Model Answers Microbiology Written examinations 2007 - RCPA

For
This epidemic in gaining pace throughout Australia and ST93 in increasing
rapidly and will probably overtake ST1 as the predominant strain
PVL – give explanation
PVL positive strains associated with furunculosis, and occasionally
necrotising pneumonia, osteomyelitis (+septic thrombophebitis and PE in
children), septicaemia. Fatal cases occur in young otherwise healthy children
and adults.
MRSA bacteraemia is a major issue as is S. aureus bacteraemia in general and
is now being studied nationally (ANZCOSS). Thousands of cases are thought
to occur annually with a mortality of approx. 30% (probably higher for
MRSA)
All of the above provides rationale for notification and intervention
Intervention in CA-MRSA has occurred successfully in Denmark and is now
being tried in WA. Contact tracing (household contacts) – increased hygiene,
mupirocin, phisohex or chlorhexidine washes and follow up screening
Establish baseline and benchmark
Identify problem areas for intervention
Evidence for successful HCA intervention strategies based on targeted
screening and isolation is available and increased hand hygiene has also
apparently been successful as an intervention in some settings
Reduction of HCA MRSA has shown to reduce morbidity and mortality and to
be cost effective in terms of overall health budget (through reducing
morbidity, mortality and LOS)
Establish population rates of CA MRSA
Provide guidance to practitioners at a local level (empiric therapy etc.)
Allow for community intervention
Against
Potential for stigmatisation of institutions based on MRSA rates
Perception that intervention may be associated with increased costs
Insufficient resources may be provided to labs or service providers to make the
program work successfully
Increased litigation may follow at the instigation of unscrupulous legal firms