Questions posed by Angelika Petrich-Hornetz
Multiresistant Staphylococci are bacteria that are resistant to an increasing number of antibiotics. They cause a range of illnesses and have spread worldwide in recent years. Apart from the strains found exclusively in hospitals, others are now being detected outside the clinical environment. To find out more, Wirtschaftswetter spoke to Professor Sören Gatermann, a lecturer at the University of Bochum and head of Bochum’s Institute for Medical Microbiology, whose work focuses on microbiological diagnostics, infectious disease epidemiology, resistance mechanisms in microorganisms and hospital hygiene.
Wirtschaftswetter : Professor Gatermann, what is the current situation in German hospitals and clinics? How widely has MRSA spread?
Professor Gatermann: MRSA (methicillin-resistant Staphylococcus aureus) is widespread in German hospitals. A recent study published by the Paul-Ehrlich-Gesellschaft (PEG) for Chemotherapy shows that in 2001, some 20.7 per cent of Staphylococcus aureus found were multiresistant bacteria. The rate of MRSA detected today is considerably higher. What these figures do not show, however, is that at local level (meaning both regionally and in individual hospitals) the presence of MRSA differs significantly – at the extreme, levels range from below 10 per cent to above 70 per cent.
Wirtschaftswetter : Has the experienced gained with MRSA over the past ten years resulted in improved hospital hygiene, say in the use of disinfectants and measures to isolate affected patients?
Professor Gatermann: Because MRSA has been around for quite some time (since 1961) and was already present in Germany prior to 1995, there has been no reason to make any significant changes to the way things are handled. The most important factor is still that people must make a conscious effort to comply with rules on hand hygiene and patient isolation. Some deficits do exist, however, when it comes to implementing these requirements.
Wirtschaftswetter : Has research provided any new findings on effective medication and methods to combat MRSA now or in the future?
Professor Gatermann: A new antibiotic was recently introduced for use as an alternative to established treatments. Another will be available shortly. Even so, it can be expected that bacteria will also become resistant to these new antibiotics although we cannot project how long it will take.
Wirtschaftswetter: The healthcare sector is suffering due to cost-cutting measures and outsourcing is now part of everyday hospital life. How do you feel about laboratories being outsourced and MRSA samples being sent outside a hospital for testing?
Professor Gatermann: MRSA is highly resistant to environmental influences, so there is little problem in actually detecting these bacteria in sample testing. The real problem is that sending a sample for testing takes up valuable time. This allows MRSA to spread during that time and can cause hospitals to use valuable funds and add to a patient's burden if isolation measures that are both expensive and inconvenient have to be implemented pending the results from the laboratory.
Wirtschaftswetter: Outsourcing of other services like hospital cleaning has long been the norm. Do service providers guarantee a high standard of cleanliness when it comes to disinfecting surfaces?
Professor Gatermann: This largely depends on the service provider and the terms of the service agreement. It is impossible to generalise. It is important, of course, only to use providers with the skills to cope with the problems that arise in hospitals.
Wirtschaftswetter: Private investors are aiming to further reduce hospital costs by placing services formerly performed in separate buildings under one common roof. Does the microbiology sector have any recommendations as regards hospital construction and design to prevent the spread of bacteria?
Professor Gatermann: Isolation of wards into seperate buildings has long been practised, but is no longer indicated except for highly contagious diseases, e.g. like Ebola. Modern hygiene and ventilation technology and other building systems are now so sophisticated that there is no longer a need for isolated buildings to prevent the spread of infection.
Wirtschaftswetter: What is the situation in Germany regarding MRSA outbreaks in other institutions like residential and care homes, nursery schools, sports centres and schools?
Professor Gatermann: When it comes to homes for the elderly, a number of studies have shown significantly lower prevalence in Germany compared to other countries. No data is available on nursery schools, sports centres or schools.
Wirtschaftswetter: Initial reports from the US suggest that certain strains of MRSA have become established outside hospitals and in the population at large. What is the situation in Germany and how can we expect things to develop?
Professor Gatermann: Although strains of community-acquired (CA) MRSA have been detected here in Germany they are very rare. While it is always difficult to project what will happen in the future, we must be vigilant to avoid overlooking strains of this kind and to safeguard against them spreading.
Wirtschaftswetter: How well informed are the staff in medical practices, e.g. general practitioners and paediatricians, regarding the current situation? Do you see a need for improvement or are you happy with the level of information, background knowledge, treatment and hygiene measures available to medical practitioners?
Professor Gatermann: The frequent training courses conducted here make it clear that practical knowledge still leaves much to be desired. The situation has improved compared with earlier times, however.
Wirtschaftswetter: What do patients, doctors and relatives need to consider if a patient with MRSA is released from hospital for ongoing care at home?
Professor Gatermann: When it comes to care in the home, doctors and professional care staff need really only make sure that they are meticulous about disinfection. That means disinfecting their hands to avoid passing the bacteria on to other patients. Family members are only at risk in exceptional cases. If anyone thinks they might be at risk from coming into contact with an MRSA patient they should see their doctor.
Wirtschaftswetter: Are there any newly identified risk groups who need to be given more care in order to avoid infection?
Professor Gatermann: No new high-risk groups have been identified so far. (Editor’s note: risk groups include patients in intensive care, those suffering from skin complaints and those with immune deficiency).
Wirtschaftswetter: Last but not least, can resistant staphylococci disappear over time or is it impossible to get rid of them?
Professor Gatermann: They can disappear in patients and there are specific treatments to help the process. They can also disappear from an entire country, as has happened in Denmark. The Netherlands, Sweden and Western Australia all have low MRSA levels thanks to rigorous management. It is possible to get rid of resistant bacteria – you just need to apply the right hygiene measures and use antibiotics wisely. After all, the main cause of resistant bacteria selection is the use or rather the unnecessary use of antibiotics.
Professor Gatermann, thank you for your time.
In German: Staphylokokken, Resistenzen und Hygiene
Further information and point of contact: RUB, Institut für Hygiene und Mikrobiologie
2005-07-10 von Angelika Petrich-Hornetz Wirtschaftswetter
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Text: © Angelika Petrich-Hornetz, Carol Stocks und Sören Gatermann
translated by Carol Stocks
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