Most staphylococci (see STAPHYLOCOCCUS) have evolved resistance to benzylpenicillin (see PENICILLIN) because of their ability to produce PENICILLINASE. Cloxacillin and flucloxacillin are antibiotics still effective against most staphylococci; at one time methicillin was used to combat resistant strains, but in hospital environments bacteria began to acquire immunity to this powerful drug (now withdrawn from use) and to cloxacillin. RIFAMPICIN, VANCOMYCIN, TEICOPLANIN and temocillin are still active against most penicillinase-producing gram-negative bacteria (see GRAM'S STAIN). There is, however, a growing threat to health because of the rise in the number of antibiotic-resistant bacteria, particularly in hospitals. The bacteria themselves are not more virulent than others, and, indeed, are carried by many healthy people, but the difficulty in treating them with a safe and effective antibiotic means that they are more dangerous, particularly to hospital patients who have had surgery; who have CATHETERS in place; who have a severe skin disorder; who have to take frequent antibiotic courses; or who are immunosuppressed (see IMMUNOSUPPRESSION). MRSA is mentioned on about 1,500 death certificates annually in England & Wales, usually as a contributory but not the underlying cause of death. It may be the central cause in about 1 in 5,000, mostly in the very elderly. In the under – 45 age group less than one death in a million involves MRSA.

The organisms can survive on bedlinen, towels, sinks, floors and cleaning equipment. Many hospitals now test all patients on admission to check if they carry MRSA; positive results may lead to appropriate antibiotic treatment and the need for isolation or infection precautions. It is likely that lapses in normal hygienic practice – such as frequent hand-washing – have resulted in an increase in MRSA disease, and everybody visiting a hospital ward should wash their hands thoroughly before and after the visit. Many hospitals place antiseptic solutions at the entrance of wards for visitors and staff to use before entry. Hospital staff must maintain very high standards of hygiene, wearing appropriate protection such as disposable gloves when indicated. Patients in hospital wards should do their best to keep very clean, in particular washing their hands after using toilets or a commode, and before and after eating. They should not be afraid to point out unclean facilities or failure to change bedding frequently nor to remind medical and nursing staff to wash their hands before touching them.