Hong Kong's first case of vancomycin resistant Staphylococcus aureus was reported last week.
Hong Kong is the fourth country-after Japan, the United States, and France (27 February, p 557)-to report a case of Staphylococcus aureus resistant to vancomycin. The patient, a middle aged woman with cancer, was admitted in June 1998 to Queen Mary Hospital, Hong Kong, with a fever. She died of bacteraemia after two weeks of treatment had failed to control the infection.
Professor Yuen Kwok-yung, a microbiologist at the University of Hong Kong, discovered the vancomycin resistant isolate in a retrospective study of 52 methicillin resistant Staphylococcus aureus specimens, using a new test to detect the strain. He reported the case to two local newspapers after his findings had been confirmed by a research centre in the United Kingdom and accepted for publication.
Professor Yuen has called for a reduction in the use of all antibiotics to minimise the risk of the development of bacterial resistance. He has estimated that the current prevalence of methicillin resistant S aureus in Hong Kong is between 30%and 40%In Hong Kong, pneumococcus resistance to penicillin, which was first detected 10 years ago, now occurs in 70%of cases -one of the highest rates in the world.
The Hong Kong Hospital Authority, which manages all public hospitals and outpatient clinics, held an emergency meeting of its task force on infection control last week. The authority released a statement emphasising the need to control the use of antibiotics and to restrict their use to cases in which they were clinically indicated. New screening tests to detect vancomycin resistance in S aureus in public hospitals and revised guidelines on the use of the drug are expected to follow.
As a result of the emergence of the vancomycin resistant staphylococcus, Hong Kong doctors have been criticised for overprescribing antibiotics. But Dr Lo Wing-lok, vice president of the Hong Kong Medical Association, said that it is too early to draw such conclusions. Public hospitals and clinics have statistics on the use of antibiotics. However, antibiotic resistance is not monitored in the private clinics that provide primary care to 70%of the people in Hong Kong.
Dr Lo said: “A comprehensive surveillance system is needed before an accurate assessment can be made and policy formulated. That's the place to start.” Two other factors are contributing to the problem, he suggested. Although illegal, buying antibiotics in pharmacies without a prescription is common, and the use of antibiotics in livestock imported into Hong Kong is widespread.