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Methicillin resistant Staphylococcus aureus (MRSA) is a major public health problem in the US. The incidence of invasive infections such as bacteraemia, pneumonia, and cellulitis reached 31.8 per 100000 in 2005, according to a population based surveillance programme operating in nine diverse states. The rate of MRSA infection in 2005 was higher than the combined rates of invasive pneumococcal disease (14.1/100000), invasive group A streptococcus (3.6/100000), invasive meningococcal disease (0.35/100000), and invasive Haemophilus influenzae (1.4/100000), says an editorial (p 1803). MRSA was associated with an estimated 18650 hospital deaths in 2005. If these figures are accurate, MRSA killed more US citizens that year than HIV.
Most invasive MRSA is still associated with some kind of healthcare risk factor such as surgery, previous colonisation, or an indwelling vascular catheter. In this analysis, over half the patients with healthcare associated infections became ill in the community. But many were infected with a genotype prevalent in hospitals. Patients are probably being colonised in hospital, then developing invasive infections once they get home, says the editorial. Controlling the disease will require collaboration between healthcare professionals in both sectors.