Health care associated infections, HCAI, have recently raised the concerns of both the public and politicians because of their significant socioeconomic burden. MRSA is a big player in the aetiology of HCAI and constitutes a major public threat presenting both therapeutic and infection control challenges in both the hospital setting and the community. This book, which consists of 16 chapters written by a group of international experts on MRSA, comes at important crossroads. The book starts with a summary chapter written by Ian Gould, the editor.
MRSA was first isolated in the United Kingdom in 1961, two years after the introduction of Methicillin, although there is evidence that it was there before that. Chapter 3 describes the evolution of MRSA since then and explains how the recent molecular techniques helped to understand that. However, there are other molecular advances which added to the understanding of MRSA such as VNTR, spa sequencing, toxin gene profiling and DNA arrays which are currently used in Colindale laboratories to type MRSA.
The distribution of MRSA is quite patchy and there is huge variation within the individual countries. This may reflect variations in surveillance, sampling, screening programmes and how strict the infection control measures are. There is a great difficulty in dividing MRSA acquisition to community and hospital, so most recently it is divided to community acquired, community onset and hospital acquired; Chapter four and five explains this very well.
The relationship between Staphylococcus aureus/ MRSA and its human host start with colonisation, going through local inflammatory response, to severe invasive disease. Chapter two sketches the various virulence factors and their associated host responses in simple comprehensive way without unnecessary details. I personally recommend following with reading chapter nine which explains the different clinical presentations of MRSA infections with totally devoted chapter, 8, for CAMRSA.
Since 1961, when MRSA was first isolated until now, there are huge advances in the laboratory diagnosis of MRSA. For better infection control purposes we need timely identification, but how rapid? Rapid identification is a real challenge for most of the microbiological labs. Chapter 6 explores the debates about the currently available laboratory diagnostic methods and explains the real difficulties we face when dealing with MRSA isolates.
Treatment of MRSA has been complicated by the development of resistance to the different anti-staphylococcus drugs including the newly introduced agents (chapter 10 &7). The new anti-MRSA drugs, apart from Linezolid, should be used intravenously which limits their use in the community. My only comment is, there is very little mentioned about the classical oral treatment which we usually prescribe for treating simple uncomplicated urinary tract and soft tissue infections. Natural alternative treatments have been also suggested, but unless there is clear evidence that they work without causing significant toxic effects, it is very early to consider these options.
Chapters 16, 11, 13, 14 and 15 deal with MRSA surveillance and infection control challenges. There is no clear evidence that decolonisation, environmental cleaning (unless it is terminal cleaning) and isolation/ cohorting (unless it is done right) do or do not work. Also, there is no clear consensus as to which practice is of most value in preventing transmission of MRSA. Most of the infection control specialists believe that package of measures that work most.
I enjoyed reading “MRSA in Practice” and I recommend this book for those who are interested in furthering their knowledge about MRSA infections. I would also like to commend on further readings' section which follows most of the chapters, giving chances for those who would like more details. I think, apart from the feeling that the chapters may need to be arranged differently, to maintain a more streamlined reading, and unavoidable duplication of information, “MRSA in Practice” is a very useful up to date comprehensive review.