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Report from the MRSA Working Group Background 20th SSAC in Odense Presentation by Prof. Karl G. Kristinsson documented an increasing incidence of MRSA in the Nordic countries SSAC MRSA Working Party formed Goal Keeping the level of methicillin resistance in Staphylococcus aureus below 1% in the Nordic Countries Denmark: Dr. Hans Jørgen Kolmos, Odense University Hospital Dr. Robert Skov, SSI, Chair Finland: Dr. Reijo Peltonen, Turku University Hospital Dr. Jaana Vuopio-Varkila, KTL Iceland: Dr. Hjordis Hardardottir, Landspitali University Hospital Dr. Olafur Gudlaugsson, Landspitali University Hospital Norway: Dr. Stig Harthug, Haukeland University Hospital, and Norsk Folkehelse Dr. Yngvar Tveten, Telelab Sweden: Dr. Barbro Olsson-Liljequist, SMI Dr. Tinna Åhrén, Sahlgrenska University Hospital Tasks 1 Suggest simple ways on how national data on the epidemiology of MRSA can be reported to the Working Party reporting of the information to different stakeholders and the public domain Compare current guidelines and practices, including registration practices, laboratory methodology and infection control in the Nordic countries and identify similarities and major discrepancies. Tasks 2 Suggest quantifiable (measurable) goals for the preventive strategies against MRSA in the Nordic countries. Suggest measures to obtain these goals Identify and prioritise areas where there are important gaps of knowledge and suggest studies in these areas Report regularly to the SSAC board and at SSAC meetings. Focus areas Epidemiology Laboratory Methodology Infection Control Epidemiology Currently the terms and definitions vary between the Nordic countries. Reporting infections vs both infections and carriers Definition of a new episode vs relapse Acquisition • HA-MRSA • CO-MRSA • CA-MRSA * 04 20 03 20 02 20 01 20 00 20 99 19 98 19 97 19 96 19 95 19 94 19 Denmark 500 400 300 200 100 0 Denmark - acquisition - 2003 Unknown 5% Active screening 18% Comunity onset without risk 25% Imported 10% Community onset with risk 17% Hospital aquired 21% Finland, 1.1.1995-31.7.2004 Number of cases (infections AND carriers) 900 800 700 600 582 500 389 400 495 300 267 200 106 100 0 100 184 231 59 27 62 72 61 83 111 36 77 77 102 1995 1996 1997 1998 1999 2000 2001 2002 Helsinki area Rest of the country Source: KTL, National Infectious Disease Register 2003 291 31-072004 Finland; children and the elderly Number of cases (infections AND carriers) 900 800 700 600 500 <14 years >65 years total 400 300 200 100 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 Aug 04 Source: KTL, National Infectious Disease Register Iceland 50 No. of Individuals 45 40 Health Care Ass. 35 Community Acq. 30 25 20 15 10 5 0 2002 2003 Year 2004 (-> Sept. 1st) MRSA in Norway By Acquisition (January Through Aug 10th 2004) No 160 140 Hosp. Acq. 120 Community-acq. 100 Unknown 80 60 40 20 0 1995 1996 1997 1998 1999 2000 Year 2001 2002 2003 2004est Sweden 700 No. of Isolates 600 500 400 300 200 100 0 2000 2001 2002 2003 2004est Sweden Acquisition i 2004 24% Domestic Abroad 53% 23% Unknown Epidemiology Suggestions for the future Development of uniform terms and definitions Initiate a coordinated Nordic surveillance project Laboratory methods All countries but Norway have one central laboratory for MRSA surveillance Norway is expected to have one quite soon Collaboration on optimizing detection of MRSA Collaboration on uniform strain nomenclature Infection Control It is possible to care for MRSA positive patients without spread of MRSA. For the successful control of MRSA it is imperative that the MRSA positive patient have the same rights for and access to medical care as the MRSA negative patient. Infection Control It has been observed that the increase is slower in areas which practice very strict MRSA policy For control of MRSA in hospitals it is imperative to convince medical staff and administrators that hygiene precautions must be incorporated into daily routines Infection Control In order to enhance compliance and decrease the risk for confusion, identical measures should be applied within all institutions within the same area/region. These measures should be in accordance with national guidelines and regulations. Infection Control Suggestions for the future Perform a Nordic multicenter study in community onset MRSA Conclusion 1 The information collected and shared in the Working Party has been of great importance for use in the debate and decision making in the individual countries. Conclusion 2 What is needed now Development of uniform epidemiological terms and definitions • Priority 1 Increased knowledge on CA-MRSA Establish rapid exchange of information of epidemics and endemicity between the Nordic countries.