MRSA Infection

MRSA-busting firm could help save lives

Superbug-busting firm could help save lives - Hartlepool Mail.

Bio-Solutions International, a new company set up at Graythorp Industrial Estate, Hartlepool, aims to be a world leader in producing the newly-developed technology that could stop MRSA, C difficile and other infections in their tracks – saving thousands of lives. It is estimated that the manufacturing of the products could create 15 jobs at the company's yet-to-be sourced factory and laboratory, which will be in Hartlepool, and a further 15 in providing training in the use of the chemicals, as well as the manufacture of the machines. The products are a sanitiser, disinfectant and de-odouriser called Superquat80, a Biostat RU500 chemical that destroys microbes and a Superhydroxyl generator which disinfects the air passing into it. It is thought 150,000 hydroxyl units at around £300 each could be sold worldwide within the first year – totalling £45m. The other products could turn over at least £1.5m. Bio-Solutions International is currently based in the premises of water treatment firm Hydrochem Group after being set up by bosses from Hydrochem, Pearson and Black, Peter Stagg and Endo-Med, which will be distributing the products. The new company was only registered in August and already it has big plans to corner the global market with the ground-breaking technology. Similar bio-stat technology has already been used by the American Armed Forces in uniforms and the hydroxyl generator units are being installed in hospitals throughout the world.

Rumoursof MRSA decline in USA may be premature

Deadline for MRSA Prevalence Study Participation is Extended.

The Association for Professionals in Infection Control and Epidemiology (APIC) announces that the deadline for participation in the 2010 MRSA Prevalence Survey has been extended to December 31, 2010 due to the high number of APIC members expressing the need for additional time. To access the survey, CLICK HERE. APIC says that the 2010 MRSA Prevalence Survey is a tremendously important tool. First, it is the only MRSA survey that is specifically targeting infection preventionists, who know what the MRSA infection rates are and which MRSA infection control practices are in place. A recent study by the Centers for Disease Control and Prevention (CDC) suggests that invasive MRSA rates may be declining. However, there are important differences between the CDC study and the APIC study. For example, the CDC study is focused on invasive MRSA (primarily bloodstream infections), and includes only a convenience sample of nine large metropolitan areas. That study uses the general geographic population as the denominator to calculate the infection rate, and then extrapolates these data to the entire United States. In contrast, the APIC survey is sent to infection preventionists at hospitals throughout the U.S. (from large to small metropolitan areas, cities and rural areas), and includes all MRSA infection sites and colonization, as well as uses the hospital population on the day of the survey as the denominator to calculate the MRSA infection rate.

Slow release vancomycin materials to aid MRSa fight

Superbug-Resistant Bandages :: MaterialsViews.

Clearing up an existing infection, for example, requires a high-dosage ‘blast’ of antibiotics, whereas preventing infection from developing (or re-occurring) needs a lower concentration but regular repeated dose. One such delivery mechanism has been the subject of recent research by Professor Paula Hammond and her team at MIT. The team has developed a coating that can be applied either by dip-coating or spray-coating, using a layer-by-layer assembly technique to build a multilayered, degradable polymer film with vancomycin molecules trapped between the layers. The key to achieving multifunctionality in a single coating (which might be up to 60 layers thick) lies in the different assembly techniques. The drug molecules diffuse more effectively into dip-coated layers than into the spray-coated layers, meaning that the release of the drug as the film degrades is slower and steadier. Initial results with the coatings are promising, with delivery of a strong initial therapeutic dose of vancomycin, followed by a regular, steady dose at high enough concentrations to inhibit re-infection. The film eluent was also checked for toxicity towards healthy cells, and came up clean, making this an important step forward in medical care, particularly in post-operative and battlefield casualty settings.

Danes want action over MRSA ST398

Alarm over “pig MRSA” — but not in the US | Wired Science | Wired.com.

t was also covered by the Norwegian farm publication Norsk Landbruk, which picked apart the statistics in the DANMAP report to show that Denmark’s rate of MRSA in pigs was 4x greater than an EU-wide estimate from just one year earlier. To make clear what they consider the risk, DR tracked down three farm workers who acquired MRSA ST398 at work — including one who then passed the bacterium to her year-old son. This burst of news and reaction from Denmark makes it clear — as though it weren’t already — that there are places in the world which take the emergence of MRSA in farm animals, as a result of farm antibiotic use, to be a very serious issue. Surely it’s time for the US to take this seriously as well.

More at the link above

Alarm over “pig MRSA” — but not in the US

Alarm over “pig MRSA” — but not in the US | Wired Science | Wired.com.

I wish I could say the attention to ST398 was being paid in the United States, where there is almost certainly more MRSA in livestock than has been recorded, given that the only published surveillance, from 2009, covered only Iowa and Illinois. Unfortunately, there is still no indication that federal agencies have any intention to test for the presence of the organism in animals or in meat. In fact, the major surveillance mechanism for drug-resistant organisms in meat animals, retail meat and meat-eaters in the US, the National Antimicrobial Resistance Monitoring System or NARMS, doesn’t test for MRSA at all; it handles only enteric or gut-borne bacteria such as Salmonella and Campylobacter. (NARMS IS shared among three agencies: the CDC handles drug-resistant foodborne bacteria in humans, the FDA looks for the same bacteria in food, and the USDA looks for those bacteria being carried by livestock.) Instead, as so often seems to happen with antibiotic resistance, the country paying attention is in Scandinavia — in this case, Denmark. The annual report from Denmark’s surveillance scheme, DANMAP (Danish Integrated Antimicrobial Resistance Monitoring and Research Programme) is out. Denmark does surveil for MRSA, and here’s what they found: 13% of pigs, at slaughter, were positive for MRSA ST398.

Click the link above for much more

MRSA rampant in homes without plumbing

Superbugs rampant in homes without plumbing - Winnipeg Free Press.

"Most of the adults I see with MRSA have diabetes. Lots of kids have MRSA, but it is being passed back and forth between adults and kids, and with diabetes rampant in the north, the MRSA flourishes." Sometimes MRSA can go deeper into the body, invading the heart, lungs, blood or bone. In 2007, a four-year-old Nunavut boy died from MRSA after being flown to Churchill. The superbug seems to be taking off in First Nations in the region which includes Island Lake, the number of positive tests almost doubling in the last two years. Health Canada has not investigated whether the incidence is higher in communities that lack running water, but a 2008 Alaska study found MRSA rates were three times higher in villages where less than 80 per cent of homes had running water.

FDA Approves New Antibiotic for MRSA Skin Infections

FDA Approves New Antibiotic for Pneumonia, Skin Infections.

The US Food and Drug Administration (FDA) yesterday gave clinicians a much-needed new weapon against tough bacterial infections by approving ceftaroline fosamil (Teflaro; Forest Laboratories) for treating community-acquired bacterial pneumonia (CABP) and acute bacterial skin and skin-structure infections (ABSSSI), including the notorious methicillin-resistant Staphylococcus aureus (MRSA). Ceftaroline, an injectable antibiotic, is a cephalosporin, which counter bacteria by interfering with their cell walls.

Animal MRSA and Contaminated Meat

About MRSA (Methicillin-Resistant Staphylococcus Aureus) : Food Poison Journal.

Of even greater concern is the identification of MRSA in retail meats and food products, including pork, beef, and diary products. This has occurred in the U. S. as well as in Austria, China, The Netherlands, Portugal, and South Korea. However, few foodborne or food-initiated outbreaks have been reported. One ‘food-initiated’ outbreak in The Netherlands involved the transmission of MRSA from a colonized but healthy hospital dietary worker to a patient through food. The contaminated food (which tested positive for MRSA) was ingested by the patient who was severely immunocompromised, and the patient contracted a fatal infection. Transmission from that patient to other hospital workers and subsequently to other patients resulted in a major outbreak. In another food-related case, a community-acquired foodborne illness outbreak occurred in Tennessee. In that outbreak, a family developed typical foodborne illness symptoms after eating food prepared by a commercial foodhandler who was colonized with MRSA (see details below).

Improving antibiotic prescribing in neonatal units to help fight MRSA

Improving antibiotic prescribing in neonatal units: time to act -- Russell et al. -- ADC - Fetal and Neonatal Edition.

Antibiotics are increasingly prescribed in the peripartum period, for both maternal and fetal indications. Their effective use can be life-saving, however, injudicious use drives antibiotic resistance and contributes to the development of abnormal faecal flora and subsequent immune dysregulation. Neonatal units are a high risk area for the selection and transmission of multi-resistant organisms. Very few new antibiotics with activity against Gram-negative bacteria are under development, and no significantly new Gram-negative antibiotics will be available in the next decade. This review seeks to summarise current practice, and suggests restrictive antibiotic strategies based on epidemiological data from recently published UK neonatal infection surveillance studies.

Chlorhexidine more effective then iodine for pre-op infection control measures

Chicago Journals - Infection Control and Hospital Epidemiology.

Nine RCTs with a total of 3,614 patients were included in the meta‐analysis. Meta‐analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51–0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35–0.56]) than was iodine antisepsis. In the cost‐benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of $16–$26 per surgical case and $349,904–$568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances. Conclusions.Preoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.

New strategy to kill MRSA that has 'hibernated'

New Strategy To Kill Bugs Even Those In Hiding.

"One of the difficulties of applying antibiotic strategies against bugs is that some of the microbes tend to go into hibernation," said Dr Steuernagel. "Although the medication can wipe out the active populations, it often misses the hibernating ones because they are metabolically inactive. It may not be enough just to kill off the active bacteria, the hibernating rest will 'wake up' and reestablish themselves." Through use of an optimization approach called 'multiobjective optimization' that is tailored to such multifaceted scenarios, the researchers found that the best solution is to kill the microbes early and late during the therapy period, but not during the intermediate period. "This is the first time that this approach has been used in a bug eradication scenario and our solutions should be more efficient than existing approaches to kill hibernating bugs," said Dr Steuernagel. "Current practice does not take account of persistence due to hibernation although this may well be a problem. After all, microbes which are known to hibernate include Escherichia coli, multiply resistant Staphyloccus aureus (MRSA "superbug"), Mycobacterium tuberculosis, Pseudomonas aeruginosa."

Nylon Flocked Swabs better for MRSA Nasal detection?

Better Detection of Staphylococcus aureus Nasal Carriage by Use of Nylon Flocked Swabs -- Verhoeven et al. 48 (11): 4242 -- Journal of Clinical Microbiology.

Flocked swabs (Copan) were compared to rayon swabs (Copan) for the nasal detection of Staphylococcus aureus in 90 healthy volunteers sampled sequentially during a 5-week period. The use of flocked swabs improved the number of nasal carriers (P = 0.026), the number of positive specimens (P = 0.01), and the quantity of bacteria in positive samples (P = 0.004).

Community MRSA evading militant MRSA control measures in hospitals

Changing Epidemiology of Methicillin-Resistant Staphylococcus aureus in Iceland from 2000 to 2008: a Challenge to Current Guidelines -- Holzknecht et al. 48 (11): 4221 -- Journal of Clinical Microbiology.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is continuously changing. Iceland has a low incidence of MRSA. A "search and destroy" policy (screening patients with defined risk factors and attempting eradication in carriers) has been implemented since 1991. Clinical and microbiological data of all MRSA patients from the years 2000 to 2008 were collected prospectively. Isolates were characterized by pulsed-field gel electrophoresis (PFGE), sequencing of the repeat region of the Staphylococcus protein A gene (spa typing), staphylococcal cassette chromosome mec (SCCmec) typing, and screening for the Panton-Valentine leukocidin (PVL) gene. Two hundred twenty-six infected (60%) or colonized (40%) individuals were detected (annual incidence 2.5 to 16/100,000). From 2000 to 2003, two health care-associated outbreaks dominated (spa types t037 and t2802), which were successfully controlled with extensive infection control measures. After 2004, an increasing number of community-associated (CA) cases without relation to the health care system occurred. A great variety of clones (40 PFGE types and 49 spa types) were found, reflecting an influx of MRSA from abroad. The USA300 and Southwest Pacific (SWP) clones were common. SCCmec type IV was most common (72%), and 38% of the isolates were PVL positive. The incidence of MRSA in Iceland has increased since 1999 but remains low and has been stable in the last years. The search and destroy policy was effective to control MRSA in the health care setting. However, MRSA in Iceland is now shifting into the community, challenging the current Icelandic guidelines, which are tailored to the health care system.

Diabetes a factor in surgical site MRSA infection?

Postoperative hyperglycemia may be key risk factor for surgical site infection.

Postoperative hyperglycemia may be a significant risk factor for surgical site infection in patients undergoing colorectal or general surgery, according to new findings from a retrospective medical record review.. For the study, researchers assessed whether the presence of perioperative hyperglycemia was associated with an increased risk for surgical site infection in 1,561 patients who underwent general surgery (n=776), vascular surgery (n=559) or colorectal surgery (n=226) at an academic tertiary referral center between 2006 and 2009. Data were pooled from an institutional quality improvement database. Primary outcome measure was postoperative surgical site infection. Surgical site infections occurred in 7.42% of the overall cohort. This included 14.11% of patients who underwent colorectal surgery; 10.32% who underwent vascular surgery; and 4.36% who underwent general surgery. A postoperative serum glucose level of more than 140 mg/dL was the only significant predictor for surgical site infection in patients who underwent colorectal surgery. Compared with only 7.6% of patients with serum glucose levels of 140 mg/dL or less, 20.6% of patients had serum glucose levels of more than 140 mg/dL (95% CI, 1.4-7.2). Of those who underwent general surgery, age, emergency status, physical status, time in surgery, diabetes or hyperglycemia were all associated with surgical site infection. Conversely, operative time and presence of diabetes were associated with surgical site infection in patients who underwent vascular surgery, but not postoperative hyperglycemia. “If hyperglycemia is confirmed in future prospective studies with better postoperative glucose data to be an independent risk factor for postsurgical infection in general surgery patients, this would give surgeons a modifiable variable to reduce the incidence of postoperative infection,” the researchers concluded.

MRSA ST239 - replacing old strains or supplementing them?

Two Thoughts About MRSA ST239 : Mike the Mad Biologist.

Maryn McKenna has a good article about a new strain of methicillin resistant of Staphylococcus aureus, ST239, aka The Brazilian Clone (as far as I know, no bikini wax is involved...). ST239 is troubling since it's not only resistant to methicillin, but also resistant to other antibiotics, including clindamycin, tetracycline, cotrimoxazole (also known as Bactrim), moxifloxacin, and gentamicin. While cotrimoxazole and tetracycline are old drugs, they have proven to be reasonably effective against many MRSA. So spread of a multidrug resistant MRSA means that we really only have one drug that approved and effective against all types of infections, vancomycin (linezolid is primarily used against skin and tissue infections). But this leads to a question--and I haven't been able to find an answer. Does ST239 mean there are additional infections? In other words, is ST239 replacing other MRSA strains (which, admittedly were probably easier to treat), or does it represent an additional burden of infection? To what extent is this clone spreading because of a general breakdown in infection control (i.e., more cases of MRSA infections)?

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FDA Sanctions Thermo Fisher Scientific’s MRSA Test for Use with Blood Samples

FDA Sanctions Thermo Fisher Scientific’s MRSA Test for Use with Blood Samples.

Thermo Fisher Scientific received FDA clearance for additional claims for Spectra MRSA. The test is now available for the qualitative detection of MRSA from positive blood cultures demonstrating Gram-positive cocci on Gram stain. Original approval was granted in 2008 and covered use of the product to detect nasal colonization of MRSA. Spectra MRSA is manufactured, distributed, and sold under the Thermo Fisher specialty brand Remel. Spectra MRSA is a selective chromogenic medium that can be adopted in healthcare facilities to aid in appropriate patient management. It provides results within 24 hours, allowing more targeted antibiotic therapy.

Another MRSA Drug Route Found

Inhibition of Translocater Proteins Halts Superbug Invasion.

Many infectious bacteria have a protein secretion system that makes them more virulent and harder to kill than non-virulent organisms. According to Lee and Schneewind, there are three main "strategies" a pathogenic organism should have to launch a perfect invasion: "microbial adhesion, secretion of toxins into the extracellular milieu, and injection of virulence factors into host cells". The McMaster patent describes novel inhibitors of a protein secretion system in gram negative bacteria called the Type III Secretion System (T3SS), specifically translocater proteins PopD and PopB of a Pseudomonas sp. The inhibitors are polypeptides about 30 amino acids in length that inhibit the growth of the bacteria by interacting with the binding domain of translocater proteins, preventing binding of the proper ligands. They are not cyto-toxic when tested in animal models and appear to have potential to be safe and effective broad-spectrum drugs.

MRSA: If Vancomycin fails what drugs are left?

Methicillin-resistant Staphylococcus aureus: the superbug.

Over the last decade, methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged as serious pathogens in the nosocomial and community setting. Hospitalization costs associated with MRSA infections are substantially greater than those associated with methicillin-sensitive S. aureus (MSSA) infections, and MRSA has wider economic effects that involve indirect costs to the patient and to society. In addition, there is some evidence suggesting that MRSA infections increase morbidity and the risk of mortality. Glycopeptides are the backbone antibiotics for the treatment of MRSA infections. However, several recent reports have highlighted the limitations of vancomycin, and its role in the management of serious infections is now being reconsidered. Several new antimicrobials demonstrate in vitro activity against MRSA and other Gram-positive bacteria. Data from large surveys indicate that linezolid, daptomycin, and tigecycline are almost universally active against MRSA.

Poverty and Staph Infections - Tracing the Links

Differences in nasopharyngeal bacterial carriage in preschool children from different socio-economic origins - Jourdain - Clinical Microbiology and Infection - Wiley Online Library.

Carriage rates were high for all pathogens. Fifty percent of the children were colonized at least once with S. aureus, 69% with S. pneumoniae, 67% with M. catarrhalis and 83% with H. influenzae. PCV7 uptake was higher among children from higher socio-economical setting and S. pneumoniae serotypes varied accordingly. Children from lower socio-economic schools were more likely to carry M. catarrhalis, S. aureus and antibiotic resistant S. pneumoniae, including a high proportion of non-typeable pneumococcal strains. Positive associations between S. pneumoniae and H. Influenzae, between H. influenzae and M. catarrhalis and between H. influenzae and S. aureus were detected. Our study indicates that nasopharynx flora composition is influenced not only by age but also by socio-economical settings. Children nasopharynx might represent a unique dynamic environment modulated by intricate interactions between bacterial species, host immune system and PCV7 immunization.

MRSA creams - what dose needed? Not sure say scientists

Activity of topical antimicrobial agents against multidrug-resistant bacteria recovered from burn patients.

Topical antimicrobials are employed for prophylaxis and treatment of burn wound infections despite no established susceptibility breakpoints, which are becoming vital in an era of multidrug-resistant (MDR) bacteria. We compared two methods of determining topical antimicrobial susceptibilities. Methods Isolates of Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae, and Acinetobacter baumanii-calcoaceticus (ABC) from burn patients were tested using broth microdilution and agar well diffusion to determine minimum inhibitory concentrations (MICs) and zones of inhibition (ZI). Isolates had systemic antibiotic resistance and clonality determined. MDR included resistance to antibiotics in three or more classes. Results We assessed 22 ESBL-producing K. pneumoniae, 20 ABC (75% MDR), 20 P. aeruginosa (45% MDR), and 20 MRSA isolates. The most active agents were mupirocin for MRSA and mafenide acetate for the gram-negatives with moderate MICs/ZI found with silver sulfadiazene, silver nitrate, and honey. MDR and non-MDR isolates had similar topical resistance. There was no clonality associated with resistance patterns. Conclusion Despite several methods to test bacteria for topical susceptibility, no defined breakpoints exist and standards need to be established. We recommend continuing to use silver products for prophylaxis against gram-negatives and mafenide acetate for treatment, and mupirocin for MRSA.