MRSA Infection

Switching off the early warning system of MRSA drug resistance

Discovery of Controlled Swarm in Bacteria.

The research reveals for the first time the relation between the bacteria DNA repair system, known as SOS response, and swarming. Researchers demonstrated that the presence of antibiotics activates SOS response and thus increases concentration of RecA protein. This interferes with the action of the CheW protein, essential for swarming, and thus causes the bacterial colony to stop moving. When the concentration of this antibiotic decreases, the amount of RecA protein reduces and CheW once again can continue its task of spreading the bacteria. The results obtained indicate that given the special characteristics of this type of collective movement, antibiotics only affect outer cells of the swarm, which in turn act as sensors and activate the aforementioned molecular repair system. This action thus cancels out the effect of the drug on the rest of the bacteria population. Jordi Barbé, Laura Medina Ruiz and Susana Campoy, researchers at UAB's Department of Genetics and Microbiology and directors of the study, highlight the importance of this basic discovery since it will allow for the design of targets blocking RecA action and thus increase antibiotic sensitivity of bacteria.

Antibiotics and animals - wide variation in use across Europe

Comparison of the sales of veterinary antibacterial agents between 10 European countries -- Grave et al., 10.1093/jac/dkq247 -- Journal of Antimicrobial Chemotherapy.

To compare the sales of veterinary antibacterial agents between 10 European countries. Methods: Data were compiled from published reports from the 10 countries. We express the usage as amounts sold of veterinary antibacterial agents per country and year, in mg active substances per kg biomass of slaughtered pigs, poultry and cattle plus estimated biomass of (live) dairy cattle for the corresponding year. Results: The usage, as expressed in mg antibacterial drugs sold/kg biomass of slaughtered pigs, poultry and cattle and of (live) dairy cattle, varied from 18 to 188 mg/kg. The relative proportion of the various classes of antibacterial agents sold varied considerably. Conclusions: The apparent wide variations in the usage of veterinary antimicrobial agents between countries cannot be explained by differences in the animal species demographics alone. Further in-depth analyses are required to identify the factors underlying the observed differences.

Some MRSA strains more likely to mutate than others

A type III-like restriction endonuclease functions as a major barrier to horizontal gene transfer in clinical Staphylococcus aureus strains — PNAS.

Staphylococcus aureus is an versatile pathogen that can cause life-threatening infections. Depending on the clinical setting, up to 50% of S. aureus infections are caused by methicillin-resistant strains (MRSA) that in most cases are resistant to many other antibiotics, making treatment difficult. The emergence of community-acquired MRSA drastically changed the picture by increasing the risk of MRSA infections. Horizontal transfer of genes encoding for antibiotic resistance or virulence factors is a major concern of multidrug-resistant S. aureus infections and epidemiology. We identified and characterized a type III-like restriction system present in clinical S. aureus strains that prevents transformation with DNA from other bacterial species. Interestingly, our analysis revealed that some clinical MRSA strains are deficient in this restriction system, and thus are hypersusceptible to the horizontal transfer of DNA from other species, such as Escherichia coli, and could easily acquire a vancomycin-resistance gene from enterococci. Inactivation of this restriction system dramatically increases the transformation efficiency of clinical S. aureus strains, opening the field of molecular genetic manipulation of these strains using DNA of exogenous origin.

Mupirocin Resistance in MRSA Slow to Develop?

Mupirocin Resistance Related to Increasing Mupirocin Use in Clinical Isolates of Methicillin-Resistant Staphylococcus aureus in a Pediatric Population -- Hogue et al. 48 (7): 2599 -- Journal of Clinical Microbiology.

We investigated the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from pediatric patients demonstrating mupirocin resistance related to mupirocin use at our institution. No mupirocin resistance was found in 98% of isolates, whereas mupirocin prescriptions increased by 110%. Resistance rates remained low despite the increasing use of mupirocin.

Key MRSA drug out of stock

Controversies in Hospital Infection Prevention: IV bactrim is gone.

Hospitals across the country are facing a shortage of IV trimethoprim/sulfamethoxazole (bactrim). This is a severe shortage with hospitals reporting that they have completely exhausted all supplies. It is manufactured by a single company, Teva Pharmaceuticals, which is currently not able to project a date when it will be available. Moreover, the company has no supply to release for emergency use

See link above for other drugs to use

Antibiotic Use in Animals Should be Limited, F.D.A. Says

Antibiotic Use in Animals Should be Limited, F.D.A. Says - NYTimes.com.

The F.D.A. released a policy document stating that agricultural uses of antibiotics should be limited to assuring animal health, and that veterinarians should be involved in the drugs’ uses. While doing nothing to change the present oversight of antibiotics, the document is the first signal in years that the agency intends to rejoin the battle to crack down on agricultural uses of antibiotics that many infectious disease experts oppose.

Spread of MRSA when shaving prevented by eliminating infection source

Spread of MRSA when shaving prevented by eliminating infection source - - ModernMedicine.

The best way to prevent the spread of MRSA when shaving is to eradicate the source of the infection. This can be done by administering a 30-day course of oral Septra DS (sulfamethoxazole and trimethoprim, King) twice daily accompanied by the twice-daily application of Altabax (retapamulin, GlaxoSmithKline) into both nostrils. Nasal recolonization is common, so patients should continue to apply the Altabax to both nostrils each night before bed. After the patient has been infection-free for some time, the frequency of application can be decreased to once weekly and then once monthly. This strategy is successful as long as the patient does not get recolonized from another family member or significant other.

More at the link above

Superbug drug warning

Superbug drug warning - Scotsman.com News.

ANTIBIOTICS should not be available to patients over the counter at pharmacies as the NHS battles to prevent the rise in hospital superbugs, doctors have warned. The inappropriate use of antibiotics and growing resistance to the drugs if they are not used properly has been linked to the growth in infections such as MRSA in hospitals. Doctors at the British Medical Association conference in Brighton yesterday voted in favour of stopping any more antibiotics being made available without a prescription for the foreseeable future.

Hospital's movie posters promote handwashing

Hospital's movie posters promote handwashing - Framingham, MA - The MetroWest Daily News.

Spread across walls inside two local hospital campuses, promotional posters fill mock theater marquees and offer slight twists on famous blockbusters: "Germbusters!" "101 Germations." "Staph Wars." But instead of proton packs, handcuffs or lightsabers, the villains in MetroWest Medical Center's "flicks" are vanquished with a less obvious tool: handwashing. "This is an international issue," said Dr. Chinhak Chun, MetroWest Medical's infectious disease chief. In the last five years, Chun said, infections have become the greatest risk to hospital patients, with viruses and bacteria looking for opportunities to colonize intravenous lines, respirators, catheters and spots cut open by surgeons.

Empowering patients to ask providers to wash their hands

Controversies in Hospital Infection Prevention: Empowering patients to ask providers to wash their hands.

There is a qualitative study out in the June issue of the Journal of Patient Safety by Amanda Garcia-Williams and colleagues from the CDC's DHQP that assessed the CDC video "Hand Hygiene Saves Lives" as a tool of patient empowerment. They conducted four focus groups using laypersons without hospital exposure in the past year, laypersons with hospital exposure, nurses and physicians. There are a lot of interesting findings within the study and many should be subject to further analysis. The primary finding was that laypersons were much more likely to ask a nurse to wash his/her hands after watching the video, however, those with recent hospital exposure stated that they would still be "nervous" or "scared" to do so. Interestingly, laypersons with hospital exposure were more likely to ask physicians to wash their hands after watching the video but those without hospital exposure were not influenced by the video to ask physicians to wash their hands.

Kids and MRSA: The latest facts

PhillyBurbs.com:  Kids and MRSA: Combination spreading fast.

This is a very well researched item - read it at the link above

Researchers found that among children, infections involving methicillin-resistant staphylococcus aureus, better known as MRSA, jumped from two to 21 cases per 1,000 hospital admissions between 1999 and 2008, according to a study in the journal Pediatrics. Doctors believe the infection is spreading more rapidly among children than adults because they often have more direct physical contact with each other. The constant contact also raises the risk of re-infection, Shapiro and others said.  Most children in the study developed skin, soft tissue or muscle infections. Nearly 30,000 were hospitalized and 374 died, though the study didn't examine whether the deaths were infection-related or if the number of deaths or infection severity increased.

Another problem that Mass sees is the MRSA found in the community settings has developed the ability to last longer on the skin and the bacteria is more aggressive, which can lead to deeper, more dangerous, infections. The last five years, St. Christopher's Hospital for Children in Philadelphia has treated about 800 children for staph skin infections and about half MRSA, said Dr. Sarah Long, chief of infectious diseases. The biggest problem health providers see is reoccurring infections, Long said. It's not unusual to see the same children as many as eight times on an outpatient basis. The problem is that MRSA is extremely difficult to eliminate from carriers, a process called decolonization. Multiple studies show the drug regime used in the nose and skin failed to eliminate the MRSA bacteria in one-third of people, Long said. It can take up to a year for the bacteria to disappear on its own.

 The bacteria are also smart. Grand View's Mass said she has seen clindamycin-induced resistance develop during treatment with the drug. Clindamycin is one of the common antibiotics used to treat MRSA skin infections. Clindamycin doesn't work in only an estimated 10 percent of MRSA cases, the study found, but doctors worried since if the bug develops a resistance to the drug, it will further reduce the antibiotics that can treat it.

Two Emerging MRSA Drugs

The Uptake of Two Emerging Agents from Forest/AstraZeneca/Takeda and Trius Will Drive the... -- WALTHAM, Mass., June 28 /PRNewswire/ --.

Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that the uptake of two emerging agents from Forest/AstraZeneca/Takeda and Trius will drive the methicillin-resistant Staphylococcus aureus (MRSA) drug market to increase from $631 million in 2009 to $752 million in 2019 in the United States, France, Germany, Italy, Spain, the United Kingdom and Japan. The Pharmacor 2010 findings from the topic entitled Methicillin-Resistant Staphylococcus Aureus find that Forest/AstraZeneca/Takeda's ceftaroline and Trius's torezolid will capture more than one-third of the MRSA drug market in 2019. A new drug application for ceftaroline for complicated skin and skin structure infections (cSSSIs) and community-acquired bacterial pneumonia was filed in the fourth quarter of 2009, and torezolid -- a second generation oxazolidinone -- is expected to begin Phase III clinical trials for cSSSI by end of 2010.

Infectious Diseases Consultations Save Lives

The Value of Infectious Diseases Consultation in S... [Am J Med. 2010] - PubMed result.

Among 341 patients with S. aureus bacteremia, 189 (55%) were male, 196 (58%) were Caucasian, 185 (54%) had methicillin-resistant S. aureus, 108 (32%) had nosocomial bacteremia, and 231 (68%) had a central venous catheter at the time of diagnosis. The median age was 56 years (range 22-95 years). A total of 111 patients (33%) had an infectious diseases consultation. Fifty-four patients (16%) died within 28 days after diagnosis. Factors associated with mortality were intensive care unit admission 48 hours or less after the first positive blood culture (adjusted hazard ratio, 4.65; 95% confidence interval [CI], 2.65-8.18), cirrhosis (adjusted hazard ratio, 4.44; 95% CI, 2.40-8.20), and advanced age (adjusted hazard ratio, 1.27 per every 10 years of age; 95% CI, 1.08-1.50). Infectious diseases consultation was associated with a 56% reduction in 28-day mortality (adjusted hazard ratio, 0.44; 95% CI, 0.22-0.89). CONCLUSION: Only one third of patients with S. aureus bacteremia in this cohort had an infectious diseases specialist consultation. Infectious diseases consultation was independently associated with a reduction in 28-day mortality. Routine infectious diseases consultation should be considered for patients with S. aureus bacteremia, especially those with greater severity of illness or multiple comorbidities.

Throat samples offer more acuratte picture of MRSA infection in young children

Higher Prevalence of Pharyngeal than Nasal Staphylococcus aureus Carriage in Pediatric Intensive Care Units -- Nakamura et al., 10.1128/JCM.00547-10 -- Journal of Clinical Microbiology.

Sensitive detection of Staphylococcus aureus colonization is important for epidemiologic studies, infection control, and decolonization measures. We examined the sensitivity of nasal and pharyngeal sampling for S. aureus colonization in 331 children admitted to intensive care units. Pharyngeal screening was more sensitive than nasal screening (92.6% versus 63.1%, p<0.0001).

MRSA infection Protocols flawed?

Controversies in Hospital Infection Prevention: Should we just skip SCIP?.

There is a new paper and editorial on SCIP (Surgical Care Improvement Project) in this week's JAMA. SCIP is a Medicare project to improve compliance with practices that have been shown to reduce surgical site infections. These metrics include correct antimicrobial selection and timing, and appropriate hair removal. In this study the authors correlate compliance with SCIP metrics to surgical site infection rates, and the conclusion is that SCIP compliance doesn't correlate with reduction in SSIs. However, in my opinion, there's a huge problem with this study. The outcome data on SSIs were obtained using administrative data (ICD-9 codes), which are notoriously inaccurate.

Read More at the link above

3 hour MRSA test debuts

Molecular Detection Debuts MRSA Molecular Assay in UK, Ireland | The Sample | GenomeWeb.

Molecular Detection has launched its PCR-based MRSA-detection assay in the UK and Ireland, and has tapped Launch Diagnostics to exclusively distribute it in those countries and France. The CE-marked Detect-Ready kits, which takes less than three hours to detect of MRSA in nasal swabs, are compatible with "multiple" real-time PCR platforms, MD said.

Study finds MRSA bacteria in unexpected places

KVOA.com | Tucson, Arizona UA study finds MRSA bacteria in unexpected places.

A new study is causing changes for Tucson firefighters. The University of Arizona found high levels of MRSA bacteria on couches, class desks and commonly touched surfaces in Tucson Fire Department offices. Prompted by these results, firefighters now are taking strict prevention measures, and UA researchers have developed an online training program to help firefighters across the country recognize and prevent MRSA infections.

MRSA Alert: Do Locker Rooms Breed Deadly MRSA Infections

MRSA Alert: Do Locker Rooms Breed Deadly Infections? Just Ask College Wrestler Kyle Frey - - CBS News.

"Close quarters that promote skin-to-skin contact and bodily secretion contact make athletes particularly vulnerable" to fungal, viral and bacterial conditions, according to the report, issued today by the National Athletic Trainers' Association at its annual convention in Philadelphia. "MRSA and other skin conditions can be passed along from athlete very quickly, sometimes with fatal consequences," Mike Moyer, executive director of the National Wrestling Coaching Association, said in a statement. "So prevention and detection efforts aren't just nice to have. They're imperative." The paper included several recommendations athletes can take to avoid MRSA and other skin conditions, including frequent hand-washing and showering after sporting events. In addition, the report cautions athletes not to share towels, athletic gear, water bottles, disposable razors or hair clippers. All clothing and equipment should be laundered or disinfected on a daily basis.

C section babies more MRSA prone

Baby’s first bacteria depend on route of delivery | Not Exactly Rocket Science | Discover Magazine.

But babies who were delivered by C-section were colonised by bacteria that are more commonly found on the skin, including Staphylococcus. These colonists didn’t necessarily come from mum either. The skin bacteria of C-section mothers were no more similar to those of their own babies than to those of other infants delivered in the same way. Instead, it seems that C-section babies pick their first bacteria from the hospital environment. These early differences could directly affect a baby’s health. Staphylococcus is mostly benign but they can also go rogue, causing a wide variety of infections from spots to pneumonia. Antibiotic-resistant strains such as MRSA are particularly problematic and it’s perhaps unsurprising that in a Californian study, between 64-82% of newborns with MRSA infections were delivered through C-sections.

Worcestershire hospital chief blasts superbug screening priorities

Worcestershire hospital chief blasts superbug screening priorities (From Worcester News).

A HOSPITAL boss has admitted his “frustration and irritation” over some of the previous government’s targets for screening patients for the deadly superbug MRSA. John Rostill, chief executive of the Worcestershire Acute Hospitals NHS Trust, said compulsory screening of all emergency patients for MRSA should have been introduced before screening less vulnerable elective patients. Instead, the Department of Health introduced screening of elective patients first – people who are both less likely to have an MRSA bloodstream infection in the first place and less at risk of developing serious complications as a result. The trust is now screening all elective patients and about 80 per cent of the 45,000 emergency patients coming through its doors each year.