Johnson Alan P, Pearson Andrew, Duckworth Georgia
Department of Healthcare-Associated Infection and Antimicrobial Resistance, Communicable Disease Surveillance Centre, HPA Centre for Infections, Colindale, London NW9 5EQ, UK.
J Antimicrob Chemother. 2005 Sep;56(3):455-62. doi: 10.1093/jac/dki266. Epub 2005 Jul 26.
Surveillance of bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA) in the UK has involved collection of data from hospital microbiology laboratories via several mechanisms, including a voluntary reporting scheme that has been operational in England and Wales since 1989 and mandatory reporting schemes that have been running independently in England, Wales, Scotland and Northern Ireland since 2001. In addition, surveillance schemes involving panels of participating sentinel laboratories that submit isolates for centralized susceptibility testing, such as the Bacteraemia Resistance Surveillance Programme run by the BSAC, have also been established. Each of these data sources have particular advantages, but they also have their individual limitations, with the result that they each give an incomplete picture if considered in isolation. However, by pooling the findings from these different but complementary surveillance programmes, a much more comprehensive and credible picture of the problem posed by MRSA is produced. These schemes have shown both a dramatic rise in the total numbers of cases of S. aureus bacteraemia reported annually and an increase in the proportion of such cases that involve MRSA (from 2% in 1990 to >40% in the early 2000s), although the most recent data indicate a slight reversal of these trends. Characterization of isolates of MRSA shows a marked temporal relationship between the rise in MRSA bacteraemias and the emergence and spread of two strains of epidemic MRSA, EMRSA-15 and EMRSA-16. Surveillance and control of MRSA infection continue to be high profile and further developments to the mandatory surveillance system in England are likely in the near future.
在英国，耐甲氧西林金黄色葡萄球菌（MRSA）引起的菌血症监测工作通过多种机制从医院微生物实验室收集数据，其中包括自1989年起在英格兰和威尔士实施的自愿报告计划，以及自2001年起分别在英格兰、威尔士、苏格兰和北爱尔兰独立运行的强制报告计划。此外，还建立了监测计划，涉及参与的定点实验室小组，这些小组提交分离株进行集中药敏试验，例如由英国抗菌化疗学会（BSAC）开展的菌血症耐药性监测计划。这些数据来源各有其独特优势，但也存在各自的局限性，结果是如果单独考虑，它们各自提供的情况都不完整。然而，通过汇总这些不同但互补的监测计划的结果，可以更全面、更可靠地呈现MRSA所带来的问题。这些计划显示，每年报告的金黄色葡萄球菌菌血症病例总数急剧上升，且此类病例中涉及MRSA的比例也有所增加（从1990年的2%增至21世纪初的40%以上），尽管最新数据表明这些趋势略有逆转。对MRSA分离株的特征分析显示，MRSA菌血症的增加与两种流行的MRSA菌株EMRSA - 15和EMRSA - 16的出现和传播之间存在明显的时间关系。MRSA感染的监测和控制仍然备受关注，近期英格兰的强制监测系统可能会有进一步发展。
