Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England

Abstract

Background: National responses to healthcare-associated infections vary between high-income countries but when analysed for contextual comparability, interventions can be assessed for transferability. Aim: To identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England. Methods: A longitudinal analysis (2000-17), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: typemandatory requirements, recommendations, or national campaigns; method-restrictive, persuasive, structural in nature; level of implementation-macro (national), meso (organisational), micro (individual) levels. Healthcare organisational structures and role of media were also assessed. Findings: In England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multidisciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public. Conclusion: Policy interventions need to be relevant to local epidemiological trends, while acceptable within health system cultures and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and economic challenges.

Contribution of whole-genome sequencing to understanding of the epidemiology and control of meticillin-resistant Staphylococcus aureus

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Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

“…Key stakeholders may then work proactively to formulate contingent strategies particularly where wider influences carry high levels of uncertainty. For example, in countries which perform well in the economic domain, the factors in the political domain can still hinder progress; notably, in Japan, five terms of office, seven general elections since 2000 and an average length of 1.9 years of office (July 1998 and December 2017) may need reliance on strengthening the other domains for sustainable solutions 39…”

Effect of High Blood Glucose Level on the Antimicrobial Activity of Daptomycin against <i>Staphylococcus aureus</i> in Streptozotocin-Induced Diabetic Mice

“…Daptomycin (DAP) is active against S. aureus including MRSA (8). Several studies have suggested the clinical utility of DAP in diabetes patients (6,(9)(10)(11)(12)(13).…”