Control of multiply resistant cocci: do international comparisons help?
Antibiotic resistance has become a worldwide problem. However, the reasons for the uneven geographic distribution of antibiotic-resistant microorganisms are not fully understood. For instance, there are striking differences in the epidemiology of multiresistant gram-positive cocci between the USA and Germany. According to recent reports, the prevalence of high-level penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) in clinically relevant isolates of hospitalised patients in the USA and Germany are: PRP, 14% versus less than 1%; MRSA, 36% versus 15%; and VRE, 15% versus 1%. These disparities may be explained by several determinants: (1) diagnostic practice and laboratory recognition (all three pathogens); (2) clonal differences and pathogen transmissibility (VRE); (3) antibiotic prescribing practices (all three pathogens); (4) population characteristics, including extensive daycare exposure in the USA (PRP); (5) cultural factors (all three pathogens); (6) factors related to the health-care and legal system (all three pathogens); and (7) infection-control practices (MRSA and VRE). Understanding these determinants is important for preventing further spread of multiresistant cocci within the USA. A rational approach to national surveillance is urgently needed in Germany to preserve the favourable situation and decrease MRSA transmission. Finally, we suggest that a macro-level perspective on antibiotic resistance can broaden the understanding of this worldwide calamity, and help prevent further dissemination of multiply resistant microorganisms.
Harbarth
S
S
Children's Hospital, and Harvard Medical School, Boston, USA. stephan.harbarth@hcuge.ch
Albrich
W
W
Goldmann
D A
DA
Huebner
J
J
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000145:classification; D024901:Drug Resistance, Multiple, Bacterial; D005858:Germany / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006095:Gram-Positive Cocci / Q000187:drug effects*; D006801:Humans; D007391:International Cooperation; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D010818:Practice Patterns, Physicians'; D014481:United States / Q000453:epidemiology; D020713:Vancomycin Resistance
D000900:Anti-Bacterial Agents