MRSA Infection

MRSA killing paint - coming to a ward near you?

Sprucing up health care with disease-killing paint | Health.

A leading antibiotic-resistant bacteria in health care and health club settings is MRSA (methicillin resistant Staphylococcus aureus). Though deadly to humans, MRSA is no match for a naturally occurring enzyme called lysostaphin. By piggy-backing the enzyme onto carbon nanotubes, the Rensselaer researchers have added it to a latex paint, creating a water-based coating that kills MRSA on contact. In tests, splashing a MRSA solution on surfaces coated with the enzyme-enhanced paint resulted in a 100 percent of the bacteria being killed, a potentially potent approach to an otherwise tough health care problem. Best of all, the painted surface is safe to touch, does not appear to promote resistance, and will not leach into the environment. "Lysostaphin is exceptionally selective," says Jonathan Dordick, chemical and biological engineering professor at Rensselaer and one of the investigators on this project, "it doesn't work against other bacteria and it is not toxic to human cells."

Poor funding threat to war on MRSA

Poor funding threat to war on superbugs - Scotsman.com News.

A LACK of funding is posing a "major risk" to fighting superbugs in Lothians hospitals, health chiefs have warned. NHS Lothian currently has a £70 million funding black hole because of the way Scottish Government funding favours other areas of the country. And in a report on hospital acquired infections (HAI) from NHS Lothian, it is warned that this means local health chiefs are less able to channel resources into reducing infections like MRSA and C.diff.

MRSA policies differ among hospitals, study shows

MRSA policies differ among hospitals, study shows.

Hospitals vary in how they detect and treat drug-resistant staph infections, but most follow national guideline recommendations, according to researchers at the University of Illinois at Chicago.  Researchers sent a 61-item questionnaire to pharmacy directors at 263 acute-care hospitals in the United States to learn of their policies and practices regarding methicillin-resistant Staphylococcus aureus (MRSA). The study was published in the American Journal of Health-System Pharmacist. Among the 102 hospitals that responded, 43% said they had a procedure to screen patients for MRSA, lead author Yoojung Yang, a fellow in the Center for Pharmacoeconomic Research, stated in a University of Illinois press release.

MRSA outbreak strikes third victim at safety center

MRSA outbreak strikes third victim at safety center | InsideNova.com.

A third victim had been hospitalized after contracting MRSA at the Prince William County Public Safety Training Center. The center in Nokesville was closed about 5 p.m. Thursday, after two county fire and rescue employees were diagnosed with the staph bacteria, Methicillin-resistant Staphylococcus Aureus, known to be resistant to some antibiotics. The center is scheduled to reopen Monday. It is used to train police, fire, rescue and other public safety personnel from Prince William County and the Greater Washington area. The first victim told officials he had a small wound. "Approximately one week ago, a Department of Fire and Rescue employee reported a wound on the ankle that resembled a spider bite. The employee was immediately sent to an Occupational Health facility for a medical evaluation," said Prince William spokeswoman Nikki Brown. Investigators from the Health and Safety Office and EMS Training Section suspected MRSA as the cause of the wound and disinfected the surfaces touched by the victim.

Staph Carriers less likely to die from staph infections than non carriers who suffer an infection

Controversies in Hospital Infection Prevention: Why are we colonized with Staphylococcus aureus?.

Pretty cool. S. aureus carriers were 3 times more likely to have a nosocomial S. aureus bacteremia as non-carriers, but had one-quarter the risk of death from S. aureus bacteremia. So, if you are a S. aureus carrier you have a 3/3420 or 0.000877 chance of death from S. aureus. If you're a non-carrier you have a 13/10588 or 0.001228 chance of death. Yes, I know, sig figs. Amazingly, being colonized, while increasing the risk of infection, drastically cuts the risk of death such that colonized patients are 30% LESS likely to die. Is this enough to explain why 30% of us are colonized? Obviously not, it's just one paper. Their work and other's since has studied factors associated with colonization, but there is more work to do.

TV's Aggie MacKenzie warns of antibacterial cleaner overuse

Express.co.uk - Home of the Daily and Sunday Express | UK News :: TV's Aggie MacKenzie: Homes face risk of superbug invasion.

Now Aggie, who co-presented the popular Channel 4 show with Kim Woodburn, has come up with cleaning products which contain probiotics. These “good” bacteria are said to promote health. The Scottish cleaning guru said: “Overuse of antibiotics is one of the reasons that superbugs such as MRSA evolved. There is no reason to believe the same thing won’t happen from the overuse of antibacterial cleaners. We need to put the brakes on their use before it is too late.” Aggie’s Probiotics cleaners inhibit the growth of harmful germs on kitchen and bathroom surfaces, creating more space for good counterparts to thrive and create a protective layer. In contrast, antibacterial cleaners wipe out all bacteria including those that are there to safeguard our health. Aggie added: “These days we’re led to believe that all bacteria are bad for us. Only one per cent will do us any harm, the other 99 per cent are there to keep us healthy.

The chink in the VRSA drug resistance armour

Molecular basis of vancomycin-dependence in VanA-type Staphylococcus aureus VRSA-9 -- Meziane-Cherif et al., 10.1128/JB.00613-10 -- The Journal of Bacteriology.

Vancomycin-resistant Staphylococcus aureus VRSA-9 clinical isolate was partially dependent on glycopeptide for growth. The responsible vanA operon had the same organization as that of Tn1546 and was located on a plasmid. The chromosomal D-Ala:D-Ala ligase (ddl) gene had two point mutations that led to Q260K and A283E substitutions, resulting in a 200-fold decrease in enzymatic activity compared to that of the wild-type strain VRSA-6. To gain insight into the mechanism of enzyme impairment, we determined the crystal structure of VRSA-9 Ddl and showed that the A283E mutation induces new ion-pair/hydrogen bond interactions leading to an asymmetric rearrangement of side chains in the dimer interface. The Q260K substitution is located in an exposed external loop and did not induce any significant conformational change. The VRSA-9 strain was susceptible to oxacillin due to synthesis of pentadepsipeptide precursors ending in D-alanyl-D-lactate which are not substrates for the {beta}-lactam resistant penicillin binding protein PBP2'. Comparison with the vancomycin partially-dependent VRSA-7, whose Ddl is 5-fold less efficient than that of VRSA-9, indicated that the levels of vancomycin dependence and susceptibility to {beta}-lactams correlate with the degree of Ddl impairment. Ddl drug targeting could therefore be an effective strategy against vancomycin-resistant S. aureus.

ST93-IV Community MRSA a unique new variant

Complete Genome Sequence of Staphylococcus aureus strain JKD6159, a Unique Australian clone of ST93-IV Community Methicillin-Resistant Staphylococcus aureus -- Chua et al., 10.1128/JB.00878-10 -- The Journal of Bacteriology.

Community methicillin-resistant Staphylococcus aureus (cMRSA) is an emerging issue that has resulted in multiple worldwide epidemics. We report the first complete genome sequence of an ST93-MRSA-IV clinical isolate that caused severe invasive infection and a familial outbreak of skin infection. This isolate is a representative of the most common Australian clone of cMRSA that is unique and unrelated to the previously sequenced genomes of S. aureus.

Creeping resistance to vancomycin for MRSA in Malaysia

Increased vancomycin minimum inhibitory concentration among Staphylococcus aureus isolates in Malaysia -- Ahmad et al., 10.1099/jmm.0.022079-0 -- Journal of Medical Microbiology.

Treatment failures have been reported in MRSA infections with vancomycin MIC of 2 microgram/mL. The prevalence of Staphylococcus aureus clinical strains with high MICs is not known in Malaysian hospitals. This study was conducted to determine the MICs of Staphylococcus aureus isolates obtained from clinical samples from 6 major Malaysian hospitals. A total of 300 MSSA and 300 MRSA strains from invasive infections and non-colonizers were included in this study. Vancomycin MICs were determined by broth microdilution (BMD) and E-test method. By BMD method, the majority of MSSA strains (87%) showed vancomycin MIC of 0.5 microgram/mL while MIC of 1.0 microgram/mL was observed more frequently in MRSA compared to MSSA (41% and 13%, respectively). By E-test method, higher MIC values of 1.5 microgram/mL and 2.0µg/mL were observed in 50% and 16% of MSSA and 51% and 30% of MRSA respectively. MRSA strains were also shown to have a significantly higher vancomycin MICs than the MSSA strains (p<0.05). Analysis of bacteraemia isolates showed a higher proportion of MRSA with E-test vancomycin MIC of 2µg/mL compared to MSSA (39% vs. 13%) (p<0.05). Even though the MIC values were dependent on the method used, the high vancomycin MICs of ≥ 1 µg/ml observed among our strains is a cause of concern as it may have an impact on the success of vancomycin treatment.

Positive Role of Vacuum in Methicillin-Resistant Deep Sternal Wound Infection

Role of Vacuum in Methicillin-Resistant Deep Sternal Wound Infection -- De Feo et al. 18 (4): 360 -- Asian Cardiovascular & Thoracic Annals.

Between January 2002 and January 2009, 39 patients with post-cardiotomy staphylococcal deep sternal wound infection were treated primarily by a vacuum-assisted closure method (group A). Results were compared with those of 30 patients with staphylococcal deep sternal wound infection who received closed mediastinal irrigation with antibiotics (group B). The prevalence of methicillin-resistance was similarly high in both groups (64.1% in A, 56.7% in B). One group B patient died during treatment. The median healing time was significantly shorter at 13 days in group A (mean, 13.5 ± 3.2 days) compared to 18 days (mean, 21.2 ± 16.4 days) in group B. Deep sternal wound infection did not recur after vacuum treatment, while 7 (24%) patients in group B suffered a recurrence. Hospital stay was significantly shorter in group A (median, 30.5 days; mean, 32.2 ± 11.3 days vs. median, 45 days; mean, 49.2 ± 19.3 days). The significantly shorter healing time with vacuum-assisted closure was confirmed in both methicillin-sensitive (12 vs. 17 days) and methicillin-resistant infections (14 vs. 21 days). Hospital stay remained significantly shorter in group A (35 vs. 46 days) when only methicillin-resistant deep sternal wound infection was considered.

PVL MRSA Strains Entering UK Hospitals

Characterization of community and hospital Staphylococcus aureus isolates in Southampton, UK -- Green et al. 59 (9): 1084 -- Journal of Medical Microbiology.

Staphylococcus aureus infections are a burden to healthcare systems. There remains a lack of understanding on the relative contributions of S. aureus infection in the healthcare and community settings. In this study, 59 S. aureus isolates were selected for molecular analysis. The mobile variant staphylococcal cassette chromosome mec type IV was present in both healthcare-associated meticillin-resistant S. aureus (HA-MRSA) and community-associated MRSA (CA-MRSA), as was the Panton–Valentine leukocidin gene. PFGE identified 24 distinct clonal groups whilst multi-locus sequence typing identified 26 different sequence types, including four with new combinations of alleles. This is the first time, to our knowledge, that a selection of CA and HA MSSA and MRSA strains have been subjected to molecular analysis and comparison in the UK. Definitions for CA-MRSA need further debate as the movement of strains between healthcare and community settings is confounding the use of epidemiological definitions.

Six cases of daptomycin resistant Staphylococcus aureus bacteremia in Singapore

Six cases of daptomycin non-susceptible Staphylococcus aureus bacteremia in Singapore -- Hsu et al., 10.1099/jmm.0.022533-0 -- Journal of Medical Microbiology.

We report the first six cases of daptomycin-non-susceptible Staphylococcus aureus infections from Singapore. These strains were rapidly isolated after bacteremic patients were switched to daptomycin following initial prolonged unsuccessful therapy with vancomycin, despite confirmation of daptomycin susceptibility just prior to initiating daptomycin therapy. The majority of post-vancomycin therapy strains had exhibited marked thickening of their cell walls on electron microscopic examination. In patients with persistent S. aureus bacteremia, therapeutic failure with daptomycin may occur if used as salvage therapy following vancomycin failure, notwithstanding initial susceptibility testing results.

MRSA Drugs and Cystic Fibrosis

Newer antibacterial agents and their potential role in cystic fibrosis pulmonary exacerbation management -- Parkins and Elborn 65 (9): 1853 -- Journal of Antimicrobial Chemotherapy.

However, the epidemiology of pathogens infecting CF airways is changing, with increased incidence of methicillin-resistant Staphylococcus aureus (MRSA), drug-resistant Pseudomonas aeruginosa and other Gram-negative non-fermenters such as Stenotrophomonas maltophilia and Achromobacter xylosoxidans. Accordingly, a great need for new and novel agents for the management of acute exacerbations in CF exists. While several antibiotics have recently been approved or are close to approval for clinical use, frequently their emphasis has been for Gram-positive, and specifically MRSA-related, disease. Despite this, these agents may have a role in CF-related exacerbations. This article reviews the spectrum of activity, pharmacokinetics and clinical and theoretical evidence for the use of newer agents including tigecycline, doripenem and ceftobiprole in the management of CF pulmonary exacerbations. Appropriate use of these agents in CF will require detailed CF-specific pharmacokinetic and pharmacodynamic data.

MRSA Drugs Powerless Against New Bacteria

Scientists Find New Superbug Spreading From India - ABC News.

Walsh and his international team collected bacteria samples from hospital patients in two places in India, Chennai and Haryana, and from patients referred to Britain's national reference laboratory between 2007 and 2009. They found 44 NDM-1-positive bacteria in Chennai, 26 in Haryana, 37 in Britain, and 73 in other sites in Bangladesh, India, and Pakistan. Several of the British NDM-1 positive patients had recently traveled to India or Pakistan for hospital treatment, including cosmetic surgery, they said. Most worryingly, NDM-1-producing bacteria are resistant to many antibiotics including carbapenems, the scientists said, a class of the drugs generally reserved for emergency use and to treat caused by other multi-resistant bacteria such as MRSA and C-Difficile.

Nabi Scores Another $8M from GSK under MRSA Vaccine Deal

Nabi Scores Another $8M from GSK under MRSA Vaccine Deal.

Nabi Biopharmaceuticals triggered an $8 million milestone by completing the transfer of PentaStaph™ know-how to GlaxoSmithKline (GSK) Biologicals. Nabi sold the S. aureus vaccine candidate and related technologies to GSK in November 2009 for a total consideration of $46 million, including $26 million associated with accomplishing four milestone tasks. With this milestone Nabi has earned a total of $21 million in PentaStaph success-based fees. The remaining $5 million stipulated in the agreement will be dispersed upon completion of a Phase I trial that began in December 2009.

Beta toxin - making staph dangerous

Beta toxin catalyzes formation of nucleoprotein matrix in staphylococcal biofilms — PNAS.

Extracellular DNA (eDNA) is a major structural component in many biofilms of the pathogenic bacterium Staphylococcus aureus, but its role is enigmatic. Here, we demonstrate that beta toxin, a neutral sphingomyelinase and a virulence factor of S. aureus, forms covalent cross-links to itself in the presence of DNA (we refer to this as biofilm ligase activity, independent of sphingomyelinase activity) producing an insoluble nucleoprotein matrix in vitro. Furthermore, we show that beta toxin strongly stimulates biofilm formation in vivo as demonstrated by a role in causation of infectious endocarditis in a rabbit model. Together, these results suggest that beta toxin cross-linking in the presence of eDNA assists in forming the skeletal framework upon which staphylococcal biofilms are established.

Health Care-Associated Invasive MRSA Infections, 2005-2008

JAMA -- Abstract: Health Care-Associated Invasive MRSA Infections, 2005-2008, August 11, 2010, Kallen et al. 304 (6): 641.

From 2005 through 2008, there were 21 503 episodes of invasive MRSA infection; 17 508 were health care associated. Of these, 15 458 were MRSA BSIs. The incidence rate of hospital-onset invasive MRSA infections was 1.02 per 10 000 population in 2005 and decreased 9.4% per year (95% confidence interval [CI], 14.7% to 3.8%; P = .005), and the incidence of health care–associated community-onset infections was 2.20 per 10 000 population in 2005 and decreased 5.7% per year (95% CI, 9.7% to 1.6%; P = .01). The decrease was most prominent for the subset of infections with BSIs (hospital-onset: –11.2%; 95% CI –15.9% to –6.3%; health care–associated community-onset: –6.6%; 95% CI –9.5% to –3.7%). Conclusion Over the 4-year period from 2005 through 2008 in 9 diverse metropolitan areas, rates of invasive health care–associated MRSA infections decreased among patients with health care–associated infections that began in the community and also decreased among those with hospital-onset invasive disease.

Nevada looks to Patient screening to cut MRSA?

Controversies in Hospital Infection Prevention: What happens in Vegas....

It looks like there is a move afoot in Nevada to mandate universal MRSA screening. Sheila Leslie, D-Reno, whose otherwise healthy cousin recently died from MRSA infection at a California hospital, is considering drafting a bill on the subject. A recently posted Las Vegas Sun piece focused on the MRSA surveillance mandate in the VA system and quoted from the usual and also unusual subjects in the never ending debate around MRSA control.

VA system stanching MRSA via Patient Screening

VA system stanching MRSA - Sunday, Aug. 8, 2010 | 2 a.m. - Las Vegas Sun.

The VA had a 59 percent decrease in hospital-acquired MRSA cases in intensive care units nationwide from October 2007 to March 2009, and a 29 percent decrease in non-ICU cases from October 2007 to November 2008. Some facilities have reduced their rates to almost zero, Jain said. The VA's mind-set and methods are in place at all 153 acute care VA hospitals nationwide, including the O'Callaghan Federal Hospital at Nellis Air Force Base. Dr. Ramu Komanduri, chief of staff at O'Callaghan, said the screening showed that 8 percent of incoming patients are either infected with MRSA or are carriers who can infect others. Each tests costs about $25 and results take about two hours, he said. Patients with the bacterium are immediately isolated. The VA also tests patients before they are transferred internally and at discharge, to identify whether they picked up MRSA at the facility. Komanduri said he can't remember the last time O'Callaghan had a hospital-acquired MRSA infection. The hospital has fewer than 100 beds.

Eaten Alive: A 5-year battle with flesh-eating germ

The Associated Press: Eaten Alive: 5-year battle with flesh-eating germ.

Waking from a fog of anesthesia, Sandy Wilson found she was a patient in one of the hospitals where she worked as a nurse. She remembered having a baby, and being told she had gotten an infection. But nothing could prepare her for what lurked beneath the sheets. Flesh-eating bacteria were eating her alive. "When I looked down at my belly, basically all the skin was gone and I could see my internal organs," she said. "I remember seeing my intestines. I thought, 'There's no way I can live like this ... This is a death sentence.'" In all of medicine, few infections are as feared as this one. It strikes out of the blue, especially obese people, diabetics, cancer patients, transplant recipients and others with weak immune systems — a growing group of Americans. It kills 20 percent of its victims and horribly disfigures others. It used to be caused almost exclusively by one type of strep bacteria. Now there's a scary trend: drug-resistant superbugs like the staph germ MRSA increasingly are able to make "flesh-eating" toxins and cause nightmarish infections like Wilson's.

Read the whole article at the link above