resistance is detected in the laboratory using methicillin or oxacillin, microbiologists call these strains “methicillin-resistant Staphylococcus aureus” (MRSA) (see Box 1 for acronyms). All MRSA harbour the mecA gene that encodes a modified cell wall protein to which no β-lactam antibiotic is able to bind. Strains of health care-associated MRSA (HA-MRSA) are usually not only resistant to β-lactam antibiotics, but also carry several other resistance genes or mutations. Typically, Australian HA-MRSA isolates are not only “methicillin-resistant” but also “multiresistant”, leaving only vancomycin and a very short list of alternatives as the last line of defence.
Fortunately, when clinicians have to prescribe antibiotics for S. aureus infections, the decision has been relatively straightforward — a β-lactam such as flucloxacillin or cephalexin if the infection is community-acquired (because MRSA has been rare in the community), or vancomycin if the patient has recently been in hospital. However, in the article by Nimmo and colleagues in this edition of the Journal, this neat epidemiological distinction is under attack. MRSA appears to be at large in the community, and the types of infections we associate with MRSA are changing. What is going on out there? Has MRSA escaped from the hospitals? ....
The ABC are reporting: Western Australia looks to combat spread of golden staph
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Concern about a rise in the number of golden staph cases in the community has prompted the Western Australian Health Department to consider testing entire communities for a new drug-resistant form of the bacteria.
The number of people who contract the infection in the community, not from the health system, is on the rise across Australia and around the world.
In some cases, the strains are accompanied by toxins that can make the infection much more severe and sometimes life-threatening.
The Health Department is looking at ways of slowing the spread of the infection, and one proposal is to examine everyone who may have come in to contact with the bacteria.
Royal Perth Hospital microbiologist Helen Van Gessel says there is no simple solution.
"How do you control them in a community setting - and that's been a topic of major discussion all over the world about exactly how you do that in people's houses and school settings and things like that," she said.
Staphylococcus aureus: a guide for the perplexed
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