Correspondence (reply): In Reply

Dr. Orth points out that in the German Protection Against Infection Act (Infektionsschutzgesetz, IfSG), the term “CA-MRSA” is not explicitly listed. That is correct. However, the definition of this term is still controversial. Often, an epidemiological definition is used, in which “CA-MRSA” reflects all MRSA cases found in patients without a “ history of risk for nosocomial acquisition of the pathogen”. The question of whether MRSA should be classified as “CA-MRSA” can therefore not be answered in a laboratory. Laboratory indicators of “CA-MRSA” (for example, PVL genes) are usually not routinely determined and do not necessarily define “CA-MRSA.” Thus, the practical implementation of a reporting requirement for individual cases of “CA-MRSA” by laboratories (similar to the existing reporting requirements for detecting MRSA from blood cultures according to the “regulation for adapting the reporting requirements of § 7 IfSG to an epidemiological situation”) is difficult, in our opinion.

However, it is already required that attending physicians report any “threatening illness” that presents “a serious danger for the general public” (§ 6[1]5 IfSG) to the health department. This definition does not exclude “CA-MRSA.”

In any case, we agree with Dr. Orth that involving public health services in preventing CA-MRSA would be useful, as this would permit for example therapies to be monitored and evaluation of relatives, colleagues, school children, and so forth, to be organized.

It should also be noted that, due to the decentralized organizational structure of the German infectious disease reporting system, data on MRSA bacteria is reported for the place of residence of the patient, rather than for the location of the hospital in which the infection occurred. The data therefore could support a global or, in the best case, a regional surveillance of MRSA infections rates, but would not be usable for an evaluation of the hygiene management of individual hospitals.