Prevention of CA-MRSA
Community-acquired/associated–methicillin-resistant Staphylococcus aureus (CA-MRSA) poses a special challenge, since the disease is still unknown to many physicians, and since it is often acquired by traveling in CA-MRSA “hot spots” and is frequently transferred to other family members. Thus, relying on public health services for its prevention would make sense.
Unfortunately, this approach is currently not feasible in Germany because of data protection. According to § 7 (2) of the Protection Against Infection Act (Infektionschutzgesetzes), CA-MRSA can only be reported if the investigating laboratory finds indications for multiple infections that are clearly interconnected. However, establishing such a chain of infection is already made difficult by the fact that samples (if these even undergo microbiological analysis) would have to be sent to the same laboratory. A further problem emerges from the fact that infections often occur either abroad or aboard the plane. Moreover, the current discussion about reporting extended-spectrum β-lactamase (ESBL) in neonates shows that defining “spatial and temporal clustering” leaves much room for interpretation.
The argument for data protection is difficult to understand, since MRSA in cerebrospinal fluid and blood is specifically reported in order to obtain a marker for hygiene management. However, since this evaluation can only be performed based on the patients' place of residence, it does not reflect hygiene management for high-performance medicine in the major urban centers. Additionally, data protection does not appear to play a decisive role for other, normally self-limiting diseases, such as for norovirus or, recently, influenza A (H1N1) virus.
I would highly welcome it if the spread of CA-MRSA could be contained through rational prevention—and this includes specific reporting of CA-MRSA and having the health department take the necessary measures.
PD Dr. med. Matthias Orth
Institut für Laboratoriumsmedizin
Vinzenz von Paul Kliniken gGmbH, Stuttgart, firstname.lastname@example.org
|1.||Köck R, Mellmann A, Schaumburg F, Friedrich AW, Kipp F, Becker K: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Germany. Dtsch Arztebl Int 2011; 108(45): 761–7. VOLLTEXT|