Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe

Within the healthcare setting alone, MRSA infections are estimated to affect more than 150,000 patients annually in the European Union (EU), resulting in attributable extra in-hospital costs of EUR 380 million for EU healthcare systems. Pan-European surveillance data on bloodstream infections show marked variability among EU Member States in the proportion of S. aureus that are methicillin-resistant, ranging from less than 1% to more than 50%. In the past five years, the MRSA bacteraemia rates have decreased significantly in 10 EU countries with higher endemic rates of MRSA infections. In addition to healthcare-associated infections, new MRSA strains have recently emerged as community and livestock-associated human pathogens in most EU Member States. This review describes the current burden of MRSA infections in healthcare and community settings across Europe and outlines the main threats caused by recent changes in the epidemiology of MRSA. The burden of HA-MRSA extends beyond acute care hospitals to long-term care facilities (LCTFs), such as nursing homes. Consequently, effective MRSA containment in the healthcare setting cannot be limited to acute care hospitals, but must include LCTFs also. Otherwise, the significant MRSA reservoir that has developed in LTCFs and the transmission dynamics between LTCFs and acute care hospitals due to the transfer of patients is bound to compromise control. A second challenge concerns CA-MRSA which has now emerged across Europe. Although its prevalence is still considerably lower than in the USA, the number of CA-MRSA infections appears to be increasing, especially in those European countries where the incidence of HA-MRSA is low and surveillance of MRSA more extensive. The problem of CA-MRSA infections is not limited to the community but also affects nosocomial infections due to the introduction of CA-MRSA in healthcare settings. In addition, only a limited number of European countries have developed national strategies and no common European strategy has yet been developed for the surveillance or the prevention of CA-MRSA spread. The final challenge to tackle is the animal MRSA reservoir For long-term success in controlling MRSA, coordinated actions between different healthcare sectors (acute, long-term, ambulatory) and veterinary care are warranted and concerted efforts at European level will be of increasing importance. Eurosurveillance. 2010;15(41);pii=19688. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19688