• Staphylococcus aureus
• methicillin-resistant

The pattern of MRSA in UK hospitals nowadays is very different to that seen a decade or so ago. Then, MRSA was confined mainly to a relatively small number of hospitals in the southeast of England and some of the large provincial conurbations.¹ However, new strains of epidemic MRSA, especially EMRSA-15 and EMRSA-16, have since emerged and spread to become established to some extent in virtually every hospital in the country.¹ Between 1992 and 2002 the proportion of blood culture isolates of Staphylococcus aureus reported by microbiology laboratories to the Communicable Disease Surveillance Centre that were methicillin resistant increased from 3% to 43%.² The pervasiveness of MRSA is underlined by the fact that MRSA now accounts for over 30% of S aureus bacteraemias in every health care region in England, Wales, and Northern Ireland.³

MRSA are frequently not only resistant to methicillin and other β-lactam antibiotics, but to other classes of antibiotics as well.¹ The glycopeptide antibiotics teicoplanin and vancomycin are currently the mainstay of treatment of infections with MRSA.¹ However, strains of MRSA have emerged that exhibit higher than usual minimum inhibitory concentration values for these antibiotics: glycopeptide-intermediate S aureus (GISA), or vancomycin resistant S aureus (VISA).⁴ Although not fully glycopeptide resistant, infections with these isolates often respond poorly to treatment with these agents. Fortunately only a small number of infections with these bacteria have been reported so …