[From MRSA to MRSA's in general practice]

Methicilline resistant Staphylococcus aureus (MRSA) remains a major cause of healthcare associated infections. Limited therapeutic options, the fact that MRSA disease burden do not replace but adds to the sensitive strains burden and its association with increased morbidity and mortality justify reinforced efforts in both prevention of transmission and treatment. Although transmission in acute hospital is decreasing in Belgium, general practitioners face actually to an important prevalence of carriage in nursing homes. Hand hygiene, promotion of prudent use of antimicrobial agents, MRSA surveillance and control are all preventive strategies whom improvement should result in control of MRSA transmission and progressive prevalence decrease in this particular setting. More recently, community acquired strains (CA-MRSA) harboring Panton Valentin Leucocidin were associated with skin and soft tissue among younger people, and livestock associated strains were identified as causing agents of infection in farmer population. CA-MRSA are now transmitted in general population and are causative agents of recurrent or chronic skin infections resistant to beta-lactamine. The diagnosis needs to be evoked in particular settings such as frequent close skin contact (sport, ...). CA-MRSA may also cause necrotising pneumonia. The general practitioner is a central actor in the battle against MRSA both in the field of prevention and treatment by the prudent use of antibiotics, the promotion of hand hygiene and associated specific measures and the accuracy to detect clinical situation evoking infection due to CA-MRSA in the general population.