[Nosocomial infections: MRSA und CDAD as a challenge]

W V Kern, M Dettenkofer
Der Internist 2009, 50 (6): 691-703; quiz 704-5
Inadequate antibiotic prescribing and poor adherence to infection control guidelines are the main reasons for the development and spread of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (CD), the most important cause of antibiotic-associated diarrhoea (AD) and colitis. Both CDAD and MRSA infection are associated with significant morbidity, excess mortality and substantial consumption of resources. Increases in the incidence of both infections have been observed in Germany and represent a challenge to clinicians, infection control practitioners, quality management teams und hospital administration. Prudent use of antibiotics, in particular critical prescribing of fluoroquinolones and cephalosporins, is an important component in programmes aiming at an effective prevention of MRSA and CDAD. Other similarly important components are minimization of pathogen transmission between patients and healthcare personnel by isolation and contact precautions, early detection of MRSA carriers and MRSA decolonization treatment. It must be ascertained that patients nursed in isolation rooms receive medical care of similar high quality as all other patients. Over the last years, there has been no major breakthrough in therapy and outcomes in both CDAD and MRSA infection. Close collaboration between hospitals, nursing homes and primary care institutions will be critical for better control of MRSA and CDAD.

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