MRSA Survivors Network, the prominent advocacy group in the USA is joining with organisations across the world for World MRSA Day - October 2nd.  The official website can be found at www.worldmrsaday.org

MRSA activists, including MRSA Action UK, are calling for world unity from governments, the healthcare industry and the community for a greater response to MRSA and other resistant pathogens.  In a bid for everyone to gain a greater understanding this web-page gives a potted history of MRSA.

October 2nd 1960 was the day when Professor Patricia Jevons observed Staphylococcus aureus that was resistant to the antibiotic Methicillin.  This new drug, also known as the chemical compound BRL 1241, had been published in the British Medical Journal as a suitable alternative to Penicillin for resistant strains of Staphylococcus aureus just a month beforehand (September 3rd 1960).  There was some caution reserved in the publication with resistance being shown in lower doses of the drug.  Shortly after in February 1961 the British Medical Journal cited Professor Jevons observation of the resistant pathogen that we now know as MRSA.   It soon became endemic in UK hospitals and around the world.  Now we are seeing its spread in the wider community.  With much more virulent strains of other "superbugs" evolving we wonder what the next 50 years will bring.

MRSA - A potted history

M stands for methicillin, a chemical derivative of penicillin, first called BRL 1241 because it was developed during the 1950s in the Beecham Research Laboratories at Betchworth in Surrey. R stands for resistant; the development of methicillin resistance in a hospital was first detected in October 1960 in Guildford, also in Surrey.  And SA stands for Staphylococcus aureas (commonly called Staph), the bacterium that causes boils, carbuncles, abscesses, osteomyelitis and most wound infections after surgery. Staph was discovered in the late 1870s by Alexander Ogston, a surgeon at the Aberdeen Royal Infirmary.

 

Staphylococcus aureas

 

The name Staphylococcus is derived from the Greek word staphyle or "bunch of grapes" because of the characteristic cluster-like appearance of the bacteria under the microscope. Due to its golden appearance Staphylococcus aureas was chosen (Aureas being a Roman golden coin).

 

There are 32 species of staphylococci, but only 17 are indigenous to humans.

Staphylococcus aureas is especially prevalent due to its surface proteins, which allow the organism to bind to tissues and foreign bodies coated with collagen, fibronectin, and fibrinogen. This permits the bacteria to adhere to devices such as sutures, catheters, and prosthetic valves.

 

Alexander Fleming was studying Staphylococcus aureas at St Mary's Hospital London when he discovered penicillin in 1928, and the first patient to be treated in the first clinical trial of the new antibiotic at Oxford was infected with it.

 

Albert Alexander, a 43-year-old policeman, was suffering from a spreading infection of his face that had started with a rose thorn scratch.  He had lost an eye and the infection had spread to his lungs and his shoulder.  On 12 February 1941 he was injected with penicillin made by Howard Florey and his team.  Alexander's condition improved dramatically. Treatment continued for five days.  But ten days later he relapsed, dying of staphylococcal septicaemia on 15 March: the supplies of antibiotic had run out despite attempts to make up for the depleted supply by extracting it from his urine for re-use.

 

Penicillin revolutionised the treatment of Staphylococcal infections.  But its power over them began to wane soon after its general introduction.  The first naturally occurring penicillin-resistant Staphylococci were noted by Fleming in 1942.  Between April and November 1946, 12.5 per cent of Staphylococcus aureas strains isolated at the Hammersmith Hospital in London were penicillin-resistant.  By early 1947 the percentage had tripled.  The bacteriologist Mary Barber showed that this rise was not due to the development of resistance while patients were being treated, but due to the spread of a Penicillin-resistant strain in the hospital. Some Staphylococci had the ability to make Penicillinase, a Penicillin-destroying enzyme. The introduction of Penicillin gave them an evolutionary advantage over strains killed by the antibiotic.  Methicillin was developed in response.

 

Florence Nightingale had revolutionised healthcare in the Crimean War, and following her methods after the turn of the century wards were well ordered and clean, strict attention to hygiene, assiduous hand washing and aseptic conditions meant every precaution to avoid infection was taken.  We were however about to become over reliant on antibiotics, and a culture developed where the strict discipline and skills needed to do the sick no harm seemed to relax.

 

With bacteria developing more and more resistance, and the most common surgical bacteria Staphylococcus aureas evolving, the first culture of Staph aureas found to be resistant to Methicillin was identified under a microscope at Colindale Laboratories in London by the late Professor Patricia Jevons, on October 2nd 1960.  This was followed by an outbreak at Queen Mary's Children's Hospital, Carshalton in 1962.

 

MRSA has now evolved and spread, is endemic in our hospitals, and now in the community.  The countries in Northern Europe adopted a strict Search and Destroy policy that was developed here in Britain.  The Royal Free had an outbreak in 1985 and controlled this by using this policy.  However, it was believed to be too expensive and consequently more outbreaks occurred until it became endemic. The Northern European policy that works is to Search, Isolate and Destroy the bacteria.  Strict screening and decolonising is carried out before patients are admitted to hospital, if patients have to be admitted as emergencies they are put into isolation.  Judicious prescribing of antibiotics is also a key in reducing resistance, using the correct antibiotic at exactly the right dosage and time.  Over use of broad spectrum antibiotics is not only responsible for resistance but for the problems we have with another killer super bug Clostridium difficile.

 

We are now beginning to reintroduce the strict policies here in the UK in an effort to bring this under control.  Patients who are going into hospital for surgery are being screened to see if they carry MRSA.  If they are found to be carrying it on their skin then they are decolonised with antibacterial wash and an antibiotic cream for the nose.  If they are found to be MRSA positive in hospital then hospitals should be placing patients into isolation until it has cleared.  It is now a top priority for the Department of Health in the UK.

 

Timeline of Methicillin Resistant Staphylococcus aureas

 

1959:

Methicillin is introduced as an antibiotic

1961:

Bacteriologist Professor Patricia Jevons discovers first Methicillin-resistant Staphylococcus aureas (MRSA) in England hospitals

1968:

First report of MRSA in American hospitals in Boston

1974:

MRSA accounts for 2% of hospital Staph infection in the USA

1981:

First reports of MRSA acquired in the community, while MRSA in hospitals rises steadily

1997:

MRSA accounts for 50% of hospital Staph infections

1998:

University of Chicago researchers report a 25-fold increase in community-acquired MRSA from 1993 to 1995.  During the same period, 35 children in Chicago are hospitalised with community-acquired MRSA

1999:

CDC reports deaths of four otherwise healthy children from community-acquired MRSA

2002:

University of Chicago team finds that new cases of community-acquired MRSA are genetically distinct from hospital strains

2007:

CDC estimates that MRSA causes 94,000 severe infections each year, killing 19,000

 

Sources: CDC, University of Chicago, Chicago Tribune

 

 

European Antimicrobial Resistance Surveillance System
showing MRSA bloodstream infections in Europe in 2007
:


 

European Antimicrobial Resistance Surveillance System - MRSA in Europe 2007 Number Total Percentage
Susceptible Resistant Number of recorded bloodstream infections Susceptible Resistant
United Kingdom 3096 1715 4811 64.4 35.6
France 3154 1096 4250 74.2 25.8
Sweden 2152 11 2163 99.5 0.5
Czech Republic 1439 213 1652 87.1 12.9
Spain  1224 418 1642 74.5 25.5
Austria 1364 139 1503 90.8 9.2
The Netherlands 1449 20 1469 98.6 1.4
Portugal 714 669 1383 51.6 48.4
Ireland 825 507 1332 61.9 38.1
Denmark 1304 11 1315 99.2 0.8
Hungary 920 279 1199 76.7 23.3
Turkey 739 388 1127 65.6 34.4
Italy 702 357 1059 66.3 33.7
Belgium 656 199 855 76.7 23.3
Germany 714 139 853 83.7 16.3
Switzerland 740 104 844 87.7 12.3
Finland  801 13 814 98.4 1.6
Greece 419 387 806 52 48
Norway 789 1 790 99.9 0.1
Israel 303 153 456 66.4 33.6
Slovenia 387 35 422 91.7 8.3
Croatia 234 141 375 62.4 37.6
Lithuania 219 21 240 91.3 8.8
Estonia 188 18 206 91.3 8.7
Poland 157 28 185 84.9 15.1
Latvia 154 14 168 91.7 8.3
Bulgaria 105 16 121 86.8 13.2
Luxembourg 83 22 105 79 21
Malta 50 55 105 47.6 52.4
Cyprus 44 41 85 51.8 48.2
Iceland 64 0 64 100 0
Romania 31 11 42 73.8 26.2
Recorded MRSA that is non susceptible to Cloxacillin or Dicloxacillin or Flucloxacillin or Methicillin or Oxacillin or Cefoxitin in participating European countries 2007
Source: http://www.rivm.nl/earss/database/

References:
Don�t pick your nose, Hugh Pennington - Stationery Office, July 2004, 0 10 292915 7

BRL 1241 - BRITISH MEDICAL JOURNAL SEPT.3,1960
CORRESPONDENCE - BRITISH MEDICAL JOURNAL JAN.14,1961

For further information on events in the USA, activist participation and how organisations or companies can become official sponsors contact:

Jeanine Thomas
MRSA Survivors Network
630 654-4588 USA
jthomas@mrsasurvivors.org

For events or details of being an official sponsor in the UK contact:

Derek Butler
Chair
MRSA Action UK
01772 683 788
07762 741114
derek.butler6@btinternet.com

Official World MRSA Day web site:
www.worldmrsaday.org

If you or someone you care about has been affected by a healthcare infection and you wish to discuss this with us, please contact us at info@mrsaactionuk.net