The problem of MRSA in the ICU

It has been estimated that hospital-acquired infections (HAIs) cost the NHS £1 billion per annum. HAIs involving antibiotic-resistant bacteria are particularly challenging as, by definition, they are more difficult to treat. Prominent among such infections are those caused by methicillin-resistant Staphylococcus aureus (MRSA), which are variants of the common pathogen S. aureus that are characterised by its resistance to all currently available β-lactam antibiotics. Isolates of MRSA, particularly those belonging to the epidemic MRSA (EMRSA) strains EMRSA-15 and EMRSA-16, which account for the majority of MRSA isolated in the UK, are commonly additionally resistant to other antibiotics, particularly erythromycin and ciprofloxacin. This article focuses on surveillance strategies for assessing the extent of the problem posed by MRSA in ICUs and on interventions that may be used in efforts to control their emergence and spread, both in ICUs and in the hospital environment at large.