§ Mr. Horam
The Department has made no such estimates. Data on the incidence of methicillin resistant staphylococcus aureus compiled by the Public Health Laboratory Service from numbers of isolates for which hospitals have requested specialist typing show a total of 2,286 confirmed reports from hospital incidents in 1992, 4,592 in 1993, 10,818 in 1994, 17,063 in 1995 and 21,272 until the end of October 1996. These figures represent the number of patients affected by MRSA, not the number infected, as about 80 per cent. of people who acquire MRSA, carry it harmlessly and do not suffer infection. An incident is three or more patients with the same strain in a month from the same hospital.532W
The results of the "Second National Prevalence Survey of Infection in Hospitals," published earlier this year, showed an overall prevalence rate for all types of hospital acquired infection of 9 per cent., compared with 9.2 per cent. in 1980. The survey, undertaken jointly by the Hospital Infection Society, the Public Health Laboratory Service and the Infection Control Nurses Association, was conducted between May 1993 and June 1994 and covered 37,000 patients across 23 specialties in 157 hospitals in the United Kingdom and Eire. There have been no published national studies on the incidence of hospital acquired infection, but the incidence rate is generally thought likely to be around half the prevalence rate.
§ Mr. Horam
MRSA infection can take the form of many different diseases from trivial skin infections to pneumonia or septicaemia. It would be wholly 533W impracticable to make all these diseases notifiable. Appropriate measures to control MRSA do not depend on it being notifiable.
MRSA does not have a distinct code within the revision of the International Classification of Diseases used for encoding death registration data at the Office for National Statistics. Consequently, there are no centrally held statistics on deaths from this cause. The Public Health Laboratory Service publishes aggregate data on numbers of cases of certain severe infections, some which are due to MRSA which are voluntarily reported to it by hospitals. It also publishes data derived from isolates of MRSA sent to it for specialist typing. Although these data give helpful indications of trends, it is not possible from either of these data sets to identify the total number of cases of MRSA infection.
§ Mr. Horam
Bacteria have the ability to develop resistance to antibiotics which are normally effective against them through exposure to these drugs. The emergence of some resistant bacteria such as MRSA is therefore a consequence of the necessity of antibiotic treatment in modern medical practice. Prevention of the spread of existing MRSA is dependent on effective infection control arrangement. In the case of tuberculosis, there is good evidence to relate the emergence of drug resistant tuberculosis to inadequate treatment of initially drug sensitive tuberculosis. In the United Kingdom, standard protocols have been in use for the treatment of tuberculosis for many years and the incidence of drug resistance is very low. New guidance issued this year aims to keep it this way.
Recently published research conducted in Gloucester into general practitioner antibiotic prescribing and meningitis has produced some interesting observations—including a possible link between meningitis and the high use of one particular type of antibiotic in towns in Gloucestershire in 1987. Such a hypothesis is, however, speculative and the findings need to be tested in other areas. The Public Health Laboratory Service will be asking its meningococcal working group for its recommendations on further work.
Drug resistance of Plasmodium falciparum malaria to the anti-malarial drug cholroquine has increased in both intensity and geographical distribution over the last few years, and resistance to the newer antimalarial, mefloquine, is now a problem in parts of south-east Asia. These facts have to be borne in mind when considering an appropriate malaria prevention strategy for travel to endemic areas.