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At the heart of general practice since 1960

Community-acquired infections rocketing

By Lilian Anekwe

Serious staphylococcal diseases are soaring in general practice, as community-acquired MRSA and other resistant infections begin to circulate freely in the community.

Research by the Health Protection Agency reveals a dramatic fivefold increase in rates of hospital admission for community-onset staphylococcal septicaemia, pneumonia and impetigo over a 15-year period.

Pulse first exposed soaring rates of staphylococcal infection last October, and revealed Department of Health plans for a ‘robust and comprehensive' surveillance system to monitor antibiotic-resistant infections in primary care.

The move was approved by ministers in response to the previously unpublished HPA findings, which also found an increase in GP prescriptions for antibiotics to treat staphylococcal infections.

The full research, published in May's Emerging Infectious Diseases, analysed admission data from 1990 to 2001 and 2003/4, and reveals ‘a major and previously undocumented increase in community-onset staphylococcal diseases'.

Staphylococcal blood infections increased by more than 15 times in patients over 85 years of age. Staphylococcal skin infections increased threefold, and bone and joint infections rose by more than 50%.

Between 1991 and 2006, figures from the Prescription Pricing Division showed a ‘major increase' in the prescription rates of floxacillin and fusidic acid – for which staphylococcal infection is the only indication given in the BNF.

The floxacillin prescribing rate per 100 of the population was 4.0 prescriptions in 1991 and 7.3 in 2006 (a 1.8-fold increase). The fusidic acid prescription rate per 100 persons rose from 2.0 to 5.0, a 2.5-fold increase, over the same period.

Study leader Dr Andrew Hayward, senior lecturer at the University College London centre for infectious disease epidemiology, said the increases in hospital admissions and GP prescribing were unlikely to be an artefact. ‘S. aureus is a common cause of infection, and it is unlikely most of this increase relates to healthcare activity. The admissions trends are more likely to reflect real increases

in community-acquired infections. That there were no equivalent increases in admission rates for unrelated community-onset conditions suggests the increase in staphylococcal disease represent a real shift.'

Dr Jim Kennedy, RCGP prescribing spokesperson, said: ‘Given that serious infections have increased, the increase in prescribing is not surprising.

‘There's something going on with staph, either with the organism itself becoming more virulent, poorer hygiene, or that with an aging population people are more susceptible.'

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