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Understanding MRSA. (Mersa or Staph)

Ask an MRSA question * MRSA News * MRSA in your locality

Jsw_mrsacouk_1_2 MRSA Watch has gathered over 4500 articles on MRSA into a unique directory - see A-Z  guide in right hand column. Click on coloured text in the MRSA Basics guide below for more information on a specific subject.  The site is updated daily. Scroll down past the guide for specific information about aspects of MRSA

We also have an information packed audio introduction will help you grasp the key facts and the key issues surrounding MRSA

Simple staph aureus (SA) bacteria, (mrsa is not a virus), can be found on the bodies of up to 30% of the general population. It caused many problems before the use of antibiotics made wound recovery a safer process. Hospital acquired staph is generally resistant to several antibiotics but especially Methicillin, hence the name MRSA. This is found in about 1% of the population but in some pockets of the population this figure can be much higher.

Super_bug_091404Image from Komo News

Community Acquired MRSA (CA MRSA) is a different strain of MRSA, mainly causes skin infections and is treatable by more drugs at this time. CA MRSA (sometimes known as Mersa or Mursa) is more infectious and some strains of it are more destructive - should it become resistant to more antibiotics it could pose a considerable public health risk. Many people carry or are 'colonised' by staph bacteria but only suffer when they have another illness.

The colonisation stage carries no symptoms. Many only suffer MRSA as an infection of an existing wound. In recent times however some types of CA MRSA have begun to cause significant skin infections in otherwise healthy patients. The entry point is often a tiny cut, graze or exisiting skin condition.

How do people catch MRSA?
There are several ways it is believed to spread.

  • Hand carriage - this is why hospital staff are encouraged to wash their hands after each patient.
  • Contaminated surfaces - this is why clean hospital wards are vital.
  • Via medical instruments - this is why many now have special coatings or have silver elements. This discourages lingering residues and/or kills external infection entering the wound
  • Via airborne particles - MRSA often resides in the nasal passages and can spread with colds and flu as a secondary infection that may be dormant for some while.
  • Shared items - Families or other close knit groups sharing a facility such as military personnel, a sports team or prison inmates may share hygiene items such as towels etc. This is another vector for the spread of the bacteria
  • Needles - Drug users sharing needles may be passing on MRSA alongside HIV or Hepatitis C. The same could be said of tattoo artists who do not have strict hygiene regimes.
  • Sexual Intimacy - the nose, groin and underarms are key colonisation areas for the bacteria. Sex workers and the habitually promiscous will be super spreaders in a society in much the same way as they are for AIDS.

How is it treated?
There are 3 key treatment regimes that are commonly used.

  • For those who are colonised - a nasal treatment and a skin wash. This is often the strategy when MRSA is rare or prior to an operation as a means of preventing infection. Where MRSA is common some doctors will not suggest decolonisation as many will be recolonised within months within the local community. Some deep seated - throat and intestine - colonisation may require drug treatment.
  • For those who have a potential or active bloodstream infection - drugs such as Vancomycin, Linezolid or Daptomycin.
  • For those with infected wounds - special honey, silver bandages, garlic preparations and tea tree oil are all believed to be effective in killing MRSA in a wound. Many who have the skin infections common with CA MRSA simply need incision and drainage of the infected area and good hygiene while it heals. Antibiotics are not always needed.

How can it be prevented
The media often focus on clean hospitals and clean hands as a key to combating MRSA. Others believe that this will only cut cases by 30% and that a diverse strategy is vital and will include:

What can I do

  • Stay informed - this site and several others can help you do this. The A-Z guide in the right hand column will give you in depth information on over 50 aspects of MRSA from over 4000 articles, news items and academic papers.
  • Ask others via our MRSA Watch forum
  • Act locally by becoming involved in patient advocacy or patient/hospital forums
  • Seek justice - do you need to take legal action because of neligence or do we all need to speak up for communities who are being hit by CA MRSA but are underinsured and often powerless.

MRSA Headlines

Ward lockdown to combat superbugs : Express & Star:

Link: Ward lockdown to combat superbugs : Express & Star:.

Wards at three West Midland hospitals will be “locked down” in a bid to combat the spread of superbugs. The move is one of a raft of measures being introduced by Sandwell and West Birmingham Hospitals trust. Bosses have introduced the crackdown to fight potentially fatal infections such as MRSA and C. diff. Needles and syringes will also become a thing of the past at Sandwell, City and Rowley Regis hospitals, to be replaced with a hi-tech vacuum that takes blood samples from arms.

Two children diagnosed with MRSA

Link: WHDH-TV - New England News - Two children diagnosed with MRSA.

Two children have been diagnosed with Methicillin-resistant Staphylococcus Aureus (MRSA). One of the children attends Reingold Middle School, but there is no information about the other child. The Superintendent of Schools in Fitchburg sent parents a letter explaining the situation and an outline of precautionary measures to pass on to their children.

EPA Registered Disinfectant Kills Both Known Types Of MRSA

Link: EPA Registered Disinfectant Kills Both Known Types Of MRSA.

While MRSA has been an issue in healthcare settings for years, CA-MRSA outbreaks in the community have been on the rise, with the greatest risk in community settings such as fitness clubs, in sports teams, at schools and daycare centers. In May, The Clorox Company will launch Clorox® Pro Quaternary All-Purpose Disinfectant Cleaner, a disinfectant that is EPA registered to kill germs, including Healthcare-associated and Community-associated methicillin-resistant Staphylococcus aureus (HA-MRSA and CA-MRSA). Clorox® Pro Quaternary All-Purpose Disinfectant Cleaner is a one-step, labor-saving solution for killing both strains of MRSA as well as a variety of other illness causing germs, such as Hepatitis B and C, Avian Influenza A, HIV-1 and HIV-2, SARS-associated Coronavirus, Rotavirus, Salmonella enterica and E. coli. This hospital grade disinfectant is also a powerful cleaner with a no-rinse pH-neutral, bleach free formula.

FAMILY’S ANGER AT ‘UNDIGNIFIED’ MRSA DEATH

Link: icWestlothian - FAMILY’S ANGER AT ‘UNDIGNIFIED’ DEATH.

A GRIEVING pensioner slammed St John’s Hospital staff after his dead wife was left in bed for almost two hours surrounded by patients. Andrew Skedd said his wife had also contracted MRSA at the hospital — but he wasn’t told until after she died. He told the Courier this week: “Margaret was a beautiful woman and a very proud person, she did not deserve this.

Blood changes test can help stop sepsis before it begins

Link: The pre-symptomatic prediction of sepsis in intensive care unit patients: a pilot study -- Lukaszewski et al., 10.1128/CVI.00486-07 -- Clinical and Vaccine Immunology.

Post-operative or post-traumatic sepsis remains one of the leading causes of morbidity and mortality in hospital populations, especially in populations in intensive care units (ICUs). Central to the successful control of sepsis-associated infections is the ability to rapidly diagnose and treat disease. The ability to identify sepsis patients before they show any symptoms would have major benefits for the healthcare of ICU patients. In this study ninety-two ICU patients, who had undergone procedures that increased the risk of developing sepsis, were recruited upon admission. Blood samples were taken daily until either a clinical diagnosis of sepsis was made or until the patient was discharged from ICU. In addition to standard clinical and laboratory parameter testing, the expression of Interleukins (IL) -1{beta}, -6, -8, -10, Tumour necrosis factor (TNF)-{alpha}, FasL and CCL2 mRNA was also measured by real-time RT-PCR. Analysis of the data using a non-linear technique (neural network analysis) demonstrated discernible differences prior to the onset of overt sepsis. Neural networks using cytokine and chemokine data were able to correctly predict patient outcome in an average 83.09% of patient cases between 4 and 1 days before clinical diagnosis with high sensitivity and selectivity (91.43% and 80.20%, respectively). The neural network also had a predictive accuracy of 94.55% when data from 22 healthy volunteers was analysed in conjunction with the ICU patient data. Our observations from this pilot study indicate that it may be possible to predict the onset of sepsis in a mixed patient population using a panel of just 7 biomarkers.

A review of vancomycin therapeutic drug monitoring recommendations in Scotland

Link: A review of vancomycin therapeutic drug monitoring recommendations in Scotland -- Helgason et al. 61 (6): 1398 -- Journal of Antimicrobial Chemotherapy.

Confusion continues regarding the therapeutic monitoring of vancomycin. Most clinicians would agree that the analysis of peak concentrations is of limited value due to both the pharmacodynamic (time-dependency) and pharmacokinetic (multiexponential decline) properties of vancomycin.1 However, there is still a lack of uniformity with respect to trough concentrations. The historical recommendation of 5–10 mg/L was based on efficacy data from in vitro experiments, protein-binding information and early concerns about nephrotoxicity. However, recent evidence suggests that nephrotoxicity is rare with vancomycin monotherapy

New test offers extreme MRSA accuracy

Link: Microbiological evaluation of a new growth-based approach for rapid detection of methicillin-resistant Staphylococcus aureus -- von Eiff et al. 61 (6): 1277 -- Journal of Antimicrobial Chemotherapy.

Objectives: Recently, a rapid screening tool for methicillin-resistant Staphylococcus aureus (MRSA) has been introduced that applies a novel detection technology allowing the rapid presence or absence of MRSA to be determined from an enrichment broth after only a few hours of incubation. To evaluate the reliability of this new assay to successfully detect MRSA strains of different origin and clonality, well-characterized S. aureus strains were tested in this study. Methods: More than 700 methicillin-susceptible and methicillin-resistant strains covering >90% of all registered European MRSA spa types within the SeqNet network were studied. Results: All 513 MRSA strains tested were recognized as methicillin-resistant: among these, 96 MRSA strains were from an institutional collection, each presenting a unique spa type. None of the 211 methicillin-susceptible strains were detected as positive. Conclusions: The new growth-based rapid MRSA assay was shown to detect without exception all MRSA strains of large collections of strains comprising highly diverse genetic backgrounds, indicating that such a phenotypic test might be potentially more likely to cope with new strains.

How will we know if the deep clean worked?

Link: Mrsa: 14 May 2008: Written answers (TheyWorkForYou.com).

Andrew Lansley (Shadow Secretary of State for Health, Health; South Cambridgeshire, Conservative) | Hansard source To ask the Secretary of State for Health (1) what estimate his Department has made of the percentage changes in incidence of (a) MRSA and (b) clostridium difficile as a result of the deep cleaning programme; and over what timescale his Department expects such changes to be reflected in hospital infection statistics; (2) by what means his Department will assess the effectiveness of its deep cleaning programme for hospitals in England in reducing cases of healthcare associated infections. Click on the platypus! Free Our Bills! Photo of Ann KeenAnn Keen (Parliamentary Under-Secretary (Health Services), Department of Health; Brentford & Isleworth, Labour) | Hansard source As set out by my right hon. Friend the Secretary of State in his written ministerial statement on 17 January 2008, Official Report, columns 38-39WS, following completion of the deep clean of the national health service on 31 March 2008, the Department will work with strategic health authorities (SHAs) to draw up examples of where a deep clean has had a demonstrable effect in improving patient care and experience and will share these across the NHS. SHAs will take the lead on evaluation locally as the impact of each trust's programme will be different and no single measurement method will pick up all the benefits, particularly as trusts may be implementing a range of measures to improve cleanliness and tackle healthcare associated infections. Improvements to patient experience and environment may be measurable through: Patient Environment Action Team scores; scores on national specifications for cleanliness; compliance with the Code of Practice for the Prevention and Control of Healthcare Associated Infections; compliance with the Department is national core standards; Healthcare Commission inpatient survey scores; and infection rates. Deep cleaning is just part of a comprehensive range of measures to improve cleanliness and tackle infections set out in the Strategy "Clean, Safe Care: Reducing Infections and Saving Lives". Copies of the Strategy are available in the Library.

Superbug test case can go ahead

Link: BBC NEWS | Scotland | Glasgow, Lanarkshire and West | Superbug test case can go ahead.

A Lanarkshire grandmother who contracted the MRSA superbug has been given the go ahead to bring a test case against an NHS board. Elizabeth Miller, 71, from Kilsyth, said she was "overjoyed" that a legal challenge by Greater Glasgow NHS Board to her case had been dismissed. Judge Lady Clark ruled a full hearing into the £30,000 claim should be held. The case is believed to be the first of its kind in the UK and could lead to scores of others, if it succeeds. Mrs Miller contracted the MRSA bug in 2001 when she was recovering from a heart operation at Glasgow's Royal Infirmary. I just feel my life will never be the same again. Elizabeth Miller She claims it has turned her life upside down.

Teenage student dies from MRSA

Link: Teenage student Sam Fallon has died after being struck down with MRSA in hospital. The 17-year-old died nine days after contracting the superbug at the University Hospital of North Staffordshire.She....

Teenage student Sam Fallon has died after being struck down with MRSA in hospital. The 17-year-old died nine days after contracting the superbug at the University Hospital of North Staffordshire. She had spent a month in hospital fighting a rare immune disease affecting blood cells before catching MRSA and dying on Friday. Now Sam's family are taking legal action against the hospital after blaming MRSA for her death. Mum Sue, aged 42, of Campbell Road, Stoke, said: "I can only describe the wards Sam was on for the first two weeks before she was diagnosed as filthy. I washed her every day, there was a big sticky patch on the floor which never moved and dust and dirt everywhere - it just looked grubby.

Lawsuit: Life-threatening conditions at Lake County Jail

Link: Lawsuit: Life-threatening conditions at Lake County Jail -- -- chicagotribune.com.

HAMMOND, Ind. - Four men filed a federal lawsuit Tuesday alleging conditions at the Lake County Jail are so dangerous they are life-threatening, including presence of the drug-resistant staph known as MRSA. The lawsuit, which seeks to gain class-action status, seeks unspecified damages from Sheriff Roy Dominguez, two people who served as warden of the jail since May 2006 and other unidentified jail supervisors. It was filed in U.S. District Court in Hammond. The Associated Press left a message seeking comment on the lawsuit from Dominguez on Tuesday at his office. The lawsuit contends that the plaintiffs were the moving force behind the alleged violations, condoning the unconstitutional conditions. It alleges that people are held for weeks in crowded holding cells in which they are forced to sleep on concrete floors. It also claims that people in the holding cell are not provided showers, soap or change of clothes and that toilet paper is often not available.

Do the detergents keep working

Link: Longitudinal analysis of chlorhexidine susceptibilities of nosocomial methicillin-resistant Staphylococcus aureus isolates at a teaching hospital in Taiwan -- Wang et al., 10.1093/jac/dkn208 -- Journal of Antimicrobial Chemotherapy.

Background: Chlorhexidine has been widely used for hand hygiene to prevent transmission of nosocomial pathogens, including methicillin-resistant Staphylococcus aureus (MRSA). However, data on longitudinal surveillance of the susceptibility of MRSA isolates to chlorhexidine are limited. Methods: A total of 240 nosocomial MRSA isolates obtained in 1990, 1995, 2000 and 2005 at National Taiwan University Hospital (NTUH), a hospital where chlorhexidine gluconate was used for hand hygiene for more than 20 years, were included in the study. Chlorhexidine susceptibility, molecular typing using multilocus sequence typing and distribution of the qacA/B gene of these MRSA isolates were studied. Results: The proportion of tested MRSA with a high MIC of chlorhexidine (≥4 mg/L) was 1.7% in 1990, 50% in 1995, 40% in 2000 and 46.7% in 2005. Among these 83 isolates with high chlorhexidine MICs, 55.4% carried the qacA/B gene. MRSA isolates carrying the qacA/B gene were first detected in 1995 and belonged to a single clone at that time. However, the qacA/B gene was detected in MRSA isolates belonging to seven different clones in 2005. Conclusions: The proportion of tested MRSA isolates with high chlorhexidine MICs at NTUH increased from 1990 to 1995 and remained steady thereafter. The presence of the qacA/B gene may contribute to the spread of specific MRSA clones.

EU investigating MRSA in pigs

Link: Animals: MRSA: 12 May 2008: Written answers (TheyWorkForYou.com).

Jonathan R Shaw (Parliamentary Under-Secretary (Marine, Landscape and Rural Affairs) and Minister for the South East), Department for Environment, Food and Rural Affairs; Chatham & Aylesford, Labour) | Hansard source Methicillin-resistant Staphylococcus aureus (MRSA) has not been detected in farmed livestock in the UK and there is no current evidence that food-producing animals form a reservoir of infection in the UK. The organism has been isolated from dairy cows, pigs and chickens outside the UK, as well as in companion animals (including cats, dogs and horses) both in the UK and elsewhere. Ongoing monitoring of the international picture is being maintained. A 12-month long study to provide an initial overview of the presence of MRSA in breeding pig herds across Europe began in January 2008. This is being carried out under Community legislation. It is anticipated that the results of this study will be published in mid 2009 and that they will inform the direction of future work by DEFRA. DEFRA's Antimicrobial Resistance Co-ordination (DARC) Group continues to provide guidance on policy relating to antimicrobial resistance. The membership of the DARC Group reflects a partnership approach and includes representatives from many organisations involved in both human and animal health throughout the UK. DARC created a MRSA sub-group in 2005, through which DEFRA is assisting and encouraging various initiatives relating to MRSA from the Bella Moss Foundation (a UK registered charity promoting awareness of MRSA in animals), industry and the veterinary profession. DEFRA has funded research to better understand the epidemiology of MRSA in companion animals and livestock and any role it may play in human infections.

Fury at ambulance cancellation for pacemaker baby

Link: Fury at ambulance cancellation for pacemaker baby - icWales.

A BABY who became one of the world’s youngest pacemaker patients when he had a device fitted at just five days old was last night battling the superbug MRSA. Three-month-old Liam King, of Cwm, near Ebbw Vale, was being treated with antibiotics last night in the Bristol Royal Children’s Hospital. And the baby’s desperately concerned father, 26-year-old DJ Andy King, claimed yesterday an ambulance due to whisk Liam from Nevill Hall Hospital in Abergavenny to Bristol for the MRSA treatment last Friday was cancelled “at the last minute” . Mr King said he was forced to drive Liam and his girlfriend Ann Collier, 21, Liam’s mother, to Bristol himself.

Fury at ambulance cancellation for pacemaker baby

Link: Fury at ambulance cancellation for pacemaker baby - icWales.

A BABY who became one of the world’s youngest pacemaker patients when he had a device fitted at just five days old was last night battling the superbug MRSA. Three-month-old Liam King, of Cwm, near Ebbw Vale, was being treated with antibiotics last night in the Bristol Royal Children’s Hospital. And the baby’s desperately concerned father, 26-year-old DJ Andy King, claimed yesterday an ambulance due to whisk Liam from Nevill Hall Hospital in Abergavenny to Bristol for the MRSA treatment last Friday was cancelled “at the last minute” . Mr King said he was forced to drive Liam and his girlfriend Ann Collier, 21, Liam’s mother, to Bristol himself.

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