Methicillin-resistant Staphylococcus aureus: Do we just have to live with it?

For two decades methicillin-resistant Staphylococcus aureus (MRSA) has been spreading among hospitals by transfer of infected patients or housestaff. Once entrenched, it is difficult to eradicate. Many physicians, recalling the relentless spread of penicillin resistance, doubt the clinical seriousness of MRSA and the need to try to eradicate it. New evidence indicates, however, that methicillin resistance is genetically different from penicillin resistance and that MRSA organisms tend to be more virulent than sensitive strains. Successful eradication of MRSA from hospitals has been well documented. Essential measures include surveillance to identify infected or colonized patients and personnel and to eradicate carriage, cohorting to separate infected from uninfected patients, barrier isolation precautions to interrupt spread, and environmental cleaning and disinfection around infected patients. Mupirocin is an effective new agent for eradicating MRSA carriage, but resistance can be expected if it is used indiscriminately.