MRSA targets may boost other bugs

Emma Wilkinson
Health reporter, BBC News

E. Coli is one infection which needs more attention, experts warn

Government targets to cut MRSA rates may have led to increases in other hospital infections, a UK expert warns.

The vast majority of healthcare-associated infections are not covered by targets, Dr Michael Millar told an infectious diseases meeting in London.

And intense focus on MRSA and C. difficile means other deadly bugs such as E. Coli are getting in under the radar, he said.

The Department of Health said it had taken steps to tackle all infections.

Dr Millar, a medical microbiologist at Barts and the London NHS Trust, said MRSA bloodstream infections account for only 2% of all healthcare-associated infections.

Narrow targets to reduce bloodstream MRSA rates push hospitals away from tackling other infections and even other types of MRSA infection, he added.

For example, bloodstream infection caused by antibiotic-resistant E. coli bacteria cause deaths in more than 20% of cases.

Local problems

"It's not clear that overall things have got better," he said.

"Rates of E. coli are going up and it almost compensates for MRSA.

"All you've done is replaced one problem with another one," he said

He told delegates at The Lancet Infectious Diseases conference on healthcare-associated infections that targets should be set on the basis of local problems and measure patient outcomes rather than rates of one infection.

We need to be a bit more mature about how we look at the overall problem Professor Hugh Pennington

"There's no evidence that overall we have fewer hospital infections or fewer people are dying," he added.

Professor Hugh Pennington, emeritus professor of bacteriology at the University of Aberdeen, said there were good reasons for introducing MRSA targets at the time but a broader approach was now needed.

"It's a fair point - it happened with the C. difficile outbreaks, where it was found the hospitals were paying a lot of attention to MRSA but not enough to C. difficile which was more serious.

"We need to be a bit more mature about how we look at the overall problem."

He added that he had no doubt other infections were rising because attention had been diverted away from them.

"Generally what we're seeing is the tip of the iceberg - we need to get better statistics so we can see what the trends are."

In a recent "State of Healthcare" report, the Healthcare Commission warned that trusts need to have measures in place to combat all healthcare-associated infections.

Severe consequences

A Department of Health said spokesperson said C. difficile and MRSA bloodstream infections have potentially very severe consequences for patients and both significantly affect patient confidence in the NHS.

"We are clear that the NHS needs to take action to address any infections that are a challenge locally.

"We don't currently have plans to set targets for other infections as it would be impossible to set a target for each and every infection."

According to Health Protection Agency figures, E. coli is the most common bloodstream infection with 22,000 cases reported in 2007 but rates have remained stable in recent years.

"It is worth remembering that not all healthcare-associated infections are preventable," a spokesman said.

"But we shouldn't be complacent around tackling all infections that are preventable and engaging in the battle to continually drive down rates."