raising public awareness - campaigning for safer standards
supporting sufferers and dependants

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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 3^rd 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