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MRSA and C. difficile slip through GPs' net

By Lilian Anekwe

Large numbers of antibiotic-resistant infections are going undetected in general practice because control measures are overly focused on hospitals, specialists warn.

Consultant microbiologists are demanding a new focus on controlling rates of Clostridium difficile and MRSA in the community amid soaring numbers of cases.It comes amid claims that the rate of increase of C. difficile in the community is 'far outstripping the rate in hospitals'.

A Pulse straw poll of consultants revealed concern that without systematic surveillance of antibiotic resistance, many infections would be missed.

Professor Kate Gould, director of infection prevention and control for Newcastle upon Tyne hospitals NHS foundation trust, said:

'Some attention has shifted to the community, but this is very patchy. In my opinion more effort needs to be put into infection control and antibiotic prescribing in the community if we are going to make an impact on these organisms.'

Dr Michael Millar, consultant in microbiology at the Royal London Hospital, said: 'Most GPs treat patients empirically – only using the laboratory when patients present in an unusual way or fail to get better quickly. Many antibiotic-resistant infections are not detected.'

An editorial published in the BMJ last week called for measures such as curbs on antibiotic use to be extended to the community to tackle the rise in infections.

Dr John Starr, a reader in geriatric medicine at the University of Edinburgh medical school, warned the relative increase in community-acquired C difficile 'far outstrips that seen in hospital despite reduced antibiotic use'.

Health Protection Agency data shows the number of cases of the infection rose 5.5 per cent between the first three quarters of 2005 and the same period in 2006 – although there is no national data on community-acquired infections.

Dr Starr argued: 'It is important to consider whether a C. difficile infection control policy solely focused on hospitals remains appropriate.'

But Professor Peter Davey, professor of clinical pharmacology and infectious disease at the University of Dundee, warned: 'It sounds like jumping to conclusions to say that because we're seeing more C. difficile it's because of community-acquired infections.'

Steps to tackle drug-resistant infections

• Epidemiological studies to understand the extent of resistance

• Systematic surveillance of antibiotic resistance in the community

• Debate on whether targets and incentives are needed

• Consistent infection control guidelines

• Better use of infection control expertise

Source: consensus of consultant microbiologists

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