Nordic countries risk loosing control of multiresistant staphylococci
Methicillin resistant Staphylococcus aureus (MRSA) is a major threat to patients and health
care systems. Many countries have lost control and are now battling the consequences. Until
recently, the Nordic countries were successful but now an alarming increase is taking place
both within hospitals and in the community (see figure).
Figure: Number of MRSA isolates reported to the national surveillance institutes in the Nordic countries from 1997 – 2004.
When Staphylococcus aureus acquires resistance to methicillin and thus to all other penicillins,
cephalosporins and carbapenems, the most important drugs in the treatment of Staphylococcal
infections are lost. The bacterium becomes more difficult to treat, there are fewer and poorer
therapeutic alternatives, patients suffer increased and prolonged illness and the risk of death increases.
Health costs are markedly increased since patients with MRSA require longer hospital stay than other
patients. To prevent further dissemination of the multiresistant bacterium patients are isolated in
single rooms and this adds to the cost of treatment. In USA, the added direct cost per blood stream
infection has been estimated to be over 17.000 USD. In several European countries, such as France
and the UK, the frequency of MRSA in blood stream infections is above 30%. The Nordic countries
must do everything possible to avoid travelling down that road.
A Nordic working party on MRSA was formed during the 20th Annual Meeting of the Scandinavian
Society for Antimicrobial Chemotherapy in 2003. Experts from all the Nordic countries unanimously
agreed that MRSA was a very serious threat to patients and health care systems in all the Nordic
countries. The working party has now issued its first report. All experts agree that a concerted Nordic
action to reduce the present and future consequences of MRSA is needed. The report is available on
the homepage of the SSAC: http://www.ssac.nu. The report clearly states the need for national control
programmes to identify and monitor individuals with MRSA. It unambiguously states that strict
infection control procedures are effective for combating MRSA and that such procedures must be
implemented throughout all health care facilities in the Nordic countries. It is furthermore of utmost
importance that all countries have a national policy for infection control.
For society to successfully combat MRSA, politicians, health care administrators and personnel
must understand the issues at stake, the problems involved and must be ready to support the
efforts needed. Failure to translate existing knowledge into concrete action will lead to irreversible
damage. Research on risk factors and effective interventions must be encouraged and funded. We can
not afford to wait, immediate action is needed.
Olav Øktedalen Otto Cars Niels Frimodt Møller
Chairman of the SSAC, Norway Sweden Denmark
Karl G. Kristinsson Jukka Nikoskelainen Bjørn Erik Kristiansen
Iceland Finland Norway
Gunnar Kahlmeter Bodil Eriksen-Neuman Marianne Jertborn
Sweden Finland Sweden
Lars Østergård Asle Enger Robert Skov, Denmark
Denmark Norway Chairman of the working party