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At the heart of general practice since 1960

MRSA spotlight to focus on GPs

By Lilian Anekwe

The drive to combat resistant infections is to focus on general practice for the first time, with ministers to act on the results of a new study revealing soaring rates of staphylococcal infections.

The Department of Health is to set up a ‘robust and comprehensive' MRSA surveillance system in primary care after researchers found an unexplained 90% rise in GP use of antibiotics for suspected S. aureus cases.

The programme – to begin ‘imminently' – will recruit patients through general practice, either by posting sample collection kits to patients identified through GP lists, or by collecting samples directly from surgeries.

Professor Roger Finch, chair of the department's advisory committee on antimicrobial resistance and healthcare-associated infections, called community-acquired infections the ‘unseen enemy' of primary care.

‘We know hospital MRSA has gone into the community. It's circulating in individuals who have had no contact with hospitals and we need an adequate means of horizon-scanning,' he warned.

The programme, to focus on community-associated MRSA and PVL-positive S. aureus, comes a week after another resistant infection hit the headlines, with Maidstone and Tunbridge Wells NHS Trust condemned after a C. difficile outbreak.

The DH-commissioned research showed GP rates of antibiotic prescribing for community-acquired staphylococcus infections rose by more than 90% over 10 years, from 26,000 per million in 1991 to 50,000 per million in 2001.

The analysis of UK general practice research database records – to be published in Emerging Infectious Diseases – found a comparable increase in related hospital admissions.

Study leader Dr Andrew Ha-ward, senior lecturer in infectious disease epidemiology at University College London, told Pulse: ‘We noticed a big increase in prescriptions, particularly flucloxacillin, for staphylococcal skin infections.

‘We didn't see the same rise for other acute infections and could not think of any explanation other than a rise in staphylococcus infections, or an increase in their severity.'

But a Pulse investigation has revealed huge regional variations in the amount PCTs allocate to infection control – from nothing to more than £2m.

Evidence is emerging that where cases of community-acquired MRSA arise, GPs are left to deal with them without adequate support.

Dr Stephen Fox, a GP in Leigh, Lancashire, has had to treat ‘about one MRSA-positive patient a month' with little support from secondary care or microbiologists, a situation he described as a ‘complete shambles'.

Why ministers are acting on MRSA

• 90% rise in past 10 years of antibiotic use for staphylococcal infections, thought to signal soaring rates of community-acquired MRSA
• £0-£2m: range of money currently allocated by PCTs to tackle resistant infections
• 20,000: number of samples to be collected as part of new MRSA surveillance scheme in general practice

MRSA: Infection rates soaring in people who have not had hospital contact MRSA: Infection rates soaring in people who have not had hospital contact

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