Policy implementation for methicillin-resistant Staphylococcus aureus in seven European countries: a comparative analysis from 1999 to 2015

Figures & data

Table 1. Policy implementations for healthcare-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in seven countries.

	UK	France	Germany	Belgium	Netherlands	Spain	Italy
HA-MRSA; ○, year, reference
Mandatory MRSA surveillance	○ 2001, 2005 [5]	○ 2001 [13]	○ 2009 [14]	○ 2006 [15]	○ (1988) [10]
National MRSA guidelines	○ (1986) [8]	○ (1995) [16]	○ 1999 [17]	○ (1993) [18]	○ (1988) [10]	○ 2008 [19]	○ 2011[20]
Hand hygiene campaigns	○ 2004 [9]	○ 2009 [9]	○ 2008 [9]	○ 2005 [9]		○ 2006 [9]	○ 2007 [9]
Antimicrobial restrictions	* 2008 [21]	* 2002 [21]		* 2000, 2004 [21]	○ (1988) [10]	* 2006, 2007 [21]	* 2007 [21]
Single room isolation					○ (1988) [10]
Universal screening	○ 2010, 2014 [11,22]
LA-MRSA; ○, year, reference
ESVAC mandatory reporting	○ 2005 [12]		○ 2011 [12]	○ 2006 [12]		○ 2010 [12]	○ 2011 [12]
Antimicrobial restriction	* 2012 [23]	* 2012 [24]			○ 2011 [25]
Prophylactic use restrictions	* 2012 [24]	* 2012 [24]	○ 2010 [26]	○ 2014 [27]	○ 2011 [25]

Data are shown as year [reference]; years in parentheses are before the study period.

*National voluntary campaign. ESVAC, European Surveillance of Veterinary Antimicrobial Consumption.

Table 2. Difference in proportion and rate of change among countries with and without mandatory methicillin-resistant Staphylococcus aureus (MRSA) surveillance policies.

	Implementation year or maximum			Latest data (2015)			Difference of proportion			Rate of change
	MRSA (n = 2222)	Test (n = 7246)	%	MRSA (n = 5171)	Tests (n = 19,046)	%	%	95% CI	p	%
Country with mandatory surveillance policy									< 0.001
UK	676	1488	45.4	298	2757	10.8	34.6	(29.8 to –38.8)		76% ↓
France	572	1714	33.4	869	5535	15.7	17.7	(15.3 to 20.2)		53% ↓
Belgium	189	858	22.0	112	913	12.3	9.7	(6.1 to 13.3)		44% ↓
Germany	350	1894	18.5	546	4871	11.2	7.3	(5.3 to 9.3)		39% ↓
Country without mandatory surveillance policy
Spain	234	836	28.0	498	1970	25.3	2.7	(−0.9 to 6.4)	0.13	10% ↓
Italy	201	456	44.0	1023	3000	34.1	9.9	(5.0 to 14.9)	< 0.001	23% ↓

The chi-squared test was applied for comparing two proportions of implementation year or at the maximum to the latest data (2015).

Table 3. Consumption of veterinary antimicrobial agents in seven countries, 2009–2014.

	UK	France	Germany	Belgium	Netherlands	Spain	Italy	All countries
Sales of veterinary antimicrobials (mg/PCU)
Cephalosporins	0.5 (0.1–0.8)	0.6 (0.4–0.9)	0.5 (0.4–0.5)	0.6 (0.5–0.6)	0.2 (0.1–0.3)	0.5 (0.2–0.7)	0.7 (0.6–0.8)	0.5 (0.4–0.6)
Quinolones	0.3 (0.3–0.4)	1.5 (1.3–1.7)	1.2 (0.9–1.6)	2.3 (2.0–2.5)	1.5 (0.9–2.1)	9.2 (7.9–10.6)	8.7 (5.8–11.6)	3.3 (1.0–1.7)
Cephalosporins + quinolones	0.8 (0.4–1.1)	2.1 (1.7–2.5)	1.7 (1.3–2.0)	2.9 (2.6–3.1)	1.7 (1.0–2.4)	9.7 (8.6–11.1)	9.4 (6.4–12.3)	3.7 (2.6–4.9)
All classes	62.8 (60.9–64.8)	117.2 (111.5–122.8)	186.0 (177.7–232.8)	166.6 (163.5–169.7)	106.3 (93.3–119.3)	293.6 (270.3–316.9)	343.3 (334.5–352.1)	170.4 (137.2–203.7)

Data are shown as mean (95% confidence interval).

Data from Belgium, Germany, Spain and Italy are from 2010 or 2011.

Figure 1. Trend in methicillin-resistant Staphylococcus aureus (MRSA) rates for seven countries, 1999–2015.

Figure 2. Rate of change in methicillin-resistant Staphylococcus aureus (MRSA) after the implementation of mandatory surveillance policies.

Figure 3. Cephalosporin consumption and methicillin-resistant Staphylococcus aureus (MRSA). DDD, defined daily dose.

Figure 4. Fluoroquinolone consumption and methicillin-resistant Staphylococcus aureus (MRSA). DDD, defined daily dose.

Figure 5. Trend in livestock antibiotic consumption for seven countries.

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