A field guide to pandemic, epidemic and sporadic clones of methicillin-resistant Staphylococcus aureus.

In recent years, methicillin-resistant Staphylococcus aureus (MRSA) have become a truly global challenge. In addition to the long-known healthcare-associated clones, novel strains have also emerged outside of the hospital settings, in the community as well as in livestock. The emergence and spread of virulent clones expressing Panton-Valentine leukocidin (PVL) is an additional cause for concern.

Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region.

Background: This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions.

Methods: MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions.

Results: Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use.

Antibiotic Resistance Surveillance and Control in the Mediterranean region: report of the ARMed Consensus Conference.

Antimicrobial resistance has become a global threat to effective health care delivery. This is particularly the case within the Mediterranean region, where data from recent studies suggests the situation to be particularly acute. A better knowledge base, as well as a collaborative effort, is therefore required to address this ever increasing challenge to effective patient care.

Self-medication with antibiotics in the ambulatory care setting within the Euro-Mediterranean region; results from the ARMed project.

Anecdotal data from the southern and eastern Mediterranean region suggests that self-medication with antibiotics is commonly practiced in many countries. In order to provide proper information on the situation, we undertook short structured interviews in out-patients clinics or primary health centres in Cyprus, Egypt, Jordan, Lebanon, Libya, Tunisia and Turkey. A total of 2109 interviews were undertaken of which 1705 completed the full questionnaire.

Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control.

Purpose: To report initial results from a European ICU surveillance programme focussing on antibiotic consumption, microbial resistance and infection control.

Methods: Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and infection control stewardship measures were entered locally into a web-application.

Time-series analysis of the impact of bed occupancy rates on the incidence of methicillin-resistant Staphylococcus aureus infection in overcrowded general wards.

Objective: We investigated the impact of bed occupancy, particularly overcrowding, on the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in general ward settings.

Methods: We performed a time-series and mixed-model analysis of variance of monthly incidence of MRSA infection and corresponding bed occupancy rates, over 65 months, in the medicine and surgical wards within St. Luke's Hospital, a 900-bed tertiary care facility in Malta.

Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system.

Background: Self-medication with antibiotics occurs among the population in Europe, particularly in southern and eastern countries. We studied the impact of predisposing factors (e.g.

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in invasive isolates from southern and eastern Mediterranean countries.

Objectives: Efforts aimed at curtailing the ever increasing spread of methicillin-resistant Staphylococcus aureus (MRSA) require effective information of its epidemiology. However, knowledge about the situation in southern and eastern countries of the Mediterranean is incomplete since reports have been sporadic and difficult to compare.

Methods: Over a 36 month period from 2003 to 2005, the ARMed project collected more than 5000 susceptibility test results of invasive isolates of S.

Attitudes, beliefs and knowledge concerning antibiotic use and self-medication: a comparative European study.

Purpose: Although the relevance of cultural factors for antibiotic use has been recognized, few studies exist in Europe. We compared public attitudes, beliefs and knowledge concerning antibiotic use and self-medication between 11 European countries.

Methods: In total, 1101 respondents were interviewed on their attitudes towards appropriateness of self-medication with antibiotics and situational use of antibiotics, beliefs about antibiotics for minor ailments, knowledge about the effectiveness of antibiotics on viruses and bacteria and awareness about antibiotic resistance.

Is self-medication with antibiotics in Europe driven by prescribed use?

Background: Self-medication with antibiotics may increase the risk of inappropriate use and the selection of resistant bacteria. One of the triggers for using self-medication may be past experience with antibiotics prescribed by health professionals. We examined the association between prescribed use and self-medication with antibiotics.

Self-medication with antimicrobial drugs in Europe.

We surveyed the populations of 19 European countries to compare the prevalence of antimicrobial drug self-medication in the previous 12 months and intended self-medication and storage and to identify the associated demographic characteristics. By using a multistage sampling design, 1,000-3,000 adults in each country were randomly selected. The prevalence of actual self-medication varied from 1 to 210 per 1,000 and intended self-medication from 73 to 449 per 1,000; both rates were high in eastern and southern Europe and low in northern and western Europe.

Over-the-counter acquisition of antibiotics in the Maltese general population.

Few studies have studied the frequency of over-the-counter acquisition of antibiotics in western countries. In order to provide an insight into these practices in Malta, attitudes towards antibiotic use in the general public were researched through a structured interview. Nineteen percent admitted that they took antibiotics without prescription and 11% of parents replied that they had given antibiotics to their children without prescription.