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Link: WSBTV.com
Staphylococcus is an infection that can be deadly, and it strikes healthy people, including one woman who went for a beauty treatment. "It all started when I got my eyebrows waxed. I got my hair cut and everything because I wanted to look good," Amber Witherow told television station WGAL. What happened next took Witherow completely by surprise. Days after her trip to the salon, an infection developed near her right eye. "It was to the point where my eye was purple, swollen shut and there was a hole in my head," she said. "It started to really hurt. (I) got headaches, migraines. I was throwing up, so I went to the doctor, my family doctor." The infection was so severe Witherow was admitted to Lancaster General Hospital so that infectious disease doctors could get it under control. She was suffering from a particular staph infection known as methicillin-resistant staphylococcus aureus, or MRSA. "Staphaureus is the name of the germ that causes the infections. The methicillin resistant part is something that's the new feature of these community-acquired outbreaks," Dr. Joseph Kontra said. Staph infections are nothing new. Although some can be serious, they're treated with antibiotics. But the new MRSA strain has doctors puzzled because it's resistant to those antibiotics, making it more difficult to treat. And to make matters worse, more cases are popping up. "Really, last June and going forward from there, we've seen quite a few cases -- a tripling of our caseload of those infections," said Kontra.
Link: BCNG Portals Page.
B.C.'s health officers recently met with Dr. David Patrick, head of epidemiology control with the B.C. Centre for Disease Control, to discuss whether or not to make this new strain, called community-acquired MRSA, reportable to the provincial health officer. Health officials remain unconvinced that such a labour intensive measure is necessary. However, they agree the bug is unusual and should be tracked. "It is an interesting blend and we would like to keep an eye on things," said Provincial Health Officer Dr. Perry Kendall. However, he called making it reportable, "a bit of a broad approach." "I'd like to find a way to monitor it without working through 700 reports looking for the seven hundredth (to find) one with something interesting in it," he said. Forty infectious diseases such as tuberculosis and AIDS are reportable, a designation that requires physicians to collect patient information and track the source when they come across the disease. The provincial health officer must make a recommendation to the provincial cabinet before it adds a disease to the list, but Kendall is reluctant to make that recommendation yet. Dr. Wayne Ghesquiere thinks tracking the disease would be worth the extra paper work. "It's like (the control of) TB. You control it so you know who has it, so they don't give it to someone else," he said.
Link: Multi-systemic methicillin resistant Staphylococcus aureus (MRSA) community-acquired infection..
Background: An alarming increase of the incidence of community-acquired infections due to methicillin resistant Staphylococcus aureus (MRSA) has been noted in several countries during the recent years. Case Report: We present the case of a 64-year-old male who complained of fever, shortness of breath, productive cough, and mild low back pain. The patient was diagnosed to have severe community-acquired pneumonia caused by methicillin resistant Staphylococcus aureus. Due to the severity of his respiratory symptoms and the history of back injury, the mild low back pain did not receive the appropriate attention. It became clear later that the back pain was caused by an extra-pulmonary focus of the MRSA infection. Conclusions: Staphylococcus aureus has been reported to be the cause of considerably different proportions of patients with community-acquired pneumonia in studies from various parts of the world. Our case emphasizes the occasionally multi-systemic manifestations of community-acquired MRSA infections and the difficulties in their control.
Link: Academic Emergency Medicine.
Objective: Nationally we have seen an emergence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) soft tissue infections. Anecdotally we noticed that many patients with abscess present with a complaint of a "spider bite." These lesions have a centrally demarcated eschar with surrounding cellulitis. Wound cultures in these patients often grow CA-MRSA. Our study was set up to determine the validity of a central eschar with surrounding cellulitis as a predictor for CA-MRSA infection. Methods: This was a prospective observational study. For patients with chief complaint of infection with abscess, study data sheets were placed on the chart at triage. All abscesses were treated with incision and drainage or needle aspiration and wound cultures were obtained. Physicians were asked to record on the data sheet the following: exclusion criteria, the presence of eschar, cellulitis, incision and drainage (I D) or aspiration, and antibiotic treatment used. From this data pool we followed wound culture results and determined the sensitivity, specificity, and positive/negative predictive values of a central black eschar as a clinical predictor of CA-MRSA. Results: One hundred twenty-three patients with abscess were enrolled. Of these, thirty had no culture obtained. Nine had cultures obtained but the form was incompletely filled out or culture results were inconclusive. Of the 84 remaining patients, 58 wound cultures (69%) grew MRSA. Of these 58 MRSA-positive cultures, 23 tested positive for central black eschar, yielding a sensitivity of 40%. Twenty-six abscesses grew non-MRSA bacteria. Two of these were positive for central black eschar, yielding a specificity of 92%. The positive predictive value was 92% and the negative predictive value was 41%. Conclusions: A central black eschar has good specificity but poor sensitivity in diagnosing CA-MRSA infection. In our database, if a central black eschar was present, the culture result was most likely CA-MRSA. However, if the test was negative (no eschar), CA-MRSA could not be excluded.
Link: Academic Emergency Medicine.
Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) now causes the majority of skin and soft tissue infections in emergency departments (EDs) across the United States. Little is known about patterns of CA-MRSA colonization or how it is spread. We hypothesized that emergency physicians (EPs) working in an ED with a very high incidence of CA-MRSA infections would have a high rate of CA-MRSA colonization. Objectives: To examine nasal S. aureus colonization, and the proportion that was MRSA, among emergency medicine (EM) residents. Methods: This was an observational study conducted in EM residents (years 1-4 and incoming interns) working primarily at an urban, county, academic ED in Northern California. A culture of the anterior nares for S. aureus was obtained using a Dacron swab. Positive cultures underwent antibiotic susceptibility testing. Results: 50 EM residents (10 from each year of training) underwent testing. 1 subject grew methicillin-susceptible S. aureus and 1 grew MRSA, for an overall S. aureus colonization rate of 4% (95% confidence interval [95% CI] 1.1%-13.5%) and MRSA colonization rate of 2% (95% CI 0.4%-10.5%). The MRSA isolate was resistant to oxacillin and levofloxacin, but susceptible to clindamycin, trimethoprim/sulfamethoxazole (TMP/SMX), and vancomycin (a profile typical of CA-MRSA). Conclusions: The MRSA colonization rate among EM residents working in a high-prevalence ED was low. This suggests that hand-washing and universal precautions are effective in limiting spread of CA-MRSA to health care workers, and that EPs are neither at increased risk of CA-MRSA infection nor directly involved in its spread. The overall rate of Staphylococcus aureus colonization in this study was unusually low.
Link: WLBT 3 - Jackson, MS: Ear-Stapling Moves to Black Market.
"If you're doing it in flower shops and laundromats and the bathroom of certain office buildings, but it's not out in the open, it's back behind something," Morgan said. "So it is 'back-alley.'" Dr. Morgan says the board has now closed more than 30 office-front businesses, citing that the practice is acupuncture, a type of medicine that in Mississippi requires both an M.D. and appropriate training in acupuncture. "The folks who are doing the ear stapling, at the most, are having a short course in Oklahoma City or a short course here in Pearl, Mississippi," Morgan says. "Let's be honest. The expertise is just not there." As for those patronizing the so-called "back-alley" practices, Dr. Morgan calls it dangerous. He says people are risking a serious, antibiotic resistant staph infection. "I won't raise the specter of death, but MRSA can kill you, or certainly cause a loss of a lot of tissue," Morgan says. "And unless you want to go around with only one ear, I wouldn't take that chance."
Link: BCNG Portals Page.
This is a poignant story of the impact of CA MRSA on one teenager. The family circumstance will be repeated often. How will communities with low numbers of insured people cope with the spread of CA MRSA?
Rushed from Silverdale to the Bremerton campus of Harrison for surgery, Eva learned in the ambulance that the inflammations were due to MRSA. Eva, who wants to study nursing, knew little about Methicillin-resistant Staphylococcus aureus (MRSA), a bacterium that causes infections in different parts of the body and is resistant to many antibiotics. It is more commonly known as staph. Thursday’s surgery removed the infected tissue from Eva’s arm and by Saturday, April 8, she was sent home. “Here she is with an open wound out in the community,” said Eva’s mother, Meredith Ferguson, last week. “From what I understand most people would be in isolation for a much greater period than she was,” Meredith said. “But I don’t have insurance so I was there for three days,” Eva added.
Link: WROC
"The bulk of your patients are really your healthy kids," says Dr. Ghinwa Dumyati, an infectious disease specialist at RGH. Dumyati is working with the centers for disease control to get the word out to local pediatricians about ORSA. Rochester is one of the few cities in the U.S. which still refer to the infection as ORSA; it is more commonly referred to as methicillin-resistant staphylococcus aureus or MRSA. ORSA or MRSA can be passed from person to person through contact with contaminated skin (the bacteria can be on the hands of people who carry the germ, but show no signs of infection), or through contact with contaminated objects (like towels or razors). MRSA/ORSA is now recognized to be untreatable with most antibiotics and has been called a "super bug." MRSA has been linked to serious, often fatal, complications, like pneumonia, bloodstream infections and surgical site infections. "Awareness that this bacterium now exists in Rochester that if you see someone with a skin abscess, the skin abscess needs to be cultured," says Dumyati who adds that culturing all wounds is important because ORSA/MRSA is resistant to conventional antibiotics used to treat infected wounds.
Link: Methicillin-resistant Staphylococcus aureus in the Australian community: an evolving epidemic.
This study has recieved huge publicity. Note that Australia has a high incidence of the PVL versions of CA MRSA
2652 S. aureus isolates were collected, of which 395 (14.9%) were MRSA. The number of community-associated MRSA (CA-MRSA) isolates rose from 4.7% (118/2498) of S. aureus isolates in 2000 to 7.3% (194/2652) in 2004 (P = 0.001). Of the three major CA-MRSA strains, WA-1 constituted 45/257 (18%) of MRSA in 2000 and 64/395 (16%) in 2004 (P = 0.89), while the Queensland (QLD) strain increased from 13/257 (5%) to 58/395 (15%) (P = 0.0004), and the south-west Pacific (SWP) strain decreased from 33/257 (13%) to 26/395 (7%) (P = 0.01). PVL genes were detected in 90/195 (46%) of CA-MRSA strains, including 5/64 (8%) of WA-1, 56/58 (97%) of QLD, and 25/26 (96%) of SWP strains. Among health care-associated MRSA strains, all AUS-2 and AUS-3 isolates were multidrug-resistant, and UK EMRSA-15 isolates were resistant to ciprofloxacin and erythromycin (50%) or to ciprofloxacin alone (44%). Almost all (98%) of CA-MRSA strains were non-multiresistant. CONCLUSIONS: Community-onset MRSA continues to spread throughout Australia. The hypervirulence determinant PVL is often found in two of the most common CA-MRSA strains. The rapid changes in prevalence emphasise the importance of ongoing surveillance.
Link: Fayetteville Online
Cape Fear Valley Health System is taking precautions against a virulent infection that attacks young, healthy people. The infection is spreading in other parts of the country.
Officials say the infection — a drug-resistant staphylococcus — can pass quickly in places where people congregate, such as gyms, jails and colleges.
At HealthPlex, a gym and wellness center that is part of Cape Fear Valley Health System, the staff is warning members to take precautions.
Signs around the gym instruct people to wear towels and flip flops in the steam room, stay out of the pool if they have open wounds or cuts, and clean off equipment with anti-bacterial wipes.
HealthPlex director Renee Singleton said the gym staff began taking precautions against drug-resistant staph infections about a year ago, but efforts have increased in the past few weeks in response to media reports about the infection spreading in other parts of the country.
“Obviously, we want to stop this before it begins,” said health system spokesman Clinton Weaver.
Link: Latest perspectives on antibiotic use in the community - Patient Care.
Excellent, fact filled article which also reveala that up to 50% of antibiotic prescriptions are not needed. Click the link above for more
In some geographic areas, up to 75% of the strains of the ubiquitous staphylococcus are methicillin-resistant, and these bacteria are responsible for complicated infections of the skin and soft tissue and for antibiotic-resistant cases of community-acquired pneumonia (CAP). For reasons not yet understood, serious MRSA infections can occur even in healthy people with no apparent risk factors—no recent hospitalization or surgery, no residence in a long-term-care facility, and no injectable drug abuse.4 A difference is evolving between what is now called health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA). The risk factors for CA-MRSA include participation in sports and military activities, use of day-care centers and correctional facilities, and age.5 The median age for CA-MRSA is 23 years; for HA-MRSA, it is 68 years. There is also a clear division developing in the antibiotic sensitivity of each type of MRSA with the CA-MRSA sensitive to clindamycin or trimethoprim/sulfamethoxazole (TMP/SMZ; Bactrim, Cotrim, Septra). CA-MRSA also seems to be becoming more prevalent in the hospital setting.
Link: Warning of superbug epidemic
FEDERAL health authorities have been "unreceptive" to concerns about an evolving epidemic of new strains of golden staph, a senior public health official said. Dr Keryn Christiansen, of Royal Perth Hospital (RPH), says community acquired methicillan resistant staphylococcus aureus, or CA-MRSA, is increasing for unknown reasons in some parts of Australia and particularly Western Australia. Dr Christansen and co-authors of a study published in this month's Australian Medical Journal, surveyed 2600 golden staph isolates (germs) collected from around Australia. Nationally, the appearance of the CA-MRSA strain rose from 4.7 per cent to 7.3 per cent of the sample, compared with similar surveys in 2000 and 2002. WA had a quarter of all national cases of CA-MRSA, between July 2004 and February 2005. The article refers to the issue as an "evolving epidemic". Advertisement: But Dr Christiansen, head of microbiology and infectious diseases at RPH, said she has had trouble drawing the issue to the attention of federal authorities.
Link: Radio New Zealand
The study tracked the spread of CA-MRSA over six months last year and compared the results to similar surveys in 2000 and 2002. The strain had grown to be "a major clinical and public health problem", nearly doubling in occurrence from 2000 to 2005, the research, led by Queensland Health Pathology Service's Director of Microbiology, Associate Professor Graeme Nimmo, found. Its prevalence was more marked in Perth, Darwin and Brisbane and the infection was acquiring resistance to antimicrobial medicine, Associate Professor Nimmo said. Medical treatment of CA-MRSA would become even more difficult in the future, he said.
Link: [Staphylococcus aureus Infections: New Challenges from an Old Pathogen.].
Staphylococcus aureus is a versatile organism with several virulent characteristics and resistance mechanisms at its disposal. It is also a significant cause of a wide range of infectious diseases in humans. S. aureus often causes life-threatening deep seated infections like bacteremia, endocarditis and pneumonia. While traditionally confined mostly to the hospital setting, methicillin-resistant S. aureus (MRSA) is now rapidly becoming rampant in the community. Community-acquired MRSA is particularly significant because of its potential for unchecked spread within households and its propensity for causing serious skin and pulmonary infections. Because of the unfavorable outcome of many MRSA infections with the standard glycopeptide therapy, new antimicrobial agents belonging to various classes have been introduced and have been evaluated in clinical trials for their efficacy in treating resistant staphylococcal infections. A number of preventive strategies have also been suggested to contain the spread of such infections. In this review, we address the recent changes in the epidemiology of S. aureus and their impact on the clinical manifestations and management of serious infections. We also discuss new treatment modalities for MRSA infections and emphasize the importance of preventive approaches.
Link: [Prevalence of community-acquired methicillin-r�sistant Staphylococcus aureus.].
The authors had for aim to assess the prevalence of community-acquired methicillin-resistant Staphylococcus aureus in France. METHOD: Two hundred fifty-four strains identified in 1,079 nasal samples from voluntary individuals were analyzed in 2002. An antibiogram (especially measuring the inhibition diameter of cefoxitine) and screening by oxacillin (6 mug/ml) allowed the identification of strains resistant to betalactams. The resistant phenotype was confirmed by amplification of the mecA gene by PCR. The distribution of strains was compared to the resistance to various antibiotics and especially to cotrimoxazole, macrolides, aminosides, and the mechanisms of resistance were determined. RESULTS: Eleven methicillin-resistant strains were detected in 254 carriers (4.33%), or 1% of the total population studied. CONCLUSION: Complementary tests (detection of the Panton-Valentine toxin, pulsed field electrophoresis) will be necessary to finish strain characterization. It can already be stated that compared to previous studies, community-acquired MRSA carriage is weak in France.
Link: Meeting the MRSA challenge - DermatologyTimes.
CA-MRSA historically has been susceptible to most classes of antimicrobial agents, a trait that was used to distinguish it from hospital-acquired strains of MRSA. But USA300 breaks that paradigm. Publication of the complete genome sequence of USA300 in The Lancet on March 4 demonstrates why. Lead author Binh An Diep, Ph.D., and colleagues at the University of California, San Francisco, found a unique arginine catabolic mobile element (ACME) that has not been seen in other strains of S. aureus. He says the strain chromosomally encodes resistance to beta-lactams and ciprofloxacin; it even has the potential to integrate a vancomycin resistant transposon, which could render it resistant to that last-line treatment option. Genomic evolution The ACME encodes an arginine deiminase pathway and an oligopeptide permease system that could contribute to the growth and survival of USA300. The gene segment is similar to and likely was horizontally acquired from S. epidermidis. It appears to enhance fitness and pathogenicity in USA300, as the strain has undergone rapid clonal expansion without great genomic diversification. "It is interesting to see the reading frame showing that degree of pathogenicity; it certainly is troubling from a public health point of view," says Steven J. Projan, Ph.D., vice president Biological Technologies at Wyeth Research.
Link: CBC British Columbia - Spread of drug-resistant bacteria triggers warning.
There is a note of caution in the Doctors responses here - don't panic is the message. It seems a little niave. Decisive action is needed now and the high risk groups are not just the socially marginalised. Sure it's small now but will that be the case in another 5 years?
Dr. Patrick said that's changed in the past 12 to 24 months. He noted doctors need to know that there are now "sporadic infections in the community, in people who aren't connected with high-risk groups or with being in the hospital." But he said MRSA is not a major threat to public health, because even resistant strains are treatable. He said infected people who require antibiotics cannot be treated with the "standard first-line drugs," noting there are other medications effective against MRSA. Many people carry the staph bacteria without any health problems – or symptoms that include boils, abscesses and pneumonia. Not a major threat, says health officer Vancouver Medical Health Officer Dr. John Blatherwick says it is not a major threat to otherwise healthy people. "We all at some time or another live with Staph Aureus on our bodies. Whether it's Methicillin resistant or not, it only becomes a problem when it gets into infections," he said. "The word superbug is what scares people. Most people don't have to be worried about this. So far we've been relatively successful in treating most cases of it." He said St. Pauls Hospital in downtown Vancouver started seeing patients coming in from the Downtown Eastside with the drug-resistant bacteria a couple of years ago.
Link: Clinical and Molecular
RESULTS:: We identified 446 episodes of community-acquired S. aureus infections, of which 134 (30%) were caused by MRSA. During the 3-year study period, the proportion of S. aureus infections caused by MRSA rose from 15% (12 of 80) to 40% (93 of 235) (P < 0.001) with the increase noted predominately in children with skin and soft tissue infections. RF-HAI were identified in 56 (42%) patients with CA-MRSA. Among subjects with CA-MRSA, children with RF-HAI were more likely to have had an invasive infection than healthy children (32% versus 5%; P < 0.001). CA-MRSA isolates from children with RF-HAI were similar to those without RF-HAI; all laboratory-retained CA-MRSA isolates harbored the SCCmec type IV cassette, and almost all isolates were susceptible to trimethoprim-sulfamethoxazole and clindamycin. However, pulsed field gel electrophoresis revealed greater molecular diversity among CA-MRSA isolates recovered from children with RF-HAI compared with those from otherwise healthy children (P = 0.001). Additionally CA-MRSA isolates from children with RF-HAI were less likely to contain sequences for Panton-Valentine leukocidin (P < 0.001) and more likely to be resistant to 3 or more classes of antibiotics (P = 0.033). CONCLUSION:: CA-MRSA strains recovered from children with RF-HAI were phenotypically similar to those recovered from healthy children The absence of SCCmec type II or III MRSA among children with RF-HAI suggests that CA-MRSA strains might have become endemic within pediatric health care facilities.
Link: Community-Acquired MRSA Skin/Soft Tissue Infection Rates Increasing.
Click the link above for more - including the revelation that the figures below may be conservative and the fear that CA MRSA will cause many problems in hospitals.
The prevalence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is rapidly increasing and should be considered in the differential diagnosis of patients presenting with skin and soft tissue infections (SSTI) or insect bites, according to findings from a retrospective study conducted at an urban hospital emergency department (ED). The study was presented last week at the 16th annual meeting of the Society of Healthcare Epidemiology of America in Chicago, Illinois. In certain patients, an analysis of data showed that the annual incidence of CA-MRSA increased by 250% in 2004 and 500% in 2005 compared with the 2003 rate. Study investigators reviewed the records of 224 patients with culture-proven clindamycin-sensitive MRSA-associated SSTIs presenting to the ED from January 2004 to November 2005. "We screened patients presenting to the ED with either the ICD9 code or any clinical descriptors that might suggest SSTI, then cross-matched those patients with microbiology data and selected MRSA-positive cultures with an antibiogram that was consistent with CA-MRSA (resistance to beta-lactams and azithromycin, and sensitivity to clindamycin)," lead investigator Seemi Andrabi, MD, infectious disease fellow at the Washington Hospital Center in Washington, DC, told Medscape. Patients who had been hospitalized during the past year, intravenous drug abusers, and transfer patients were excluded from the analysis, as were those with indwelling catheters, diabetic foot ulcers, chronic stasis ulcers, or prior history of MRSA infection/colonization. "This is a new and different strain of S aureus and it's important because of its magnitude — we have a high and increasing number of cases — and its virulence," said Nancy Donegan, MPH, coinvestigator and director of infection control at the Washington Hospital Center, adding that the strain is so virulent in healthy people that there is significant concern over what it will do to hospitalized patients.
Link: Journal Watch Infectious Diseases.
Researchers recently undertook a prospective study at a large Atlanta hospital to determine whether USA300 strains have become a common cause of bacteremia in healthcare settings. Over 7.5 months, 132 cases of MRSA bacteremia occurred. Thirty-nine (34%) of the 116 isolates available for analysis were of the CA-MRSA USA300 genotype. In 10 of these 39 instances (8% of all cases), the bacteremia was nosocomially acquired. Factors significantly associated with isolation of the USA300 genotype were concurrent skin or soft-tissue infection (odds ratio, 3.67; 95% confidence interval, 1.10–12.28) and injection-drug use (OR, 4.26; 95% CI, 1.08–16.84). Comment: Despite a somewhat confusing categorization of cases and presentation of numbers, the study findings demonstrate that CA-MRSA strains are creeping into the hospital environment and can cause bacteremia, albeit in the setting of soft-tissue infections. As the authors mention, no simple way exists to prevent the spread of this organism. Moreover, most clinical laboratories lack the technical ability to distinguish CA-MRSA from other MRSA genotypes.
Link: Control
To control an outbreak of community-associated MRSA (CA-MRSA) in a neonatology unit, an investigation was conducted that involved screening neonates and parents, molecular analysis of MRSA isolates and long-term follow-up of cases. During a two-month period in the summer of 2000, Panton-Valentine leukocidin (PVL)-producing CA-MRSA (strain ST5-MRSA-IV) was detected in five neonates. The mother of the index caseshowed signs of mastitis and wound infection and consequently tested positive for CA-MRSA. A small cluster of endemic, PVL-negative MRSA strains (ST228-MRSA-I) occurred in parallel. Enhanced hygiene measures, barrier precautions, topical decolonization of carriers, and cohorting of new admissions terminated the outbreak. Four months after the outbreak, the mother of another neonate developed furunculosis with the epidemic CA-MRSA strain. One infant had persistent CA-MRSA carriage resulting in skin infection in a sibling four years after the outbreak. In conclusion, an epidemic CA-MRSA strain was introduced by the mother of the index case. This spread among neonates and was subsequently transmitted to another mother and a sibling. This is the first report of a successfully controlled neonatology outbreak of genetically distinct PVL-producing CA-MRSA in Europe.
Link: The Berkeley Science Review
Their investigation revealed that CA-MRSA is not a descendent of a hospital-based strain of MRSA, but evolved on its own. In fact, the two types are genetically distinct, differing in both their resistance to the antibiotics that we use against them and the toxins they use against us. Alarmingly, the seven-year study period witnessed a nearly five-fold increase in cases of MRSA. This coincided with a five-fold increase in community-acquired MRSA infections, but no change in hospital-acquired cases. In other words, more and more healthy people were getting sick from MRSA. It seems that Sensabaugh was correct when he predicted that prevention efforts have underestimated community-acquired staph. The team also found that the CA-MRSA infections were overwhelmingly caused by only four strains, and that each carried the “type IV SCCmec” set of genes, which gives the staph methicillin resistance. One of the strains, ST8:S, is emerging as a true superbug. It was first observed in 2000, infecting only a single patient. Just two years later, ST8:S had caused 300–400 cases, and by late 2004, was responsible for 1200 cases. ST8:S is now estimated to cause 90% of all the CA-MRSA infections in San Francisco. And contrary to the traditional picture of MRSA dynamics, ST8:S appeared in hospitals only after its astonishing spread through the community.
Link: CDR Weekly, Vol 16 no 11: News.
New guidance published by the Health Protection Agency warns both commercial and domestic owners of spa pools about the risks of infections if they do not follow guidance on how to maintain them properly (1). Spa pools in the home are becoming more commonplace with between 14,000 and 15,000 installed in homes each year in the United Kingdom. They provide the perfect conditions for certain bacteria to survive, and cause infection because the pools have a raised water temperature and conditions that create an aerosol of water. The new guidance sets out the practical measures that can be followed to prevent users contracting infections such as legionnaires' disease and folliculitis (inflammation of the hair follicles) and to prevent other hazards to health such as slipping. It also sets out the specific responsibilities of those who manage commercially run spa pools to ensure staff working with the pool and recreational users are protected. Commercial spa pools can have large numbers of bathers compared to water volume, which makes it important that users are informed of precautionary measures they may take to reduce health risks such as: • Not exceeding 15 minutes in the spa pool at a time; • Not immersing their heads underwater or swallowing the water; • Bathers should use the toilet and shower before entering the pool. • Bathers should not use the spa pool if they have had diarrhoea in the last 14 days and those suffering from heart diseases or skin conditions should take medical advice before entering the pool.
Link: TheStar.com
Antibiotic-resistant staph infections, long a problem in hospitals and nursing homes, are spreading into the community for the first time and could have a major impact on the health system, warns one of Canada's leading microbiologists. The superbug — methicillin-resistant Staphylococcus aureus (MRSA) — "is now a huge problem in the United States. If it emerges as quickly as it did there, it will have a major impact on health care spending," Dr. Don Low, chief microbiologist at Mount Sinai Hospital, said at the release of the annual national report card on antibiotic resistance yesterday. "This is the next big health story. I've never seen an organism come into an environment like community-acquired MRSA has in certain locales in the U.S. and it's becoming more and more prevalent," said Low, who also heads the Canadian Bacterial Surveillance Network, which collected the data. "It's in Canada, it's infrequent to date, we hope it stays that way but it's important to monitor." The strain differs from the one found in hospitals, Low said, and is much more difficult to control. The majority of infections are rashes, boils and pimples, but some patients have died of pneumonia or severe soft tissue infections.
Link: Forbes.com.
For the second study in the journal, researchers examined 384 people in the Atlanta area who had S. aureus skin or soft-tissue infections and found that 72 percent had become infected outside a hospital setting. Most doctors didn't recognize the source of the infection, and recommended ineffective treatments, the researchers said. "We were interested because, in various places people have been publishing cases, especially [involving] children, having disease caused by staph that is resistant to more antibiotics than one would expect," said Graham. As far back as 1999, four children died of the disease in Minnesota. "There are some emergency departments of pediatrics where 70 percent of all their staff infections are community acquired. That's a large percentage. We believed that the numbers were smaller on a nationwide basis," he said. Last month, researchers announced that genes responsible for the virulence of MRSA in the United States appear to come from another, less toxic, bacterium than the hospital version. The problem will be here for some time to come, said Dr. Pascal James Imperato, chairman of the department of preventive medicine and community health at the State University of New York Downstate Medical Center. "We still don't know how prevalent this problem is in the general population because the majority who acquire skin infections don't visit their physicians, they heal on their own," he said. "Only the most severe ones get treated." And, he added, the numbers may have changed since the studies were conducted.
Link: WCBSTV.com:
We're hearing a lot these days about avian flu. But there's another infection out there that has doctors worried. It used to be found in hospitals, but now it's spreading into our communities. It's called methicillin-resistant staphylococcus aureus, or MRSA. In simple terms, it's a superbug that causes skin, muscle and tissue infections. And even the strongest antibiotics can't kill it. "The bugs, the bacteria are learning how to become resistant much faster than we're learning how to create new antibiotics," says Beth Israel Medical Center's Dr. Stephen Baum. The Annals of Internal Medicine just released a study that shows MRSA is now infecting healthy people outside of hospitals. In the past, only those with low immune systems like the elderly or very young were at risk. Now, the study says the bacteria has morphed into a new, stronger strain.
Link: ScienceDaily:
Staph infections resistant to antibiotics, previously only associated with hospitalization or prior contact with the healthcare system, are now widespread in the community and coming home. A new study from Emory University School of Medicine and Grady Memorial Hospital, featured in the March 7, 2006 Annals of Internal Medicine, reports on a dramatic rise in antibiotic resistant community-acquired methicillin-resistant Staphylococcus aureus (MRSA), making it the primary cause of skin and soft tissue infections. An editorial accompanying the article notes, "the number of populations at risk for community-acquired MRSA infections is steadily expanding", making it a "remarkable epidemic." The bacterium Staphyloccus aureus (staph) normally resides on skin and in noses, and typically infects tissues through cuts or rashes. Those infections can remain minor, or lead to illnesses ranging from boils or abscesses to necrotizing skin infections, pneumonia and sometimes blood stream infections. The Centers for Disease Control and Prevention (CDC) reports that staph is one of the leading causes of skin infections in the United States. Previously, scientists have categorized staph into two main types: antibiotic resistant (MRSA), and methicillin-susceptible Staphyloccus aureus (MSSA), which can be treated by antibiotics in the penicillin or related groups (i.e, beta-lactam antibiotics). Previously, MRSA infections were usually restricted to hospital or healthcare-associated infections. This is clearly no longer the case. Henry M. Blumberg, MD, is the senior author of the study, and professor of medicine and program director of the Division of Infectious Diseases at Emory University School of Medicine and hospital epidemiologist at Grady Memorial Hospital. He says, "We have seen an explosion of community-acquired MRSA infections among the urban patient populations served by the Grady Health System. Community-acquired MRSA infections are no longer restricted to certain risk groups but appear to be wide spread in the Atlanta community."
Link: Annals of Internal Medicine.
Community-onset skin and soft-tissue infection due to S. aureus was identified in 389 episodes, with MRSA accounting for 72% (279 of 389 episodes). Among all S. aureus isolates, 63% (244 of 389 isolates) were community-acquired MRSA. Among MRSA isolates, 87% (244 of 279 isolates) were community-acquired MRSA. When analysis was restricted only to MRSA isolates that were available for pulsed-field gel electrophoresis, 91% (159 of 175 isolates) had a pulsed-field type consistent with community-acquired MRSA; of these, 99% (157 of 159 isolates) were the MRSA USA 300 clone. Factors independently associated with community-acquired MRSA infection were black race (prevalence ratio, 1.53 [95% CI, 1.16 to 2.02]), female sex (prevalence ratio, 1.16 [CI, 1.02 to 1.32]), and hospitalization within the previous 12 months (prevalence ratio, 0.80 [CI, 0.66 to 0.97]). Inadequate initial antibiotic therapy was statistically significantly more common among those with community-acquired MRSA (65%) than among those with methicillin-susceptible S. aureus skin and soft-tissue infection (1%). Limitations: Some MRSA isolates were not available for molecular typing. Conclusions: The community-acquired MRSA USA 300 clone was the predominant cause of community-onset S. aureus skin and soft-tissue infection. Empirical use of agents active against community-acquired MRSA is warranted for patients presenting with serious skin and soft-tissue infections.
Link: Journal of Clinical Microbiology.
The number of infections attributable to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Singapore is progressively increasing. Most cases in the past 2 years were caused by Panton-Valentine leukocidin-positive isolates belonging to sequence type 30, according to multilocus sequence typing. This has clearly become the predominant sequence type among CA-MRSA isolates in Singapore.
Link: Methicillin-resistant Staphylococcus aureus
PURPOSE OF REVIEW: The main goal of this review is to describe the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a community pathogen. RECENT FINDINGS: Community-acquired MRSA has emerged as an important infection in the community setting. It has primarily been associated with skin and soft-tissue infections, but can also cause severe pulmonary infections, including pneumonia and empyema. Community-acquired MRSA is typically more susceptible to a wider class of antibiotics than healthcare-associated MRSA. Community-acquired MRSA is also more virulent compared with healthcare-associated MRSA isolates. Community-acquired MRSA usually contains the gene encoding Panton-Valentive leukocidin, which is a toxin that creates lytic pores in the cell membranes of neutrophils and induces the release of neutrophil chemotactic factors that promote inflammation and tissue destruction. The optimal antibiotic treatment for Panton-Valentive leukocidin-positive community-acquired MRSA is unknown; however, antibiotics with activity against MRSA and the ability to inhibit toxin production may be optimal (linezolid or clindamycin for susceptible isolates). SUMMARY: Clinicians should be aware of the emergence of community-acquired MRSA as an important cause of serious infections arising in the community setting. Appropriate antibiotic therapy should be initiated as soon as infection with this pathogen is suspected.
Link: HighWire Press
Methicillin resistant Staphylococcus Aureus (MRSA) infection is an emerging community pathogen. Community-acquired MRSA (CA-MRSA) has been associated with virulent strains producing Panton-Valentine leukocidin (PVL) and a variety of other exotoxins. In Geneva, PVL-producing CA-MRSA was first reported in 2002 and a surveillance system based on voluntary reporting was set up.
Link: Clinical and Laboratory
Objective. To review the epidemiologic and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Detroit, Michigan, to assess the risk factors for infection and the response to therapy.Design. Prospective clinical and laboratory study of 2003-2004 CA-MRSA isolates. Molecular features were compared with CA-MRSA isolates from 1980.Setting. A 600-bed urban academic medical center.Patients. Twenty-three patients with CA-MRSA infections from 2003-2004 were evaluated. In addition, laboratory analysis was performed on 13 CA-MRSA isolates from 1980.Main Outcome Measures. Laboratory analysis of isolates included antimicrobial susceptibility testing, pulsed-field genotyping, testing for Panton-Valentine leukocidin (PVL) genes, and staphylococcal cassette chromosome mec typing.Results. Patients were predominantly young African American males and presented with skin and soft-tissue infections. All isolates were resistant to erythromycin and highly susceptible to other agents. Patients were generally treated successfully with combination incision and drainage and systemic antibiotics. Among the 23 isolates, 20 (87%) were the same strain. This strain carried the staphylococcal cassette chromosome mec type IV and PVL genes and is genetically identical to USA 300. Thirteen isolates of patients from our community who presented with CA-MRSA infections in 1980 represented a single clone that is unique compared with the 2003-2004 isolates. This strain carried staphylococcal cassette chromosome mec type IVA but did not carry the PVL genes.Conclusions. In our community, CA-MRSA is largely due to a single clone with a type IV mec gene and PVL gene. The type IV staphylococcal cassette chromosome mec type can be demonstrated in CA-MRSA isolates from a remote period, suggesting that earlier outbreaks were not related to healthcare exposure.
Link: Antibiotic-resistant bacteria prompts call for prevention
Health care workers have called it MRSA for years. It's a technical term for antibiotic-resistant bacteria. And yep, that phrase - antibiotic-resistant - is sure to scare some people. That's because healthy folks are getting these hard-to-treat staph infections, some of which can become quite serious. “This past year there has been a tremendous increase in the number of boils, abscesses, and hair follicle infections that my colleagues and I have needed to treat.” Advertisement That was the first sentence of a memo Dr. Jon Yost, a pediatrician at Bay Clinic, sent to principals, athletic directors, coaches and nurses in the Coos Bay School District. But Yost wasn't trying to scare anyone. Rather, he wants school officials' help, because more and more MRSA cases are afflicting young people in the community, and those cases are preventable.
Link: New, virulent staph infection sparks health fears
In April 2004, Simon Sparrow was a robust toddler, 17 months old and just learning to feed himself. Then he caught a cold. He awoke with a cry at his family's Chicago home. His parents took him to the University of Chicago Children's Hospital. Emergency-room doctors X-rayed his chest and chalked up his symptoms to a virus and asthma. They let him go home at about 1 p.m. At 4:30 p.m., his mother called back and asked doctors to listen to his worsening breathing over the phone. Call 911, they said. An ambulance whisked Simon back to the hospital where his condition rapidly deteriorated. Doctors scrambled to insert tubes and administer antibiotics and drugs to combat organ failure triggered by an overwhelming infection. Approaching midnight, he was taken off a regular ventilator in favor of a high-tech, heart-lung bypass system. Twelve hours later, he was dead. What killed Simon Sparrow is a new form of an old foe: the staph infection. Identified as a lethal threat in 1999, this new strain is resistant to drugs and is highly virulent, responsible for 60 percent of all skin and soft-tissue infections treated in the nation's ERs. Infections can recur and ping-pong through families. The germ can penetrate bones and lungs, and the abscesses it causes often require surgery. In severe cases, up to a quarter of patients die. Public-health officials see a silent epidemic on the rise
Link: News - SilvertonAppeal.com
Staph infections have become so widespread in the athletic arena that many competitors shake off the bug like the common cold.
But in the last two years doctors and coaches alike have been taking extra precautions against a more resistant, increasingly more prevalent staphylococcus bacteria that can have grave consequences if not taken care of promptly.
Last month Salem Hospital infectious disease specialist Dr. Clifton Bong spoke at Santiam Memorial Hospital in Stayton to discuss Methicillin-Resistant Staphylococcus Aureus, a bacteria that is making a name for itself on the national stage as it becomes more rampant – and at times destructive.
“It’s a big problem,” Bong said. “It’s not just here, but all over. The numbers have been increasing.”
These types of antibiotic-resistant infections are commonly seen in healthcare settings, where antibiotics are misused or there is improper sanitation.
But Bong said an increasing number of MRSA infections are being reported in people without links to hospitals, including athletes, construction workers, men and women in the military, prisons and daycares.
The number of actual MRSA infections in Oregon is unknown, but the Oregon Department of Human Services recently began surveying invasive MRSA in the Portland area. Preliminary data from 2004 indicates the rate of invasive MRSA in that area is approximately 26.3 infections per a population of 100,000 people, per year.
The infections are, however, becoming more pervasive and doctors suspect the number could be higher.
Link: Emergence
BACKGROUND: Community-acquired skin and soft-tissue infections due to methicillin-resistant Staphylococcus aureus (MRSA) are an emerging clinical and epidemiological problem. OBJECTIVES: To characterize community-acquired skin infections caused by S. aureus, and especially MRSA. METHODS: From November 1999 to December 2003, we conducted in a French hospital a prospective epidemiological, clinical and bacteriological study of skin infections acquired in the community, applying strict criteria for true community-acquired MRSA (CA-MRSA) and health-care-associated MRSA (HCA-MRSA). RESULTS: One hundred and ninety-seven patients had 207 skin infections (154 primary and 53 secondary infections). Twenty-two (11%) patients had skin infections caused by MRSA. The incidence of MRSA skin infections acquired in the community rose from 4% in 2000 to 17% in 2003, but the increase was not statistically significant. Six patients (3%) were infected by CA-MRSA and 15 (8%) by HCA-MRSA; one patient was lost to follow-up and could not be classified. CA-MRSA and HCA-MRSA had different epidemiological, clinical and biological characteristics. CA-MRSA infections were more severe than HCA-MRSA infections: all the CA-MRSA infections (six of six, 100%) required surgical treatment, compared with only two (15%) of 13 with HCA-MRSA infection (P < 0.001). CA-MRSA all belonged to the same clonal strain, harbouring an agr type 3 allele and the Panton-Valentine leucocidin genes (not detected in HCA-MRSA) and possessing a specific antibiotype. CONCLUSIONS: Two populations of MRSA causing skin infections are emerging in the French community, with distinct epidemiological, clinical and biological characteristics.
Link: The Daily World
It looked sort of like a pimple or an ingrown hair. But three days later, the red dot on Steve Hewitt’s armpit morphed into the size of a small tangerine.
“I couldn’t put my arm down,” the South Aberdeen man said.
The painful lump that resembled a big boil was diagnosed at Grays Harbor Community Hospital in Aberdeen in August as methicillin-resistant Staphylococcus aureus, or MRSA. These sort of serious “staph” infections are getting more common on the Harbor, health officials say.
“Five years ago it was a rare bird, today I’m seeing several cases a week,” said Dr. John Bausher, the director of infection control at Grays Harbor Community Hospital.
Last week, Aberdeen High School wrestlers opted to postpone two meets because at least three athletes were diagnosed with staph infections.
“We error on the side of caution. The last thing we want to do is put kids who are not healthy on the mats and have them possibly spread it to another teen,” said AHS’ athletic director, Derek Cook. “As soon as the coach (noticed) it, he brought in health officials right away. And we talked to the kids about it.
“Up until last year, we heard a lot about it in the Seattle area,” Cook added. “Fortunately it has not been a problem with our athletes, until now.” Cook says the infections were caught early and the kids should be fine.
Link: HighWire Press -- Medline Abstract.
Introduction: The clinical features and molecular epidemiology of further cases of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in Singapore are described. Methods: Six cases of CA-MRSA infection that occurred between April and October 2004 are described. The bacterial isolates were tested for the presence of Panton-Valentine leukocidin (PVL) genes and typed via pulsedfield gel electrophoresis, staphylococcal chromosomal cassette mec (SCCmec) and multi-locus sequence typing. The results were compared with that of previously-reported local and international CA-MRSA isolates. Results: There were four cases of cutaneous abscesses and one each of chronic osteomyelitis and endocarditis. CA-MRSA isolates from the last two cases tested negative for PVL genes. Three isolates were identical and related to the Oceanian clone, and one isolate to the predominant Taiwanese clone. The isolate causing osteomyelitis had a novel sequence type. Conclusion: CA-MRSA, though uncommon, is being isolated with increasing frequency in Singapore. A predominant clone (ST30- MRSA-IV) seems to be emerging locally.
Link: HighWire Press -- Medline Abstract.
The clinical presentation of staphylococcal pneumonia is changing. Healthy young people without traditional risk factors for Staphylococcus aureus disease are presenting with severe necrotizing infection and high mortality. The clinical picture is reminiscent of outbreaks of postinfluenzal staphylococcal pneumonia seen in the past century. Most of these staphylococcal strains are methicillin-resistant and are not health care associated. Many strains contain toxins that are likely responsible for the severity of illness seen. Panton-Valentine leukocidin has rarely been identified in S. aureus until recently. It appears that the genetic element for methicillin resistance has been introduced into multiple highly virulent methicillin-susceptible strains with great potential for further spread. Early recognition and treatment of possible community-acquired methicillin-resistant S. aureus (CA-MRSA) is essential. It is equally important to attain microbiological confirmation of the diagnosis for optimal treatment and to initiate appropriate infection control procedures.
Publication Type:
* Journal article
PMID: 16388433
Link: MRSA prevalence A dangerous drug-resistant bacterium is becoming more prevalent in many intensive care units, according to an article in the Feb. 1 issue of Clinical Infectious Diseases, now available online.
Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for a variety of infections that patients often acquire in the hospital. Skin infections are the most common, but MRSA can also infect the heart, the lungs, and the digestive tract. The emergence of MRSA and other drug-resistant bacteria may be due in part to over-prescribing and overuse of antibiotics.
Researchers at the Centers for Disease Control and Prevention examined MRSA data from more than 1,200 intensive care units (ICUs) from 1992 to 2003. They found that in 1992, 36 percent of S. aureus isolates were drug-resistant; but in 2003, 64 percent of isolates were MRSA, an increase of about 3 percentage points per year.
Despite the increase in MRSA prevalence, there was also a decrease in MRSA that was resistant to multiple drugs. The researchers hypothesize that the influx of MRSA strains from the community might have replaced those multidrug-resistant strains associated with the hospital.
"Unlike traditional MRSA the community strain is very fit - it causes infection in healthy people," said CDC epidemiologist Dr. Monina Klevens. "When it is introduced into a hospital, where ill patients are more vulnerable to infection, it has the potential to cause significant morbidity and mortality."
Link: PittsburghLIVE.com.
"I think the lack of information was the worst thing," said Raslevich, of Ohio Township, who was in the audience Wednesday when the Allegheny County Board of Health took a step to fill that vacuum.
The board voted unanimously to make methicillin-resistant staphylococcus aureus -- MRSA -- a reportable illness for pediatricians. The action asks pediatricians to report to county health authorities all cases of the illness so the department can get a better idea of how serious a problem the bacteria strain is in the community. "It's really the only way to get a handle on what the problem is," said health board member Dr. Lee Harrison.
MRSA routinely lives on the skin and noses of healthy people, often causing no harm or just irritating lesions. When it gets inside the body, it can lead to pneumonia, infections, severe fevers or even death.
Sam got over the lesions on his groin, his mother said, and is healthy at nine months.
Hospitals have been the major site of MRSA outbreaks, but Harrison said MRSA is surfacing in the community, partly as a result of widespread use of antibiotics.
Link: Journal of Clinical Microbiology.
We developed a novel PCR-restriction fragment length polymorphism test for the ccrB gene by using HinfI and BsmI for rapid typing of staphylococcal cassette chromosome mec (SCCmec). When tested with reference strains and methicillin-resistant Staphylococcus aureus isolates, the method proved to be valid and useful for rapid identification of four SCCmec types, especially type IV.
Link: Journal of Clinical Microbiology.
We examined 299 methicillin-resistant, community-associated Staphylococcus aureus isolates from Florida and Washington State for the presence of the USA300 epidemic clone. Pulsed-field gel electrophoresis demonstrated the epidemic clone in 43% of our S. aureus strains and in isolates from both states. The majority of the USA300 isolates (88%) were from wound infections.
Link: Journal of Clinical Microbiology.
A highly stable strain of Staphylococcus aureus with a pulsed-field gel electrophoresis type of USA300 and multilocus sequence type 8 has been isolated from patients residing in diverse geographic regions of the United States. This strain, designated USA300-0114, is a major cause of skin and soft tissue infections among persons in community settings, including day care centers and correctional facilities, and among sports teams, Native Americans, men who have sex with men, and military recruits. The organism is typically resistant to penicillin, oxacillin, and erythromycin (the latter mediated by msrA) and carries SCCmec type IVa. This strain is variably resistant to tetracycline [mediated by tet(K)]; several recent isolates have decreased susceptibility to fluoroquinolones. S. aureus USA300-0114 harbors the genes encoding the Panton-Valentine leucocidin toxin. DNA sequence analysis of the direct repeat units within the mec determinant of 30 USA300-0114 isolates revealed differences in only a single isolate. Plasmid analysis identified a common 30-kb plasmid that hybridized with blaZ and msrA probes and a 3.1-kb cryptic plasmid. A 4.3-kb plasmid encoding tet(K) and a 2.6-kb plasmid encoding ermC were observed in a few isolates. DNA microarray analysis was used to determine the genetic loci for a series of virulence factors and genes associated with antimicrobial resistance. Comparative genomics between USA300-0114 and three other S. aureus lineages (USA100, USA400, and USA500) defined a set of USA300-0114-specific genes, which may facilitate the strain's pathogenesis within diverse environments.
Link: Allegheny County
Pediatricians could soon be asked to notify the Allegheny County Health Department when they diagnose youngsters with a certain bacterial infection that is resistant to standard antibiotics.
The reports could help health experts get a better handle on how prevalent methicillin-resistant Staphylococcus aureus, or MRSA, is in the community, said Dr. Bruce Dixon, director of the Health Department.
The Board of Health will decide at its meeting tomorrow whether to implement the notification plan.
"There aren't that many [cases] and I don't think it's a major problem, but we wanted to see in a more global way if it was becoming more common," Dr. Dixon said. "People have told us when they've had a case, but we wanted to make it more formal."
Link: Notes from Dr. RW.
Community associated methicillin resistant Staphylococcus aureus. It’s different from the old MRSA. The resistance pattern and the genome are distinct. Although we’ve had a friendly debate here on the blogosphere about the clinical significance (or lack thereof) of certain unique virulence factors, the clinical profile is different, with more skin and soft tissue infections, occasional necrotizing fasciitis, a possible increased threat of necrotizing pneumonia, and increased transmissibility. On the other hand the risk of intravascular and bone and joint infections may be less. Here are my previous posts on the topic. [7] [8] [9] [10]
Click the link above for more
Link: JS Online: The rise of a tougher staph.
The Centers for Disease Control and Prevention estimates that at least 12% of drug-resistant staph infections are picked up in the community and have no link to health care settings.
Even more troubling, these community- associated MRSA, or CA-MRSA, infections appear to be more virulent than those detected in hospitals.
In September, a study in the New England Journal of Medicine reported that CA-MRSA caused a toxic shock syndrome-like illness that killed three Chicago-area children.
Earlier this year, another study in the same journal reported that drug-resistant staph had acquired "flesh-eating" capabilities and caused 14 cases of rare necrotizing fasciitis in the Los Angeles area.
"This is part of a much larger problem," said G. Richard Olds, a professor of medicine and an infectious disease expert at the Medical College of Wisconsin who practices at Froedtert Memorial Lutheran Hospital.
"Because we're not responsible in how we use antibiotics, we have created an environment where the bacteria have gotten tough," he said. "Now we're losing the battle between us and the bug."
Link: US Long-Term Care Facilities Harbor MRSA.
People living in long-term care facilities have "extraordinarily high" rates of methicillin-resistant Staphylococcus aureus (MRSA) compared with those in acute care facilities, according to investigators from the University of Iowa College of Medicine in Iowa City.
Based on the findings of a large study that looked at the magnitude and trends in S. aureus resistance, long-term care facilities appear to be a "reservoir" for MRSA. Upon admission to an acute care facility, such patients should be assumed to be colonized with MRSA until proven otherwise, Dr. Susan Beekmann reported at the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. Beekmann and associates evaluated 11,631 bacterial isolates from symptomatic patients living in long-term care facilities between 1999 and 2004 in six different regions of the United States. Of these isolates, 1,936 were S. aureus and 704 (68%) were methicillin-resistant. The rate of MRSA remained stable over the course of the study.
The investigators found that 0.7% of the MRSA isolates had no co-resistance and 3.1% had one co-resistant strain.
Overall, MRSA was usually resistant to erythromycin and the fluoroquinolones. The pattern most often seen was resistance to erythromycin, clindamycin, and ciprofloxacin and susceptibility to gentamicin, trimethoprim/sulfamethoxazole, tetracycline and rifampin.
The "vast majority" of MRSA isolates had multiple co-resistance, the researchers added, but about 4% fit the "community-acquired" MRSA phenotype.
Community-acquired MRSA is an emerging problem, Dr. Daniel Jernigan of the Centers for Disease Control and Prevention told conference attendees. The major reservoirs for MSRA, he said, are the nose and the skin.
In one recent study of 9,600 subjects residing in the community, the rate of colonization of MRSA in the nose was 0.8 to 1.0%. Soft tissue and skin infections are the most common MRSA infections, but it can also cause necrotizing pneumonia and infection of the heart valves.
The "Five Cs of transmission", Dr. Jernigan said, comprise "crowding; cleanliness; contaminated surfaces (such as in saunas); contact; and compromised skin." Frequent use of antibiotics is also a risk factor.
He added that other recently identified groups of MRSA carriers are crystal methamphetamine users, people with tattoos and hurricane Katrina evacuees.
Link: US
So many key facts in this item. 1% of population with CA MRSA. Tatooed people susceptible. Care homes as resevoirs
People living in long-term care facilities have "extraordinarily high" rates of methicillin-resistant Staphylococcus aureus (MRSA) compared with those in acute care facilities, according to investigators from the University of Iowa College of Medicine in Iowa City.
Based on the findings of a large study that looked at the magnitude and trends in S. aureus resistance, long-term care facilities appear to be a "reservoir" for MRSA. Upon admission to an acute care facility, such patients should be assumed to be colonized with MRSA until proven otherwise, Dr. Susan Beekmann reported at the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. Beekmann and associates evaluated 11,631 bacterial isolates from symptomatic patients living in long-term care facilities between 1999 and 2004 in six different regions of the United States. Of these isolates, 1,936 were S. aureus and 704 (68%) were methicillin-resistant. The rate of MRSA remained stable over the course of the study.
The investigators found that 0.7% of the MRSA isolates had no co-resistance and 3.1% had one co-resistant strain.
Overall, MRSA was usually resistant to erythromycin and the fluoroquinolones. The pattern most often seen was resistance to erythromycin, clindamycin, and ciprofloxacin and susceptibility to gentamicin, trimethoprim/sulfamethoxazole, tetracycline and rifampin.
The "vast majority" of MRSA isolates had multiple co-resistance, the researchers added, but about 4% fit the "community-acquired" MRSA phenotype.
Community-acquired MRSA is an emerging problem, Dr. Daniel Jernigan of the Centers for Disease Control and Prevention told conference attendees. The major reservoirs for MSRA, he said, are the nose and the skin.
In one recent study of 9,600 subjects residing in the community, the rate of colonization of MRSA in the nose was 0.8 to 1.0%. Soft tissue and skin infections are the most common MRSA infections, but it can also cause necrotizing pneumonia and infection of the heart valves.
The "Five Cs of transmission", Dr. Jernigan said, comprise "crowding; cleanliness; contaminated surfaces (such as in saunas); contact; and compromised skin." Frequent use of antibiotics is also a risk factor.
He added that other recently identified groups of MRSA carriers are crystal methamphetamine users, people with tattoos and hurricane Katrina evacuees.
Link: HighWire Press -- Medline Abstract.
Staphylococcus aureus is a major cause of infections in both hospitals and communities, and is exhibiting increasing resistance to methicillin (methicillin-resistant S. aureus, MRSA) and related beta-lactams. MRSA is usually considered a nosocomial pathogen, but increasingly it is acquired in the community. In Taiwan, MRSA was colonized in a substantial proportion of healthy children and accounted for 25% to 75% of childhood community-acquired (CA) S. aureus infections. From the preliminary data, the isolates of sequence type (ST) 59 by multilocus sequence typing method appeared to be the major clone of CA-MRSA in northern Taiwan. Compared with those reported from the US and other countries, CA-MRSA isolates in Taiwan did not always harbor type IV staphylococcal cassette chromosome (SCCmec) and were resistant to multiple non-beta-lactam antibiotics, including clindamycin and macrolides. Molecular evidence suggested transmission of the community strain of MRSA into the hospital setting, and that the community strain had became a health care-associated pathogen. The treatment of putative CA S. aureus infection should be stratified according to the severity and the disease entity.
Link: Rome News - Tribune.
While deaths due to the infections may be relatively rare, severe infections are more common. Community Associated MRSA — an infection that occurs in someone who has not been hospitalized or had a medical procedure in the past year — was added to the state’s public health Notifiable Disease registry in mid-summer 2004 due to a rising number of incidents, Abercrombie said.
The 10-county district has confirmed more than 100 reported cases for 2005, she said. And that is despite the fact that the guidelines for a reportable infection are very restrictive, said Dr. Wade Sellers, district health director.
“It’s probably just the tip of the iceberg,” Sellers said. “Those are the very serious ones where people die or need quite radical reparative surgery.”
Nurses have begun to see MRSA cases pop up within the schools only recently, said Judie Fellers, an RN and coordinator for the Rome City and Floyd County school nurses. She said almost every school has had several cases.
“We saw some last spring,” she said. “We’ve seen more since school has started back — not an excessive amount but more than last spring.”
Link: USATODAY.com
Important story that says CA MRSA will drive rise in VRE infections. Must read item.
Among the most worrisome of these superbugs is MRSA, or methicillin resistant staphylococcus aureus, a germ once found primarily in hospitals. But it's popping up so often outside of health care settings that it is, "arguably, a true pandemic," said Steven Projan of Wyeth Research in Cambridge, Mass., who spoke at the Interscience Conference on Anti-microbial Agents and Chemotherapy, ending Monday. Community-acquired MRSA usually causes boils and skin rashes but can lead to serious infections that require hospitalization. The strains found in hospitals, which generally infect the most seriously ill patients, cause blood infections, surgical site infections and pneumonia. Hospital- and community-acquired strains are different, researchers said, but both types are increasing. And in some areas they account for more than half of all staph infections.
"The prevalence of this is so high, it has fundamentally changed the way physicians treat (staph infections)," said David Hooper of Massachusetts General Hospital. "You have to treat for the possibility of MRSA" by prescribing a more potent antibiotic, usually vancomycin.
That in turn fuels the growing resistance to vancomycin of intestinal bacteria called enterococci, said Vincent Jarlier of Groupe H�pital Piti�-Salpetri�re in Paris. "Certainly the huge quantity of vancomycin used because of the MRSA epidemic is part of the (vancomycin-resistant enterococci) epidemic," he said. These resistant bacteria cause hard-to-treat intestinal infections.
MRSA infections are even showing up in animals, said veterinarian Scott Weese of Ontario Veterinary College at the University of Guelph, Canada. The bacteria may be passed from people to their pets, and vice versa, he said.
Among other drug-resistant bugs:
Link: HighWire Press -- Medline Abstract.
The aim of this study was to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered from different infectious sites of hospitalized patients at two university hospitals. Fourteen isolates were analyzed by repetitive sequence based PCR (Rep-PCR), randomly amplified polymorphic DNA assay (RAPD-PCR), and pulsed-field gel electrophoresis (PFGE). We found that a prevalent clone of MRSA, susceptible to rifampin, minocycline, and trimethoprim/sulfamethoxazole (RIF(s), MIN(s), TMS(s)) was present in both hospitals in replacement of the multiresistant MRSA South American clone, previously described in these hospitals. The staphylococcal chromosomal cassette (SCCmec) type I element was detected in this new clone.
Link: Molecular characterization
OBJECTIVES: The objectives of this study were (i) to investigate the genetic background of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from Croatia and (ii) to monitor the prevalence of Panton-Valentine leucocidin (PVL) and toxic shock syndrome toxin-1 (TSST-1) among these isolates. METHODS: Eighty-two hospital-acquired MRSA bloodstream isolates, collected in 2001 and 2002 in Croatia, were characterized by PFGE, staphylococcal cassette chromosome mec (SCCmec) typing and multilocus sequence typing (MLST). The presence of genes encoding PVL and TSST-1 was investigated by real-time PCR. RESULTS: All strains were multiresistant and were distributed among 16 different similarity groups as determined by PFGE. Two of the groups, groups H and K, harboured the majority of the MRSA strains with 52 and 12%, respectively. The predominant SCCmec type found among the isolates was type I (89%). Eleven per cent of the strains harboured a modified SCCmec type III, which contained, in contrast to the regular type III, an additional dcs region. One strain harboured a novel SCCmec type, containing the ccrC gene in combination with the mecI gene, the dcs region, the locus between pI258 and Tn554 (locus E) and the locus between Tn554 and orfX (locus F). MLST showed the presence of ST111-MRSA-I and ST247-MRSA-I among Croatian MRSA isolates. All isolates were negative for both PVL and TSST-1. CONCLUSIONS: These results indicate the emergence of ST111-MRSA-I and ST247-MRSA-I in Croatia among MRSA bloodstream isolates. The virulence factors PVL and TSST-1 were not present among these isolates.
Link: HighWire Press -- Medline Abstract.
We compared characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) and CA-MRSA invasive disease identified in Minnesota from 2000 through 2003. A total of 586 patients with SSTIs and 65 patients with invasive disease were identified. Patients with invasive disease were more likely to be smokers (p = 0.03), and report a history of immunosuppressive therapy (p = 0.03), emphysema (p = 0.011), or injection drug use (p = 0.020) than were SSTI patients. Invasive disease isolates were less likely to be susceptible to ciprofloxacin (p = 0.002) and clindamycin (p = 0.001) and more likely to have healthcare-associated pulsed-field gel electrophoresis subtypes than SSTI isolates (p<0.001). Patients with invasive disease may have had healthcare exposures that put them at risk of acquiring healthcare-associated MRSA and which were not exclusion criteria in the CA-MRSA case definition. Continued surveillance of MRSA is needed to better characterize CA-MRSA infections.
Link: RangelMD.com.
Is CA-MRSA more virulent in its transmissibility than MSSA? The Mayo Clinic review listed a study from 2004 that found that MRSA was 12 times more transmissible than MSSA in soldiers who were initially found to have MRSA colonization of the nasal mucosa. This is the most compelling evidence for the increased virulence of CA-MRSA however, although CA-MRSA was more likely to result in a skin infection, none of the CA-MRSA infections appeared to be any worse than the MSSA skin infections (though no outcome data was provided). In addition, like this study, most of the evidence for increased transmissibility of MRSA is from populations (day care centers, soldiers, prisoners, homeless persons, intravenous drug users) who share common risk factors for disease transmission in general such as crowding and/or decreased hygiene.
Link: WBTW TV-13 Florence
Medical professionals believe the bacteria has mutated and developed the resistance to common antibiotics. "The unfortunate thing is that because it's resistant to common antibiotics a lot of people will get treated with the common antibiotics that treat skin infections and it kind of suppresses the infection , but doesn't get rid of it." That's when more drastic measures are taken. "We've actually had kids hospitalized for it, neck abscesses, groin abscesses, buttocks abscesses." So, how did we we get in this situation? "I think it's part of the general concern of overuse of antibiotics and that's been going on for years." And for one Eastern Carolina family, three of the four children have dealt with this infection. Sloan Bateman is a busy mom of four. Even more busy recently as three of her four children have struggled with MRSA. Sloan says, "The first incidences were probably with Dargan and we didn't know what it was." She initially thought her daughter had an adverse reaction to a bug bite. Which is a common thought. Soon she learned it was MRSA. A certain type of bacteria that lives on your skin and without warning it attacks. "At first we'd put Neosporin on it, then the ones that became worse of course then go to the doctor and they had been on several rounds of antibiotics for them and that would take care of them." But for two of her children, Frank and Fletcher, that didn't work. Both were hospitalized to treat their infections of MRSA.
Link: HighWire Press -- Medline Abstract.
The innate and evolutionary resourcefulness of bacterial pathogens virtually guarantees that there will always be important areas in which antimicrobial therapy can be improved. Current areas of need, or ones that are anticipated to be problematic in the near future include nosocomial infections caused by multi-resistant Gram-negative bacteria, where the variety and prevalence of multidrug efflux pumps provides a particular challenge to the designers of new drugs. In the community setting, the current prevalence of ampicillin and trimethoprim-sulfamethoxazole resistance, and the growing prevalence of fluoroquinolone resistance in Escherichia coli portend a need for new classes of oral agents to address this important need. On the Gram-positive side, the rapid increase in virulent community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections as a cause of pneumonia emphasizes the importance of developing more agents that are active against MRSA and that are effective for treating pneumonia. Finally, the importance of indwelling devices as a nidus for nosocomial infections emphasizes the need for effective agents for treating biofilm-associated device infection both inside and outside of the hospital.
This comment has appeared on this site - we thought it worthy of a wider audience
I have seen several patients in prior good health that have developed MRSA abcesses responding only to Vancomycin. Repeated courses of therapy have been necessary to deal with repeated outbreaks. My concern is not so much with the antibiotic resistance but with the repeated outbreaks in previously healthy young people(22, 31, 33, and 40yo) with intact immune systems and no contributory history. Two of the four are becoming progressively weaker over 6 months with steady weight loss, lethargy, depression.. I would be pleased to hear from physicians that may have similar patients.
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Link: Sunday, 11/06/05.
A high school student from the Dyer County School System was diagnosed with a dangerous strain of staphylococcus infection. The school system notified students and parents Thursday and told parents to look for the symptoms of the infection. Staph infections are commonly found in hospitals and most often cause minor skin infections. However, the student was affected by methicillin-resistant Staphylococcus aureus, or MRSA, which is strain that is resistant to antibiotics. "It is dangerous because it can go systemic, which means it can get into the bloodstream," said Nancy Deere, community services director for the West Tennessee Department of Health. "If that happens, it can be fatal." Lyndal Gallowa, a registered nurse for the Dyer County School System, said the Centers for Disease Control and Prevention has reported this strain of infection in school athletes. Dwight Hedge, county schools director, said that the athletic facilities at the high school and two middle schools will be cleaned with a bleach solution.
Link: The Montana Standard - Butte, Montana USA.
Three Chicago-area children have died of a toxic shock syndrome-like illness caused by a superbug they caught in the community and not in the hospital, where the germ is usually found. The cases show that this already worrisome staph germ has become even more dangerous by acquiring the ability to cause this shock-like condition. ‘‘There’s a new kid on the block,’’ said Dr. John Bartlett of Johns Hopkins University School of Medicine, referring to the added strength of the superbug known as methicillin-resistant staphylococcus aureus, or MRSA. ‘‘The fact that there are three community-acquired staph aureus cases is really scary,’’ continued Bartlett, an infectious disease specialist. The Chicago deaths were described in Thursday’s New England Journal of Medicine. Health officials do not yet know how the drug-resistant staph causes this new syndrome, but it appears to be rare, said Dr. Clifford McDonald, an epidemiologist with the federal Centers for Disease Control and Prevention. However, doctors should be on the lookout for shock-like cases caused by MRSA, said Dr. Robert Daum, a pediatrician at the University of Chicago who co-authored the study.
Link: CBS 5
A bad bug is sending many Bay Area patients to the emergency room. The infection is neither a cold nor the flu, and the victims have no one to blame but themselves. The infection is a superbug. It’s a strain of bacteria that is resistant to many antibiotics. The bacteria are called Menthicillin Resistant Staphylocococcus Aureus, or MRSA. “It’s very alarming,” says Dr. Kurt Kunzel, treats patients at the Sutter Health Urgent Care Center in Terra Linda. "We see somewhere between two and four a day." "When we look at the kind of infections this bacteria causes, the vast majority are skin infections. They're boils, abscesses, and furuncles," says Dr. David Witt, Chief of Infectious Disease at Kaiser Permanente in San Rafael. "The real answer is that we use antibiotics wisely. We don't use them where they are not needed. Like colds and flu."
Link: Marin Independent Journal - News - Marin.
A superbug bacteria that is resistant to various types of antibiotics and typically causes skin infections, such as pimples and boils, has shown up in Marin. Dr. David Witt, an infectious disease specialist with Kaiser Permanente Medical Center in San Rafael, says the bacteria appeared out of nowhere about five years ago and has been sweeping the nation. Marin residents have been diagnosed with it with increased regularity over the past 18 months, Witt said. "It has dramatically increased in frequency across the country," he said. Dr. Morgan Camp, who treats patients at Sutter Health's Urgent Care facility in Terra Linda, said he treats an average of one or two patients a day who have contracted it. "Sometimes, there are three or four," Camp said. The bacteria's name, methicillin-resistant staphylococcus aureus, or MRSA for short, is bit of a misnomer. MRSA is also resistant to other more common antibiotics such as oxacillin, penicillin and amoxicillin. Witt says 30 percent of all staph infections in the United States are now MRSA strains. MRSA infections first occurred decades ago among patients in hospitals and other health care settings, where the majority of infections still occur. The strain of MRSA that occurs outside these settings is genetically different, however, and emerged only a few years ago. It tends to be less virulent but easier to spread, according to the federal Centers for Disease Control. The MRSA strain found in hospitals and other clinical settings can cause surgical wound infections, urinary tract infections, bloodstream infections and pneumonia. The strain found in the broader community usually causes only skin infections. In rare cases, however, the community-associated strain of MRSA has proved deadly.
Sixteen isolates carried lukS-lukF genes that encode the PVL toxin. All but one isolate were community-acquired. Three patients reported recent travel to North Africa and South America. They were associated with skin or soft tissue infections, bacteraemia and peritonitis. By molecular typing, they belonged to five genotypes: ST80-SCCmec IV, ST8-SCCmec IV, ST30-SCCmec IV, ST153-SCCmec IV and ST88-SCCmec IV. They belonged to the agr type 3 except for ST8 strains, which showed agr type 1. All isolates were susceptible to fluoroquinolones. Approximately, half of them were resistant to tetracycline, fusidic acid and kanamycin. Tetracycline-resistant strains harboured the tet(K) gene and resistance to kanamycin was associated with the aph(3')-IIIa gene. The single erythromycin-resistant isolate harboured msr(A/B) genes conferring the M resistance phenotype. CONCLUSIONS: These results indicate the recent emergence and sporadic importation into Belgium of PVL-positive community-associated MRSA strains belonging to five distinct clones.
Link: HometownAnnapolis.com
In the meantime, tattooing and body piercing are only loosely regulated in Maryland, leaving police and health officials with no recourse against the man who performed the work on the kids who got acquired methicillin-resistant Staphyloccocus aureus, or MRSA. MRSA is similar to the staph infections that usually appear in hospitals and other health care settings. But MRSA is resistant to methicillin and other antibiotics that doctors use to treat staph infections. Staph infections can be as minor as a pimple or boil, or as serious as a blood infection. The only requirements are that tattooists post written warnings of possible complications and follow guidelines such as wearing gloves and using disposable needles.
Skin infections caused by a drug-resistant strain of bacteria are becoming more common in the region, particularly among students who play contact sports. Sixteen football players from four school districts have had skin infections caused by methicillin-resistant Staphylococcus aureus, better known as MRSA, since the start of the academic year, according to the Allegheny County Health Department. "This is a much more common occurrence than people ever thought," said county Health Director Dr. Bruce Dixon. "The community generally ought to be a little more aware that it's occurring."
A Willis High School football player was hospitalized several days ago with an infection caused by Methicillin Resistant Staphylococcus aureus (MRSA), a strain of bacteria that has become resistant to Methicillin antibiotics. The football player was discharged from Conroe Regional Medical Center Friday, according CRMC spokeswoman Fritz Guthrie. However, one Conroe woman told The Courier a staph infection that spread from her grandson, a football player at Oak Ridge High School, to his mother and father sent the father to the hospital in serious condition. Bertha Burson's grandson first had a staph infection last year. "We thought it was just a spider bite, but it kept getting worse," she said. "His mother took him to the doctor right away, and the doctor gave them medicine. It went away, but he got another one a few months later."
Link: Seven Days: Tracking the Trail of Tainted Tattoos.
State officials filed charges Friday against Curtis Allen for tattooing without a license. The charges concluded an investigation that began in the summer, when doctors at Middlebury's Porter Medical Center raised concerns about a cluster of bacterial infections there. MRSA, or methicillin resistant Staphylococcus aureus, is an organism often found on the skin of healthy humans. If the organism gets beneath the skin or into the blood or lungs, it can cause nasty skin infections or pneumonia. Doctors at Porter treated five newly tattooed people for boils, lesions and sores on their skin. "The doctors notified the Health Department," says Derek Everett, who conducted the investigation for the Secretary of State's Professional Licensing Board. "The common thread in each instance was that the victims reported a tattoo artist operating out of his living room." Everett started by interviewing the victims who were still suffering from rashes, and oozing cuts and sores. "The virus literally eats holes in human flesh," he says. "One girl had a hole 5 inches wide and 4 inches deep in her leg."
Link: CDC EID.
The close relatedness and high prevalence of this virulent pathogen argue for a clonal expansion advantage of this particular clone. Outbreaks of C-MRSA infections caused by SCCmec IV (IVa) have been reported in several countries (4). Since our genotyping results showed that MRSA isolates possessing SCCmec V and PVL in Taiwan are clonally related, we cannot rule out the possibility of outbreaks due to this particular clone in some areas. However, our isolates came from multiple hospitals throughout the 4 geographic regions of Taiwan. Our data also showed that this particular clone was already present in 2000. In addition, this particular clone was found not only in outpatients but also in ICU and non-ICU inpatients, including in hospital-acquired infections. These findings indicate that this clone has migrated into the hospital environment; moreover, it can cause more severe infections, as shown by its presence in blood, respiratory, ear, and other specimens. Conclusions Our analysis of MRSA isolates collected in 2000 and 2002 indicated that a virulent clone of MRSA (pulsotype C:ST59, SCCmec V and PVL-positive), which caused wound infections primarily but also other potentially more serious infections, is highly prevalent in Taiwan inpatient and outpatient settings. Recognition of this clone can be facilitated by its antimicrobial susceptibility profile. Because the resistance pattern of these isolates differs from that of traditional H-MRSA strains, the antimicrobial susceptibility profile has important implications for treatment. Understanding the roles these strains play in MRSA epidemiology helps physicians choose the most appropriate treatment. Prompt and judicious management and infection control measures should help deter further spread of this virulent pathogen.
Link: Necrotizing staphylococcal pneumonia in a neonate..
Hospitalized neonates are commonly colonized soon after birth with Staphylococcus aureus. The majority of neonates do not develop infectious sequelae; however, premature neonates appear to be more susceptible to serious infections, such as pneumonia. We report a case of an extremely low birth weight infant who developed necrotizing pneumonia due to methicillin-resistant Staphylococcal aureus (MRSA). The MRSA isolate from this neonate is identical to the strains that have been causing primarily community-associated skin and soft tissue infections. The severe course of this patient may be attributed to the presence of the Panton-Valentine leukocidin gene, a well-known virulence factor leading to soft tissue and pulmonary infections.
Link: icNewcastle - Attack victim gets MRSA.
A family man fighting for his life after a one-punch attack has contracted the deadly superbug MRSA. Story continues Continue story George Spence was left critically ill after fracturing his skull on the ground when he was knocked out outside a Tyneside pub. Now his condition has worsened after doctors at Newcastle General Hospital discovered MRSA in his stomach. Hospital chiefs insist he had the superbug when he was admitted from North Tyneside General Hospital, who said he was only seen in casualty and was not admitted on to a ward.
Link: BMJ.
This is an important item. Read it all above. We would add that a a bird flu epidemic would be particularly lethal to CA MRSA carriers and the author notes that this might be a factor
Depressingly, even with what seems to be appropriate initial treatment with antimicrobial drugs, the maximal survival from necrotising pneumonia is 30%.9 During the 1919 influenza outbreak in Fort Jackson in the United States, when hundreds of troops were dying—almost certainly of PVL related necrotising pneumonia—doctors reported that "the treatment of Staphylococcus aureus infection of the lung is extremely ineffectual."The third manifestation of more serious disease caused by PVL is necrotising pneumonia, which is often lethal. It has been reported in America, Australia, Europe, and the Far East. The pneumonia often arises from bloodborne spread of organisms from infected tissue and can follow viral respiratory infections, especially influenza. Strains of S aureus that produce PVL have a particular affinity for basement membrane exposed by desquamated ciliated epithelium, and they rapidly establish themselves in the lung, producing the leukocidin. Membrane piercing PVL then destroys newly recruited polymorph cells, liberating inflammatory mediators.6 Alveolar macrophages, with depleted phagocytic ability owing to viral infection, then allow unhindered bacterial multiplication: at postmortem examination usually few neutrophils are found. Necrotising vasculitis with massive areas of pulmonary infarction and haemorrhage follows. Sheets of staphylococci cover ulcerated remnants of tracheal and bronchial epithelium. Mortality due to such necrotising pneumonia is nearly 75%.1 The first British case of necrotising pneumonia associated with PVL was in 2003,7 and I am aware of six cases managed by colleagues in the UK in the past nine months. Because postmortem specimens are rarely cultured and the disease is not notifiable, its true incidence remains unknown. No particular strain of S aureus predominates,3 and there is no predictable pattern of geographical variation.
Link: A 14-Year Study at Driscoll Children's Hospital.
There would seem to be some complacency about CA MRSA in the UK. This type of report should be a wake up call
A total of 1002 MRSA cases were identified from 1990 through 2003 of which 928 (93%) were community-acquired. The number of CAMRSA cases ranged from 0 to 9 per year from 1990 through 1999 and then increased exponentially from 36 in 2000 to 459 in 2003. The most common type of CAMRSA infection in children without (94%) and with (72%) risk factors was cellulitis and abscess. A higher percentage of children with risk factors had invasive CAMRSA infections (26% vs 3%; P<.001). From 2002 through 2003, there was a significant difference in clindamycin susceptibility between CAMRSA isolates from children without and with risk factors and nosocomial isolates (97% and 86% vs 62%; P<.005). A higher percentage of patients admitted for treatment of CAMRSA infections received an empirical intravenous antibiotic to which the organism was susceptible when comparing 2002-2003 with 1990-2000 (96% vs 15%; P<.001). During this 14-year study, all patients recovered, including those with life-threatening CAMRSA infections. CONCLUSION: The rapid emergence of CAMRSA as a cause of noninvasive and invasive infections in children, which started occurring in the 1990s, has reached epidemic proportions.
A sudden surge in spider bite reports is actually a serious form of staph infection that is resistant to antibiotics and is spreading through Nassau County, local health experts warn. "This is a serious problem and we want people to be aware that minor sores and boils that do not heal really need medical attention," said Kim Geib, an epidemiologist nurse with the Nassau County Health Department. The infection, a mutation of staph found in hospitals among the sick and elderly, is called community-acquired methecillian resisitant staph aureus, or CA-MRSA, because it is spread in the community among healthy individuals. "It's a new variety, it has a different genetic fingerprint," said Geib.
Link: CBS 6 Albany.
Vermont state officials are investigating the source of bacterial infections among five young people in Middlebury, all of whom recently received tattoos. Two of the people who came down with the infection, known as MRSA, had to be hospitalized. State law forbids anyone who is not licensed from doing tattoos or body piercings. It requires those who have a license to use sterilized instruments. Officials say they have a suspect tattoo artist in mind, but have not publicly identified who that is.
Link: NEJM -- MRSA in the Community.
Two articles in the April 7 issue (Fridkin et al.1 and Miller et al.2) deal with the subject of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection. Fridkin et al. found that 6 percent of cases of MRSA infection were invasive, but they reported no cases of the toxic shock syndrome. Although MRSA strains are toxigenic,3 MRSA-associated toxic shock syndrome appears rare4,5 and has not been described with community-acquired strains. We report a case of the toxic shock syndrome associated with community-acquired MRSA in an 18-year-old woman who presented with malaise, diarrhea,
Link: NEJM -- Transatlantic Spread of the USA300 Clone of MRSA.
The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is of great concern. USA300, the predominant epidemic clone in numerous outbreaks in closed communities in the United States, is also increasingly seen in Europe. International travel and the increasing trend of training or working abroad among health care workers probably contribute to its global spread. We describe the transfer of community-acquired MRSA from the United States to Europe and its successful eradication. A 41-year-old healthy Swiss physician performed a clinical fellowship in the United States from July 2001 to June 2003. Three months . . .
Link: A Superbug
A Superbug normally found in hospitals is spreading through the community, experts said today. Mrsa was discovered in the wounds of 357 patients swabbed in Notts health centres and 149 residents tested in care homes. Dr Richard Slack, consultant in communicable disease control, said: "There is a lot more in the community than we thought. "When it comes to trying to eradicate MRSA it is a bigger job than we thought." The emergence of community MRSA has led to calls for care homes to tighten procedures to stop it spreading. MRSA-positive people are now logged on a database, and patients going to hospital from areas with a high incidence will be routinely screened.
Link: Perth at risk from superbug.
Microbiologists at RPH have detected 20 new strains of the community superbug, known as community MRSA, in the metropolitan area. Because there are no emergency strategies in place, the superbugs have the potential to cause a health crisis. Superbugs are organisms or bacteria that are resistant to antibiotics. advertisement MRSA can cause serious, and sometimes deadly, infections. It resists almost everything but the intravenous antibiotic vancomycin, although resistance to vancomycin has recently emerged. Research shows that the bacteria spreading rapidly through the Perth metropolitan area has picked up more resistance genes. Perth microbiologists don't know what is causing the bacteria to become more resistant or how to control a massive outbreak. "We are concerned it will get into the hospitals, but it is more of a community problem," Dr Christiansen said.
Link: HighWire Press -- Medline Abstract.
Molecular typing approaches have been used with great advantage in studying of the MRSA epidemiology. It appears that a complete characterization of MRSA requires not only identification of the genetic background of the bacteria but also identification of the structural types of Staphylococcal Cassette Chromosome mec element (SCCmec), which carries methicillin resistance determinant mecA. Rapid and precise identification of MRSA is a prerequisite for control of hospital infections. This article reviews recent publications addressing the epidemiology markers of MRSA, specially of community-acquired strains, and the genetic diversity of SCCmec for identifying MRSA. It appears that MRSA will be an increasing important pathogen in the community.
Link: Medscape.
This is a part of a longer article reporting the latest insights into CA MRSA. Well worth a read
Any clinician seeing pediatric patients is aware of the striking increase in CA-MRSA. The most important points made by the presenters were the following: * If there is any chance of obtaining pus, clinicians should be aggressive even in the office setting because early drainage has been demonstrated to be an effective treatment. In an increasing numbers of cases, identification of the organism and sensitivities will be needed in order to choose optimal antibiotic coverage. * CA-MRSA is becoming a predominant organism for severe invasive soft tissue, bone, and joint infections and must remain high in the differential when treating patients with these conditions. * An increasing number of resources are available for the clinician to help with antibiotic decision making. Carol Baker, MD, Baylor College of Medicine, Houston, Texas, pointed out that an algorithm for approaching a patient with suspected CA-MRSA was published in American Academy of Pediatric News, September. 2004.[12] It's probably a good idea for all clinicians caring for children to become familiar with this information. References
Recently, acquisition of methicillin-resistant Staphylococcus aureus (MRSA) has been increasingly seen in community settings. Beginning in 1995, we have routinely conducted pulsed-field gel electrophoresis (PFGE) of MRSA isolates received at Cadham Provincial Laboratory (CPL) in Manitoba, Canada. Our diverse collection of isolates coupled with molecular subtype information allowed us to assess the extent to which MRSA isolates in general were associated with community acquisition and whether specific PFGE types were more likely to be found in community settings. Forty percent of the MRSA isolates in our analysis were designated community associated (CA), with two of the six most common PFGE types showing a greater likelihood to be CA-MRSA. Overall, CA-MRSA were more likely to show multiple sensitivity to antibiotics and to be associated with younger age groups. Mapping of specific CA-MRSA types over successive 5-year periods showed rapid temporal shifts in prevalence in different parts of the province.
Link: News Story.
Eight Scottish sports facilities were tested as part of the newspaper investigation, which showed out of 24 swabs taken from cafe tables, toilet handles, baby changing facilities and lockers by a journalist, 20 tested positive for MRSA. But today Dr Ian Gould, who's team at Aberdeen University are carrying out controlled clinical follow up tests, said he's skeptical of the results because they don't reflect current figures of the prevalence of the bug in the community. The investigation also found Inverness Sports Centre to have traces of the bug in the cafe and toilets, while the Olympia Leisure Centre in Dundee had traces in three areas. The follow up results are expected within the next few days.
Link: MSNBC.com.
Researchers at the Beth Israel Deaconess Medical Center and Harvard Medical School studied the prevalence of bacteria resistant to three or more drugs over a six-year period. From 1998 to 2003, there was a significant increase in the incidence of patients carrying multidrug resistant (MDR) bacteria when they were admitted. Tree of the four species of MDR bacteria that the researchers examined, including E. coli, saw rising numbers of cases. "We need to learn more about ways to prevent the spread of multidrug resistance," said Aurora Pop-Vicas, lead author of the second study. "What everybody wants to avoid is having an infection with an MDR bacteria resistant to all the antibiotics currently available." Both studies were announced Monday. They mirror findings released in April by the U.S. Centers for Disease Control and Prevention, which found 17 percent of drug-resistant staph infections in three regions were caught outside hospitals.
Link: Panton-Valentine leukocidin positive MRSA in 2003: the Dutch situation.
Analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Netherlands in 2003 revealed that 8% of the hospital isolates carried the loci for Panton-Valentine leukocidin (PVL). Molecular subtyping showed that most Dutch PVL-MRSA genotypes corresponded to well-documented global epidemic types. The most common PVL-MRSA genotypes were sequence type ST8, ST22, ST30, ST59 and ST80. MRSA with ST8 increased in the Netherlands from 1% in 2002 to 17% in 2003. It is emphasised that PVL-MRSA might not only emerge in the community, but also in the hospital environment.
Link: Eurosurveillance Weekly 2003;7 (10): 06/03/2003.
Methicillin resistant Staphylococcus aureus (MRSA) strains possessing the Panton Valentine Leukocidin (PVL) gene have been detected in the Netherlands recently. The PVL gene encodes a highly potent toxin, which is involved in severe skin infections and necrotising pneumonia. PVL positive MRSA strains have also been noted in France (in healthy individuals; mean age 14 years), in the United States (for example, in the Los Angeles gay community, and in a large prison), and in Scotland (small outbreaks of skin abscesses in healthcare staff. The Scottish MRSA reference laboratory is now routinely screening both methicillin susceptible S. aureus (MSSA) and MRSA for the PVL gene). It has been suggested that the PVL MRSA is acquired in the community (1-3).
Further studies will be performed in order to gain more insight into the microbiological and epidemiological background of these virulent MRSA strains. The combination of the PVL gene (virulence) and MecA gene (resistance) and proven epidemicity (cluster 28) makes this a well adapted pathogen, which can have severe implications, especially if further resistance markers are acquired.Link: Telegraph
A Royal Marine recruit who died from an infected scratch during basic training would have survived had the wound been treated early enough with a simple antiseptic cream, it emerged yesterday. Richard Campbell-Smith, 18, was killed when a bacterial infection in his leg mutated into the "super-toxin" Panton-Valentine Leukocidin (PVL) just hours after he grazed his leg. There is no known cure once PVL, which is immune to antibiotics, has established itself but doctors said yesterday that the immediate application of antiseptic cream or TCP would have prevented it entering the body and saved his life. Dr Tim Wyatt, from the Association of Clinical Microbiologists, said: "If he had cleaned it up properly early on and put a bit of antiseptic cream on it he would have been OK. "But of course as he was a Royal Marine - he's not going to worry about a wee scratch. For a young, healthy Marine to die from a preventable infection is very scary."
Link: EDP24 - New strain of killer MRSA emerging?.
The HPA said PVL, which attacks white blood cells, leaving the sufferer unable to fight infection, was produced by fewer than 1.6pc of strains of staphylococcus aureus found in the UK. Staphylococcus aureus is a bacterium termed MRSA when it is resistant to the antibiotic methicillin. Training of Royal Marines will not change following the death of a teenage recruit infected with an MRSA-linked toxin, the Royal Navy said. Mr Campbell-Smith was four weeks from the end of his 32-week training course when he reportedly scratched his legs while running on October 31 last year. He was admitted to the medical unit, and later taken to the Royal Devon and Exeter Hospital where he died on November 2. A post-mortem examination showed heart and respiratory failure and traces of PVL were later found. Hospitals across the region say they are aware of the PVL threat but the key hospital-acquired infection focus remains on MRSA.
Link: Life Style Extra.
A mum said she was "lucky to be alive" today after contracting a new superbug which left her with a four-inch scar as an ugly reminder of her ordeal. Emma Lynch, 33, was breastfeeding her baby at Derriford Hospital in Plymouth when she contracted Panton Valentine Leukocidin (PVL), which killed teenage Royal Marine Richard Campbell-Smith, and passed it on to her little daughter Daisy. After catching the infection in the hospital's maternity unit both developed huge abscesses. Emma told how her's swelled to an astonishing 20cm long and required an emergency operation to drain it. She said: "I feel lucky to be alive. It was a bit of a shock to hear news of the marine killed by the same disease and makes me think my case was played down as they always said to me I never had MRSA. "Fortunately it wasn't as severe for us, but considering how huge my abscess was it is scary to think what would have happened if it burst. And more awful to think my daughter could have died, I just can't imagine it."
Link: Times Online.
This is a very important article. When you read it you'll find a 'must not panic the public quote' from the health authorities. Clearly this is true. What is also true is that there needs to be a strategy to help contain this particular strain. Mark and others would simply like to know if the government are going to do something before we have a public health threatening epidemic
Urgent action is needed by the Government to combat deadly new superbugs that kill healthy young people, a disease expert gave warning today. Toxin-producing MRSA strains similar to the one that killed Richard Campbell-Smith, an 18-year-old Royal Marine trainee, are already a widespread medical problem in the United States and account for the majority of Staphylococcus aureus infections in some areas. Campbell-Smith, a fit, young recruit, developed necrotising pneumonia and died two days after a cut on his leg that he sustained in training became infected with an MRSA strain that produces the Panton-Valentine toxin, an inquest heard this week. Dr Mark Enright, a Bath University expert who is studying the disease, called on the Government to set up an active monitoring system, where all suspicious cases must be referred to the Health Protection Agency laboratories in Colindale, London. At present it is left to hospitals to decide whether to submit swabs for testing.
Link: BBC NEWS.
This is a very helpful overview of the MRSA strains that have a PVL element. Click the link above for the whole article
The death of a young Royal Marine has sparked concern that a superbug is emerging in the UK. BBC News website explains what Panton-Valentine leukocidin (PVL)-producing superbugs are. What is the PVL superbug? It is part of a family of common bacteria called Staphylococcus. Many people naturally carry Staphylococcus in their throats, and it can cause a mild infection in a healthy patient. Like the superbug MRSA (methicillin-resistant Staphylococcus aureus), PVL-producing bacterium is a particularly nasty clone of Staphylococcus.
Link: Telegraph | News | Marine death sparks fears of incurable new superbug.
The claim that there is no known cure may be a bit sweeping. Much CA MRSA is susceptible to drugs that don't work with the Hospital variety
Fears that a new superbug is taking hold in Britain emerged yesterday after a Royal Marines recruit was found to have died suddenly from an infection with no known cure. Richard Campbell-Smith, 18, died three days after the lethal toxin, which is linked to MRSA, entered his body through a scratch in his leg. Panton-Valentine Leukocidin (PVL) is so virulent that only a quarter of people in whom the infection spreads to the chest survive. The coroner investigating Mr Campbell-Smith's death was so worried about an outbreak that she is writing to the chief medical officer. An expert told the Exeter inquest that she had seen two examples in nine weeks and wanted to alert the public and doctors to the dangers of the disease, which has been recorded in America, France and Australia.
Link: Scotsman.com News
A medical expert at his inquest in Exeter revealed the disease was thought to have died out in the 1950s – but she had seen two cases in nine weeks, and wanted to alert the public and medics. A spokeswoman for the Health Protection Agency told the Press Association: “We are aware of strains of Staphylococcus aureus with PVL, but it is extremely rare in the UK. “There is a surveillance scheme for this, but when we have Staphylococcus aureus samples in our laboratory we test a proportion of them for PVL. We have issued advice for clinicians so that if they suspect patients that may have this infection, they can send us the patient’s sample for us to test in the laboratory.” Staphylococcus aureus is a bacterium which lives harmlessly in about one third of normal healthy people, but bacteria resistant to the antibiotic methicillin are termed methicillin-resistant Staphylococcus aureus (MRSA). Community-acquired MRSA (C-MRSA) affects a previously healthy individual who has no recognised risk factors associated with MRSA. Some of the strains carry the toxin Panton-Valentine Leukocidin (PVL), which attacks white blood cells, leaving the sufferer unable to fight infection.
Link: ABC News
This has a great Q & A section on MRSA that many may find helpful
Drug-resistant bacteria are spreading into our communities and infecting the wounds of unsuspecting people. It's not the plot of a B-rated movie, but what is actually happening in many U.S. cities, and it is causing much alarm in the medical community. Previously, hospitals were the only places you would need to be concerned about these stubborn bacteria, but in a study published on April 7, 2005 in The New England Journal of Medicine, infections caused by one such superbug, methicillin-resistant Staphylococcus aureus (MRSA), was studied in Atlanta, Baltimore and Minnesota hospitals. Over the course of a year, a surprisingly large number of MRSA infections, somewhere between 8 and 20 percent, was the result of community-acquired, out-of-hospital, infections.
Link: Journal Watch Infectious Diseases.
Community-acquired MRSA infections are increasing. Although these reports do not address the proportion of community-associated staphylococcal infections that are caused by MRSA strains not originating in hospitals, an editorialist suggests that in Atlanta this figure may exceed 5%. Community-acquired MRSA must be added to the monomicrobial etiologies of necrotizing fasciitis, and clinicians must be alert to the need for antimicrobial therapy directed against these strains, as well as to the necessity for surgical intervention. Although the development of necrotizing fasciitis due to community-acquired MRSA is disturbing, it should be noted that 9 of the 14 reported patients either had been hospitalized within the previous year or had a history of MRSA infection.
Staphylococcus aureus isolates carrying the genes that encode for Panton-Valentine leucocidin (PVL), a highly potent toxin, have been responsible for recent outbreaks of severe invasive disease in previously healthy children and adults in the United States of America and Europe. To determine the frequency of PVL-positive isolates sent to the Staphylococcus Reference Unit (United Kingdom) for epidemiological purposes, we tested 515 isolates of S. aureus, and 8 (1.6%) were positive for the PVL locus. A further 470 isolates were selected to explore the association of PVL-positive S. aureus with clinical disease. Of these, 23 (4.9%) were PVL positive and most were associated with skin and soft tissue infections (especially abscesses). The PVL genes were also detected in isolates responsible for community-acquired pneumonia, burn infections, bacteremia, and scalded skin syndrome. Genotyping by pulsed-field gel electrophoresis and multilocus sequence typing revealed that the PVL-positive isolates were from diverse genetic backgrounds, although one prevalent clone of 12 geographically dispersed methicillin-resistant S. aureus (MRSA) isolates was identified (ST80).
ncreasing frequencies of community-acquired methicillin-resistant Staphylcoccus aureus (MRSA) strain isolation have been reported from many countries. The overall prevalence of MRSA in Norway is still very low. MRSA isolates (n = 67) detected between 1995 and 2003 in northern Norway were analyzed by pulsed-field gel electrophoresis, multilocus sequence typing, and staphylococcal cassette chromosome mec (SCCmec) typing. Sixty-seven isolates were associated with 13 different sequence types. Two successful MRSA clones predominated. Sequence type 8 (ST8) (40%) and ST80 (19%) containing SCCmec type IV were detected in hospitals and communities in different geographic regions during a 7-year period. In general, there was a low level of antimicrobial resistance. Only 26% of the isolates were multiresistant. International epidemic clones were detected. The frequent findings of SCCmec type IV (91%) along with heterogeneous genetic backgrounds suggest a horizontal spread of SCCmec type IV among staphylococcal strains in parallel with the clonal spread of successful MRSA strains.
Link: Hubmed.
Community-acquired meticillin-resistant Staphylococcus aureus (MRSA) is becoming an important public-health problem. New strains of S aureus displaying unique combinations of virulence factors and resistance traits have been associated with high morbidity and mortality in the community. Outbreaks of epidemic furunculosis and cases of severe invasive pulmonary infections in young, otherwise healthy people have been particularly noteworthy. We review the characteristics of these new strains of community-acquired MRSA that have contributed to their pathogenicity and discuss new approaches to the diagnosis and management of suspected and confirmed community-acquired MRSA infections.
Link: Guardian Unlimited | Guardian Weekly | This patient's going global.
According to many scientists, MRSA in the community has done more than simply emerge. "Specific strains of it are spreading like crazy in the US," says Francoise Perdreau-Remington, of the University of California, San Francisco and co-author of the recent New England Journal of Medicine report on necrotising fasciitis. One strain, known as USA300, was identified only in 2000, but has now spread to at least 13 states and been picked up in other countries, notably the Netherlands. "This was non-existent before 2000. Now it's taking over," says Perdreau-Remington. "The way it's spread in the US so far, it's going to go abroad, no question, and it might well go round the world." If it does, it won't be the first time a Staph has gone global. Since emerging in Britain, community MRSA has killed a 28 year-old woman. In the US scientists are openly calling community MRSA an epidemic. It is hard to argue with that when in parts of the country MRSA makes up as many as 60% of the Staphs in the community. But while health officials in the US are moving on to a war footing, Britain appears to be playing a waiting game. The US reported community-acquired MRSA as early as 1998, but the first case in Britain was identified only three years ago, according to the government's Health Protection Agency. Since then only about 100 cases have been logged, including one death. But despite signs that MRSA could potentially become a bigger story outside hospitals than in them, there is no early warning system in place. : "Our old, lumbering, oafish multidrug-resistant hospital-acquired MRSA is being outcompeted in hospitals by this new, lean, mean MRSA machine. We are no longer seeing the old MRSA in our hospitals. It's all this newer, more virulent type."
Link: AP Wire | 04/23/2005 | Pittsburgh-area hospitals testing for staph infections.
Eight southwestern Pennsylvania hospitals are routinely testing nasal swabs taken from patients in an effort to reduce the incidence of a stubborn staph infection that is resistant to some antibiotics. The federal Centers for Disease Control and Prevention in Atlanta is monitoring the effort to track methicillin-resistant Staphylococcus aureus, or MRSA, to see if it works. "We could potentially see it as a model for other regions of the country," said Dr. John Jernigan, a CDC epidemiologist. "Perhaps, over time, we can have a national impact on this problem." Discovered in the last decade, MRSA is routinely carried in the noses and sometimes on the skin of healthy people. It can cause abscesses and boils, but sometimes results in flu-like symptoms or a pneumonia which can be fatal; it doesn't respond well to some antibiotics. Although researchers say the infection is commonly found in hospitals, jails, gymnasiums and other environments where people come into skin-to-skin contact, a recent CDC study of 12,000 cases in Maryland, Georgia and Minnesota found one out of five was transmitted in the community at large.
Link: FresnoBee.com
Staph bacteria occur naturally on people's skins and are colonized in the nose. The germs typically are spread through direct skin contact; and can be highly contagious. "There are some reports that the spread between family members can be as high as 80%," said Lyndon Badcoe, an epidemiologist at the Fresno County Department of Community Health. Homes, jails, day-care centers and sports teams, where people are in close contact, provide ideal settings for the infections to flourish. Antibiotic-resistant germs have long been the bane of hospitals and nursing homes, preying mostly upon elderly patients whose weakened immune systems make them vulnerable to infections. But increasingly the bacteria are attacking outside hospitals; and the germs' new victims tend to be healthy, younger people. A Fresno County Health Department survey in April of some hospitals in the county showed the medical staffs saw 894 people with community-acquired infections in 2004, more than double the number documented by the hospitals in 2002. By and large, the infected did not have a history of being hospitalized within the past year; had not been in long-term care; and had not had surgery, dialysis or catheters, said Badcoe, who conducted the survey.
Link: Staph infections up among healthy.
"There was a time in Seattle where we had very little drug resistance," said Shelton. "The drug resistance that we did see was primarily in people who were chronically ill. ... Now, you can be very, very healthy." Other hospitals have also noted increases. Children's Hospital and Regional Medical Center, which has tracked cases of antibiotic-resistant infections in its patients for a decade, has seen a doubling of infections each year for the past four years. Some -- it is not certain just how many -- had the infection before they entered the hospital. Swedish has responded to the proliferation of cases by isolating anyone admitted with a skin infection until antibiotic-resistance is ruled out. Some believe the culpable bacteria, called methicillin-resistant staphylococcus aureus, or MRSA, likely developed in response to growing antibiotic use, about half of which is unnecessary, said Dr. Tim Dellit, an infectious disease specialist at Harborview Medical Center.
Link: ABC13.com
At the VA Medical Center and Ben Taub Hospital, patients coming in with MRSA infections have doubled. At Texas Children's, they're seeing four cases a day. "Last year, we had 1,600 staph infections," said Dr. Kaplan. "Seventy-six percent were methicillin resistant." "They made me go to sleep," said Kevin. "Then they put a big bandage on my leg." Kevin, who is six years old, has an IV pumping antibiotics into his small body. It's what's keeping him alive. It began as a pain in his leg. It got severe and then fever hit. When Kevin went to the emergency room, his parents were told he had MRSA. "We needed to take him for emergency surgery," said Omana Koruthu, Kevin's mother. MRSA had quickly spread from his skin to his bone. How did a healthy six-year-old boy get this dangerous infection? It's usually spread by skin to skin contact and if there's a break in the skin...
Link: HoustonChronicle.com
In the past month, Kelsey-Seybold pediatrician Paula Schlesinger has seen at least four patients infected with an antibiotic-resistant bacterium known as MRSA. Two of them needed surgical treatment for their sores. She's begun advising parents with youngsters with repeated skin infections to add two tablespoons of bleach to their bath water. "It seems to me we're seeing more skin infections than we used to," Schlesinger said. "We're seeing children of all ages with boils and abscesses. They don't respond to the usual antibiotics." Be on the lookout As Houston approaches summer, when the most severe cases of MRSA start appearing , experts are warning parents and others to be on the lookout for unusual-looking insect bites, or red and swollen spots following minor injuries.
Link: Oakland Tribune - Op-Ed.
The reported noxious virulence of MRSA could not have been demonstrated more convincingly to us: the day before, we had hiked 2 miles and attended a party. Hours later, my friend was gasping for air, disoriented, unable to walk; her temperature spiked to 103 degrees. The first two days of her hospitalization proved harrowing, and I seriously worried that she might die. Thankfully, on the third day, her marvelous Kaiser Hawaii physician, Dr. Scott Hoskinson, became suspicious that MRSA might be causing her pneumonia, so he started a relevant antibiotic before more definitive tests were available. He was correct, as we subsequently discovered, and we will always be grateful for his sharp clinical acumen (and keen sense of humor)
Link: Hubmed
Infections with methicillin-resistant Staphylococcus aureus (MRSA), long endemic in hospitals and nursing homes, are now being reported in the community as well. While we await further epidemiological and microbiological study of this emerging pathogen, current clinical practice requires a reconsideration of the empiric use of beta-lactam agents for the seriously ill patient with a gram-positive infection.
Link: MRSA Outbreak Prompts Change in Prescribing Habits.
Part of a longer and helpful article
During a 14-year study period, the investigators observed gradual, then exponential increases in the percentage of S aureus isolates that were methicillin resistant, the total number of MRSA cases per year, and the prevalence of patients admitted for treatment of CAMRSA infections per 10,000 admissions. According to Dr. Purcell, none of these yet appear to have reached a plateau. Analysis of collected data showed an increase in the percentage of MRSA isolates from 2.9% to 11% between 1990 and 1991, followed by an increase to 19% in 2000 and then 62% in 2003. Of 1,003 such cases identified between 1990 and 2003, 93% proved to be community acquired. In addition, the prevalence of CAMSRA-related pediatric hospital admissions increased from 3.8 cases per 10,000 admissions (1990-1999) to 58.0 cases per 10,000 admissions (2000-2001), then 277 cases per 10,000 admissions (2002-2003). Cellulitis/abscess was the most common type of infection (94%). CAMSRA isolates were found to be significantly more susceptible to clindamycin therapy compared with nosocomial MRSA isolates (96% vs 62%; P < .001). "Ultimately we may see resistance to clindamycin emerge, but we've been using clindamycin a lot for the last four years and haven't seen any change in resistance thus far," noted Dr. Purcell.
Link: Guardian Unlimited.
One strain, known as USA300, was only identified in 2000, but has now spread to at least 13 states and even been picked up in other countries, notably the Netherlands. "This was non-existent before 2000. Now it's taking over," says Perdreau-Remington. "The way it's spread in the US so far, it's going to go abroad, no question, and it might well go round the world." (Talking of an earlier MRSA Strain) Earlier this month, scientists at Bath University identified a strain of community MRSA as its close relative and likely descendant. The only difference between the two, they say, is that the new strain is far more virulent. "It's difficult to see why it won't spread just like it did in the 1950s. It's a very aggressive strain and it's much more transmissible than others that are out there," says Mark Enright, who led the research.
To spot an emerging problem you have to go and look for MRSA colonising healthy people. At present, suspected cases of community-acquired MRSA are reported to the agency only after patients have been admitted to hospital with severe infections. "There's no specific surveillance system to look for community MRSA, but if we had a particular problem with it, I'm sure we'd know about it," says a spokeswoman for the HPA. Not everyone is so sanguine. "Cases are going up in every country that is properly looking for it, but we're not looking for it. Everyone's eyes are on hospitals and waiting lists and this is just not on the radar," says Enright. "It's something that really needs to be monitored because it has the potential to be devastating. The picture in the US is that this is rampaging. We'll get this, it's going to happen here in the same way as the States."
This is a very good article - click the link above for the whole peice. It also links to MRSA Watch as a source of information
Link: Public Health Grand Rounds--Antimicrobial Resistance.
Community-associated MRSA, or CA-MRSA, has caused outbreaks in several states and is the target of a public health awareness campaign to prevent antimicrobial resistance. Join us as we examine the case of Seattle-King County, Washington, a metropolitan community, whose public health department is building partnerships, providing education, and making surveillance a top priority to prevent the spread of antimicrobial resistance.
Link: SocietyGuardian.co.uk
The new MRSA has not yet been identified in this country, according to the govern ment watchdog body, the Health Protection Agency, but it is carefully monitoring all suspect cases, including patients who have not recently had surgery or been in hospital, where the bug is still more common, or who have been on antibiotics for a long time. Angela Kearns, head of the agency's stapphylococcus reference laboratory, said that the risk of contracting MRSA in the community "remains extremely small". She added that the agency was "unaware of any cases of necrotising fasciitis associated with C-MRSA in the UK at this time."
Link: ThisisLondon.
Britain has one of the worst records in Europe on combating the disease and it is at the top of the health agenda going into the general election. The patients who developed necrotising fasciitis in Los Angeles caught MRSA in the community and had not been in hospital, the usual source of the infection. Necrotising fasciitis causes skin and tissue to die and it has to be cut out to stop it spreading. It can be fatal. The study was limited and a localised strain of MRSA may have caused the problem. But the doctors' report in the New England Journal of Medicine concludes: "We characterise what appears to be a newlydescribed syndrome of necrotising fasciitis caused by commun ity - associated MRSA."
Link: Local researchers find bug causing flesh-eating disease.
At County Harbor-UCLA Medical Center near Torrance, Miller's team documented 14 cases of flesh-eating disease in the skin wounds of more than 800 patients who were infected with the antibiotic resistant-bacteria, from January 2003 until April 2004. None of the 14 patients died, but all had surgery to remove diseased flesh, and 10 spent time in the intensive care unit. Three needed skin grafts or other reconstructive surgery. When the study started, there had only been two known cases anywhere of flesh-eating disease caused by what is known as methicillin-resistant staphylococcus aureus, or MRSA, said Miller, an investigator at Los Angeles Biomedical Research Institute and a staff physician at Harbor-UCLA. "This antibiotic-resistant staph is now causing not only uncomplicated skin infections, but more serious infections of the skin and soft tissue which previously were unheard of or very rare," Miller said. "Clearly the staph bacteria has evolved not only to be antibiotic resistant but to be able to cause different forms of disease that it has caused in the past." Treated with antibiotics The findings make it clear that physicians treating cases of necrotizing fasciitis should treat for MRSA until the cause of the infection is known. The infections at Harbor-UCLA were successfully treated with antibiotics like vancomycin and clindamycin.
Link: New Scientist Breaking News
Cases are still relatively rare but have been reported throughout the world, though this form of MRSA is a particular problem in the United States, where in some areas it accounts for 70% of all reported MRSA infections. While these bacteria are not multi-drug resistant - and can still succumb to the antibiotic vancomycin - treatment can be complicated. An international team of scientists has found that a strain of CA-MRSA known as the southwest Pacific clone is closely related to an older form of Staphylococcus aureus that caused a pandemic in the 1950s. This older strain, known as phage type 80/81, was first discovered in neonatal infections in Australia in 1953 and went on to cause serious outbreaks of skin lesions, sepsis and pneumonia worldwide, often in young people and children. The older strain was almost identical to the southwest Pacific clone, and also closely related to another strain called the MRSA16 clone - commonly found in UK hospitals. Notably, the older strain also carried the genes for the PVL toxin. The southwest Pacific clone has spread into Europe, where it has caused fatal pneumonia in France, Sweden and Latvia. Only two specimens have so far been found in the UK. Mark Enright at the University of Bath, who led the study, says the results are alarming. “I have no doubt that this is going to cause serious public health problems in the UK and elsewhere in coming years. This is a very aggressive pathogen and it’s spreading rapidly.”
Link: this is bath - news, entertainment, jobs, homes and cars.
A Major new superbug crisis could be about to hit the UK. That is the stark warning from University of Bath scientist Dr Mark Enright, one of the nation's leading experts on MRSA. He says a strain of the MRSA bug, which caused a global pandemic in the 1950s, could be responsible for recent outbreaks of drug-resistant disease. And he says if his research is borne out, the disease could spread more quickly in hospitals and the wider community and affect more people than previously thought.
Link: Worldandnation
Children under 2 were more likely to have the disease. Fridkin was surprised by the final result. "The incidence of community-acquired MRSA is a significant problem," he said. "This is in the range where the health community recognizes it as a serious problem." Dr. William Schaffner, board member of the National Foundation for Infectious Diseases and chairman of preventive medicine at Vanderbilt University, is already convinced. MRSA has rapidly become the most common cause of skin infections in his hospital's emergency department, he said. "It's becoming increasingly common around the country," he said. "If areas weren't affected a year ago, I bet they're affected now. We think it's now just part of normal life." It's a message that Dr. Juan Dumois, infectious disease chairman at All Children's Hospital, has been preaching in the Tampa Bay area. Dumois gave a lecture about MRSA to local pediatricians Wednesday. Some local doctors "have sequestered themselves" and still don't seem aware that MRSA has hit the bay area, Dumois said. But they are becoming fewer. It's becoming more routine for doctors to test for MRSA with each staph infection, he said.
Link: PittsburghLIVE.com.
"A decade ago it would have been zero percent," Fridkin said. "We wanted to see if this had become commonplace in the community. The answer is a resounding, 'Yes.' It's clearly no longer limited to the hospital." The microbe is a strain of the ubiquitous bacterium staphylococcus aureus, which usually causes well-known "staph" infections that are easily treated with common antibiotics in the penicillin family, such as methicillin and amoxicillin. In recent years, small outbreaks of infections with a strain that is impervious to those antibiotics have been reported among athletes, inmates, children and other groups, but otherwise resistant staph strains had been almost exclusively limited to hospitals. "We're used to resistant staph in the hospital as a problem among patients with heart failure, liver failure, cancer or other health problems," said David Gilbert of the Oregon Health & Science University. "It's started attacking normal healthy people, causing serious, often fatal illness." The germ, which is spread by casual contact, produces potent toxins that kill disease-fighting white blood cells. That rapidly turns minor rug burns, cuts and other skin infections into serious health problems, apparently including fast-moving "necrotizing" abscesses that literally eat away tissue. Previously, such cases were thought to be caused only by strep bacteria. In other cases the microbe gets into the lungs, causing unusually serious cases of pneumonia, often on the heels of the flu, or spreads into the bloodstream, triggering life-threatening complications. "This has now become a significant problem in this country," said Donald Poretz, an infectious disease expert at Georgetown University who serves as president of the National Foundation for Infectious Diseases. "We see dozens of these cases in our offices." The infections can often be treated simply by lancing and draining abscesses and quickly administering less commonly used antibiotics, such as vancomycin. The risk of becoming infected can be minimized by taking common-sense precautions, such as frequent hand-washing. But experts fear doctors, especially in areas where it is not yet well-known, will fail to recognize the microbe. "Some of our patients had to have very extensive surgery to remove all of the dead tissue, and many of them were quite ill and required intensive care," said UCLA's Miller. "It's an infectious disease emergency, because without prompt surgery treatment and antibiotics people will die."
Link: Lifeclinic.com.
"The main hypothesis we wanted to test was whether MRSA emerged in the community independently or had leaked out of the healthcare system," said Dr. Scott Fridkin, lead author of the study and a medical epidemiologist at the National Center for infectious Diseases, part of the Centers for Disease Control and Prevention in Atlanta. "We now know that MRSA has emerged in the community," he added. "Eight to 20 percent of all MRSA in the three communities was community associated and not hospital associated." Doctors need to be aware that any staph infections they are seeing may be resistant to the first-line antibiotic treatments, the authors stated. "It's really sort of an awakening call that physicians need to think of MRSA," Fridkin said. "They used to think about it only in hospitalized persons."
Link: Staph superbug.
Fridkin says it appears that a surprisingly high 20 percent of such infections may have come from the community which was not the case a decade ago. Loren Miller of Harbor-UCLA Medical Center, led the second study which found that some cases of flesh-eating bacteria are caused by methicillin-resistant staph and they found 14 such instances over a 15-month period, and four patients had no risk factors such as drug use, diabetes or hepatitis. Miller's team said doctors must change their attitudes toward cases of necrotizing fasciitis, the "flesh-eating" part of such a bacterial infection, and check to see if methicillin-resistant staph is to blame. Good hygiene, particularly hand washing, can prevent such infections. In hospitals, MRSA resists almost everything but an intravenous antibiotic called vancomycin. But so-called community-acquired MRSA can be treated with a range of antibiotics including doxycycline and cotrimoxazole, sold under the brand name Bactrim.
Link: Journal of Clinical Microbiology.
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has recently emerged in the southwestern Pacific, North America, and Europe. These S. aureus isolates frequently shared some genetic characteristics, including the SCCmec type IV and lukS-lukF genes. In this paper we show that typical CA-MRSA isolates have spread to South America (Brazil).
Link: Community-Acquired MRSA
"We started this study because there were reports of MRSA infection occurring in scattered outbreaks, and there was a debate if this was emergence of a new strain of staph in the community or if it was just 'leakage' of hospital-based MRSA into the community," Dr. Fridkin told Reuters Health. Community-associated MRSA was diagnosed in 20% of 7819 cases of MRSA in Atlanta, 12% of 3714 in Minnesota and 8% of 1720 in Baltimore. "This was a surprisingly high proportion of all MRSA that was community associated, much higher than we anticipated when we started the study," Dr. Fridkin said. The infection primarily affected skin and soft tissue, although 6% of cases were invasive, including bacteremia, septic arthritis and osteomyelitis. Hospitalization specifically for MRSA disease was required by 23% of patients. Even though 58% were prescribed only beta-lactam antibiotics to which isolates were resistant in vitro, outcomes did not appear to be affected. According to Dr. Fridkin, "that may mean that the most appropriate and best way to treat staph infections still needs to be identified."
A troubling bacteria resistant to antibiotics that can cause skin boils and blood poisoning is on the rise in Santa Clara County. If numbers continue to increase as they have over the last three months, infections would be up 74 percent over last year, according to officials. The bacteria is known as methicillin-resistant staphylococcus aureus, or MRSA. It's a variant of the staph bacteria common in hospitals and nursing homes. Santa Clara County reported 1,397 MRSA cases in all of 2004 and 606 for the first three months of 2005, according to county public health officer Dr. Marty Fenstersheib. The increase mirrors a national trend, he said. Epidemiologists aren't sure why MRSA is becoming more prevalent. They speculate that the bacteria has mutated into new strains that are more virulent.
Link: Community MRSA is re-emergence of 1950's pandemic.
This "re-equipping and re-emergence" of a clone that caused a pandemic 40-50 years ago could mean that community acquired MRSA will spread faster and be more widespread than previously expected, warns an international team of researchers who have been studying the bacteria. First isolated in Australia and Canada in 1953, type 80/81 penicillin-resistant Staphylococcus aureus bacteria caused skin lesions, sepsis and pneumonia in children and young adults around the world. This pandemic of both hospital and community acquired infections waned throughout the 1960s as the antibiotic meticillin was used to treat these infections. Now researchers have shown that one of the key clones of community acquired MRSA (CA-MRSA) - infections picked up in public places which are resistant to treatment by powerful meticillin antibiotics - may have evolved from this earlier pandemic-causing strain. "At the time of the 1950s pandemic, many doctors thought that these isolates were unusually transmissible and virulent," said Dr Mark Enright from Department of Biology and Biochemistry the University of Bath (UK) who is leading the research. "We have shown that 80/81 and its souped-up community acquired MRSA descendent share many of the same features, which explains why 1950s pandemic was so successful, but also shows why community acquired MRSA could pose such a serious public health challenge in coming years. "The community acquired MRSA clone has a toxin and other traits with a proven track record for causing serious diseases in healthier and younger age groups than those currently regarded as at risk. The increased resistance to antibiotics of the community acquired MRSA clone over its 80/81 ancestor mean that there could also be other factors which complicate the treatment of the disease it causes."
Link: CBC News: Doctors fear epidemic of superbug that hits the healthy.
Calgary hit by 15 to 30 superbug cases a month
The Calgary cluster of cases – the first significant outbreak in Canada of the new Community-acquired MRSA – began to appear nearly a year ago. Forty cases had appeared by October. Most but not all of the infections have been in street people, intravenous-drug users or prisoners. Now Calgary physicians are seeing 15 to 30 cases a month, sparking fear that the superbug is poised to explode. "There are other pockets that are starting to surface in Canada now so in fact this could be the beginnings of what they've been seeing in the United States," Conly said.
Link: Texarkana Gazette.
Fry predicts Texarkana will see four times more MRSA infections this summer than it has the past couple of years. He's worried about the evolution of MRSA and other bacteria and people's ability to control them. "The future for all infections is they will continue to get stronger and stronger and they will continue to become more resistant to antibiotics," Fry said. "If a doctor tells you that you have a cold, don't beg for antibiotics. It won't help. We have to change the way we do things with more good hygiene, more soap, more water and healthier living habits."
Link: AMNews:.
Often misdiagnosed, CA-MRSA is spreading at an alarming rate, experts say. With outbreaks occurring from Hawaii to New England, public health officials are warning doctors about its prevalence. The University of Chicago has seen 25 times the number of cases it did in 1998. "State health departments and the CDC woke up to this rather slowly," Dr. Daum says. But health officials are now formulating what messages need to be conveyed to primary care doctors. "The implications for this are huge." Tales from across the country echo the problem that Dr. Daum describes. At the Texas Children's Hospital emergency department in Houston, for instance, cases doubled from 800 to 1,600 in just two years. CA-MRSA accounts for 95% of skin infections and abscesses at this facility. "Sixty percent of these kids get admitted. We've had several deaths, a number of kids on ventilators and right now we've got a child with four or five bones and joints involved," says Sheldon Kaplan, MD, TCH's chief of infectious disease. "This is not a simple skin infection and it's not just in Houston. It's in Corpus Christi, Dallas, Chicago, Atlanta, Los Angeles."
Link: NATA News Releases.
In an effort to educate the public about the potential risks of community-acquired methicillin-resistant staphylococcus infection (CA-MRSA), the National Athletic Trainers’ Association (NATA) has issued an official statement recommending all health care personnel and physically active adults and children take appropriate precautions if suspicious skin infections appear, and immediately contact their physician. NATA represents 30,000 members of the athletic training profession through public education and research. Certified athletic trainers (ATCs) are allied health care professionals who specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that occur to athletes and the physically active. They can be found in sports settings, performing arts, corporations, the military, schools, clinics and hospitals, physician offices, and other health care facilities. MRSA infections usually develop in hospitalized patients. However, MRSA rates have increased recently in persons outside of health care facilities, affecting athletes and the physically active. “Staph or MRSA infections develop from person-to-person contact, shared towels, soaps, improperly cleaned whirlpools and sports equipment,” says Ron Courson, ATC, PT, NREMT-I, CSCS, head athletic trainer at the University of Georgia in Athens, Ga. “Such infections usually appear first as pimples, pustules and boils. Some can be red, swollen, painful and/or have pus or other drainage. The pustules may be confused with insect bites in early states. The infections may also be associated with previous existing turf burns or abrasions. Without proper referral and care, more serious infections may cause pneumonia, bloodstream infections or surgical wound infections.” Courson believes maintaining good hygiene and avoiding contact with drainage from skin lesions are the best methods for preventing MRSA infections.
Link: HighWire Press -- Medline Abstract.
A neonatal intensive care unit outbreak was caused by a strain of methicillin-resistant Staphylococcus aureus previously found in the community (ST45-MRSA-IV). Fifteen infected neonates were identified, 2 of whom died. This outbreak illustrates how a rare community pathogen can rapidly spread through nosocomial transmission.
Link: HighWire Press -- Medline Abstract.
We report a community cluster of methicillin-resistant Staphylococcus aureus (MRSA) in Denmark with emphasis on routes of transmission and infection control measures. The objective is to extend knowledge of MRSA in a community setting where a nosocomial link could effectively be ruled out. DESIGN: Population-based observational study from November 1997 until June 2003. SETTING: North Jutland County, with approximately 495,000 inhabitants. SUBJECTS: The cluster encompassed 46 individuals and 26 households. INTERVENTIONS: Infection control measures included repeated visits to affected households by an infection control nurse who undertook screening for carriage among all household members and provided a program for decolonization. RESULTS: The causal strain was identical to a newly described international clone, ST80; SSCmec type IV; and Panton-Valentine leukocidin positive. Plausible routes of transmission included household contact and contact at work, kindergarten, and school. We did not detect a nosocomial source or any secondary cases in hospitals. Transmission by healthcare contact outside the hospital was plausible for three cases. We found evidence that the clone was introduced on more than one occasion to immigrant families from the Middle East. A 5-day decolonization program was successful at first attempt in 15 of 16 households that could be evaluated. CONCLUSIONS: Despite the described infection control measures, we continued to see new cases, underlining a need for a national policy to contain MRSA in the community
Link: HighWire Press -- Medline Abstract.
Recent reports of community-associated MRSA (CA-MRSA) infections in patients with no known risk factors have serious public health implications. Therapeutic options for these infections are untested; therefore, the potential exists for high morbidity and mortality. Recently, clinical definitions have been established, and new molecular approaches have allowed investigators to distinguish CA-MRSA more easily from traditional nosocomial-derived MRSA strains. Identifying potential risk factors for CA-MRSA acquisition and fully characterizing the epidemiologic, clinical, and molecular properties of these strains are necessary to provide effective therapeutic guidelines.
Link: HighWire Press -- Medline Abstract.
MA Siddiqui, PJ Richards, and EB Ahmed
Falling downstairs does not mean a fracture: the 1st case report of an immunocompetent community acquired MRSA disc/psoas abscess. Injury, April 1, 2005; 36(4): 569-72.
Department of Radiology, North Staffordshire Royal Infirmary, University Hospital of North Staffordshire, Princess Road, Stoke-on-Trent ST47LN, UK.
Link: 30,000 Scots ‘have new superbug’ - Sunday Times - Times Online.
UP TO 30,000 Scots are infected with a virulent new strain of the superbug MRSA that is resistant to antibiotics. Until now, MRSA infections have been confined to hospitals, where the bug, which requires a major wound to cause blood poisoning, strikes elderly and seriously ill patients. However, the new strain — CA-MRSA — thrives in the community, can attack through a graze or a small cut and poses the greatest risk to children. It produces a poison which neutralises the body’s natural defences and, in extreme cases, can kill by causing blood poisoning or pneumonia. While the rate of MRSA infections in hospitals has fallen, it is feared the decline may be mirrored by an increase in CA-MRSA, fuelled by the widespread use of antibiotics.
Link: Health Protection Agency
There has been recent media interest in community acquired MRSA (C-MRSA) but the Health Protection Agency are unaware of any link to gyms or healthclubs. Over the past three years, the Agency has identified approximately 100 cases of C-MRSA in the UK, and one patient has unfortunately died. These cases have been acquired within the community. So far, most of the UK cases identified have been seen in injecting drug users. Several other countries have encountered more serious problems with C-MRSA. Risk factors in these countries have included gay massage parlours and close-contact sports such as rugby or wrestling. In these situations, skin abrasions are common, so leaving the person more prone to contracting C-MRSA. Other risk groups in the US have included individuals who have stayed in jails and there have been infections described in children. In some countries these strains have also been seen in hospitals.
Link: Pediatrics.
Objective. More than 70% of the community-acquired (CA) staphylococcal infections treated at Texas Children's Hospital are caused by methicillin-resistant Staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods.
Methods. We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Results. Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had ≥2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died.
Conclusions. Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at Texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.
Link: The Register-Guard, Eugene, Oregon, USA.
Hard numbers are hard to come by because doctors aren't required to report the infections, known as methicillin-resistant Staphylococcus aureus, or MRSA. But public health officials, emergency doctors and infection control specialists say MRSA is on the rise. "At this point the only thing we can say is MRSA appears widespread in the community," said Nicole Coffin-Ott, spokeswoman for the Centers for Disease Control and Prevention in Atlanta. "It's an emerging disease." Local hospitals have seen sharp increases in the number of people coming into the emergency room with MRSA. At Sacred Heart Medical Center in Eugene, 104 cases of community-acquired MRSA were found from July 2003 to December 2003. From July 2004 to December 2004, there were 278 cases, said Susan Kline, infection control coordinator for PeaceHealth, Sacred Heart's parent corporation. At McKenzie-Willamette Medical Center in Springfield, infection control practitioner Cathy Stone has been tracking MRSA since 1997, when just four cases were detected. After a "major jump" in 2003, Stone counted nearly 200 cases of MRSA in 2004 at McKenzie-Willamette, most of them acquired in the community. So far this year, they've had 38 cases.
Link: Leisure Opportunities - Daily jobs, news,training and property..
Media reports regarding the superbug in UK health clubs and gyms are inaccurate and unfounded, the Fitness Industry Association (FIA) has claimed. The organisation’s announcement followed comments in the London Evening Standard and particularly in the Daily Telegraph, which reported that 100 cases of Community-Acquired MRSA (CA-MRSA) have been identified in Britain. “The fitness industry takes this issue very seriously,” said Andree Deane, communications director of the FIA. “However there have never been any reported cases of CA-MRSA in gyms and people should not be put off going for their work-out.” “FIA member gyms follow a Code of Practice with covers health and safety, staff training and customer care. The FIA is confident that its members take all necessary hygiene precautions to prevent the possibility of a CA-MRSA outbreak.”
Link: BBC NEWS | Health | Concerns over community superbug.
The 100 cases reported to the HPA were predominantly those who were infected with the strain, although some were simply people who carried CA-MRSA. Dr Donald Morrison, of the Scottish MRSA Reference Laboratory, told the BBC News Website: "These numbers are an indication of the prevalence of community-acquired MRSA. "But it's difficult to know how common it actually is because of the lack of a proper surveillance system." Liberal Democrat health spokesman Paul Burstow said: "These new findings must mean that community infections should now register on the government's radar."
Link: Telegraph
Worldwide, infections with MRSA are increasingly community-acquired and increasingly prevalent among young, otherwise healthy, adults. Initially MRSA – Methicillin-resistant Staphylococcus aureus – was a problem affecting hospitals and nursing homes, due primarily to lack of hygiene. It was concentrated among the elderly who have weaker immune systems. Last week, it emerged that deaths caused by MRSA in British hospitals have doubled in four years to almost 1,000 a year. But beginning in the early 1980s, cases of community-acquired MRSA were reported in the United States, primarily in people with a history of injecting drugs. Then, between December 2002 and June 2003, four cases of MRSA skin infections without previous hospitalisation were recorded in different areas of Germany. One was a child in an Arab family living in Germany, another was a child in a Greek family living in Germany. The third sufferer, a woman, had acquired her infection in Russia. The fourth, also a woman, divided her time between Egypt and Germany and had multiple skin abscesses.
Link: ThisisLondon.
A fresh warning over catching MRSA in gyms and health clubs is issued today. It comes after a woman died and at least 100 others were infected. The new variety of the superbug is called Community-Acquired MRSA (CA-MRSA). It has been found in changing rooms and similar communal areas and can cause skin infections. These show up as boils, abscesses and inflammations and can lead to a lethal type of pneumonia. Victims can become infected with CA-MRSA when the skin has been grazed. Experts said it was becoming a "significant threat outside healthcare settings" and is spreading. Initially, MRSA was a problem affecting hospitals and nursing homes and was concentrated mainly among the elderly who have weaker immune systems. But infections are increasingly community-acquired and prevalent among young, otherwise healthy, adults. The latest alert came after a 28-year-old woman who contracted CA-MRSA died from pneumonia. No other details of her case were available.
Link:Observer.
Highly virulent strains of the superbug MRSA which infect healthy young people with no connection to hospitals are appearing in the UK. The new varieties cause skin and soft tissue infections such as boils, abscesses and inflammation and, in rare cases so far only seen in other countries, a severe pneumonia that can kill in 24 hours. Since last April, dozens of Community-Acquired MRSA (CA-MRSA) cases have been identified by the Staphylococcus Reference Laboratory of the Health Protection Agency. Healthy children seem to be most susceptible to this infection, as opposed to older people with weak immune systems who more commonly succumb to the strains found in Britain's hospitals. Until now Britain had appeared untouched by CA-MRSA, which is distinct from the healthcare-associated strain.
Link: Medline.
This is a short item from a much longer article. Given the warnings in the UK about the rise of CA MRSA health proffesionals may want to access the entire article.
With regard to his experience in San Francisco, California, extensive epidemiologic studies indicated that CA-MRSA, predominantly clonal type ST-8, only accounted for about 10% of community-acquired S aureus infections in 1990 and now accounts for about 60%. With regard to therapy, the recommendation for soft-tissue abcesses was for incision and drainage without antibiotics for "mild" infections. For moderate infections, the recommendation for empirical treatment was beta-lactam if the risk of MRSA was low, and clindamycin, doxycycline-minocycline, or TMP-SMX if CA-MRSA was suspected. For severe soft-tissue infections that require hospitalization, the recommendation for empirical therapy was incision and drainage combined with vancomycin ceftriaxone or piperacillin-tazobactam. The spectrum of disease associated with CA-MRSA was limited to skin and soft-tissue infections (primarily furunculosis), necrotizing fasciitis, and pneumonia.
Link: Staph Cases an 'Emerging Epidemic'.
Authorities have not tracked the spread of the disease because doctors are not required to report cases. But recent studies suggest a rapid increase in the last year or two in infections treated at emergency rooms. At Olive View, Talan and his colleague Dr. Gregory Moran tracked infections last August. Two years ago, doctors treated just one or two cases in a typical month. But Talan and Moran tallied 28 cases in August — almost one a day. Those cases accounted for about half of all tested skin infections treated at the hospital. At the same time, Talan and Moran tallied skin infections at 10 other hospitals in cities including New York, Philadelphia and Atlanta, with similar results. About 60% of tested skin infections were caused by the new strain of staph. "We were totally flabbergasted," Talan said. "This is such a dramatic change, it's like a sea change." Outbreaks of the new strain have been reported in areas from Hawaii to Connecticut, prompting federal health officials to advise doctors to take swabs from patients to test for the bacterium. "We're hearing enough anecdotes for it to be safe to say that these skin infections are widespread in the community," said Nicole Coffin, a spokeswoman with the Centers for Disease Control and Prevention.
Link: HighWire Press -- Medline Abstract.
Acute hematogenous osteomyelitis is most common in children and has the potential to cause life-long musculoskeletal deformities. Most cases are caused by Staphylococcus aureus. Haemophilus influenzae type b (Hib) is now rare in countries that routinely use the Hib vaccine. Although magnetic resonance imaging is the preferred modality in localized disease, scintigraphy is often preferred as the first line of investigation because it helps to clarify the location of infection and exclude the presence of multifocal disease. Where the presentation is typical, there is no underlying disease, there is a low prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA), and there is a good response to antibacterial therapy, a diagnostic bone aspirate or biopsy is not necessary. The first-line antibacterial choice in most circumstances is a beta-lactamase-resistant penicillin. If CA-MRSA is suspected, the first-line options include clindamycin, the addition of an aminoglycoside or, rarely, vancomycin. In most patients, the total duration of therapy can be substantially shorter than the traditional 6 weeks, and oral therapy can be commenced after a brief course of intravenous antibacterials. We recommend 3 days of intravenous therapy followed by 3 weeks of high-dose oral antibacterials, provided there is no underlying illness, the presentation is typical and acute, and there has been a good response to treatment initially. Any deviation from this requires more intensive confirmation of the diagnosis (with imaging and/or biopsy or aspiration), and prolongation of intravenous therapy and total duration of treatment. Close monitoring and follow-up for at least 2 years are advised to detect complications.
Link: HighWire Press -- Medline Abstract.
There are increasing numbers of reports of community-acquired Staphylococcus aureus being resistant to methicillin. The present study was undertaken as no such reports are available for the developing nations. In a prospective study, between June to December 2001, at the Karnataka Institute of Medical Sciences, Hubli, Karnataka, India, methicillin-resistant S. aureus (MRSA) isolates were tested for clindamycin-susceptibility, a surrogate marker for community-acquired strains. Patients with clindamycin-susceptible isolates were interviewed to determine if they had acquired them in the community and also to identify any risk factors. Of the 116 patients with S. aureus infection, 18.1% had infection with methicillin-resistant strains. Clindamycin-susceptible MRSA accounted for 61.9% of cases. Among these, 46.1% patients were confirmed to have acquired the MRSA from the community, based on inclusion criteria. The community-acquired MRSA were susceptible to multiple antibiotics, as compared to nosocomial isolates. Except for one patient with diabetes mellitus, no other patient had any known risk factor for acquiring MRSA. As significant numbers of MRSA infections are being acquired from the community, treatment options for S. aureus infections may need to be reviewed. Effective infection control programs for the community should be considered to prevent the spread of these infections.
Link: HighWire Press -- Medline Abstract.
In contrast, 74% of the patients with SA had one or more surgical procedures performed to drain pus from involved joints. Conclusions: Staphylococcus aureus remains the most common organism causing AO and SA; however, community-acquired methicillin-resistant strains are now occurring. Haemophilus influenzae is no longer a common cause of SA. Our study supports the current Australian antibiotic guidelines that recommend flucloxacillin alone as the empiric treatment of choice of both AHO and SA in children fully immunised against Hib. However the possibility of community-acquired MRSA should be considered, particularly in high risk groups such as indigenous Australian children or children from regional areas with a high rate of community-acquired MRSA.
Link: HighWire Press -- Medline Abstract.
In Taiwan, MRSA was prevalent among pathogens of CA infections in children, and these CA isolates were multiresistant and genetically associated with HA isolates. In an area with a high prevalence of methicillin resistance, for children with putative S. aureus infection, even community-acquired, a glycopeptide-containing regimen should be considered for initial empirical therapy in the case of serious infection.
Link: HighWire Press -- Medline Abstract.
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging problem in pediatrics, with clinical and microbiologic characteristics that differentiate it from hospital-acquired MRSA (HA-MRSA). RECENT FINDINGS: Relative to HA-MRSA, CA-MRSA tends to cause localized disease (although serious illness occurs), is susceptible to more antibiotics, and has the same risk factors for acquisition/disease as methicillin-susceptible S. aureus (MSSA). At the gene level, CA-MRSA is more similar to MSSA than HA-MRSA: its emergence is apparently due to acquisition by an MSSA of the Staphylococcal Cassette Chromosome that bears mecA: the gene that encodes the methicillin-resistant penicillin binding protein. Carriage of recognized staphylococcal virulence factors, particularly Panton-Valentine leukocidin, is common in CA-MRSA, emphasizing its potential for causing serious illness. CA-MRSA is usually susceptible to clindamycin, trimethoprim-sulfamethoxazole, and rifampin, but inducible macrolide-lincosamide-streptogramin resistance in a subset of CA-MRSA could be problematic when clindamycin is used. SUMMARY: The appearance and spread of CA-MRSA represents a new challenge in pediatric medicine. A high level of clinical suspicion and development of rapid methods for its identification are needs for the future.
Link: CytoGenix .
Johns Hopkins AIDS Service reports, "The emergence of CA-MRSA infections is an additional threat to the growing global public health crisis of antimicrobial resistance. Efforts to control MRSA infections can no longer depend solely on surveillance, infection control efforts, and judicious antibiotic prescribing practices within the hospital setting. Proactive patient education, aggressive diagnostic efforts, and effective treatment for CA-MRSA infections by outpatient clinicians, will not only improve patient care, but also protect our communities and hospitals from an increasingly prevalent pathogen."
Link: Journal of Clinical Microbiology.
A total of 1,838 subjects from the community and 393 subjects from health care-related facilities in Taiwan were evaluated for the prevalence of nasal Staphylococcus aureus colonization and to identify risk factors associated with S. aureus and methicillin-resistant S. aureus (MRSA) colonization. In conclusion, a high prevalence of MRSA colonization was observed among people with no relationship to the hospital setting. The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics in Taiwan highlights the importance of the problem of antibiotic selective pressure. Our results indicate that both the clonal spread of MRSA and the transmission of hospital isolates contribute to the high MRSA burden in the community.
Link: HighWire Press -- Medline Abstract.
The aim of the present study was to investigate strains of methicillin-resistant Staphylococcus aureus (MRSA) for the presence of the lukS-lukF determinant of Panton-Valentine leukocidin and to further characterize strains found to contain the genes. During the past 2 years, MRSA containing the lukS-lukF genes for Panton-Valentine leukocidin, particularly those emerging outside of hospitals, have become of interest. MRSA strains sent to the national reference center in Germany were investigated for lukS-lukF by polymerase chain reaction (PCR).
Link: HighWire Press -- Medline Abstract.
Infections by community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) have been reported worldwide. Here we present characterisation of the first CA-MRSA isolated in Latvia. A PVL-positive ST30-MRSA-IV strain was isolated from a nasal swab and the central venous catheter of a patient with fever and multiple organ failure. The PFGE pattern of this strain was identical to pattern SE00-3 of MRSA isolated in Sweden from 29 patients during 2000-2003. This strain is related to the South Pacific area, and its appearance in Sweden and Latvia demonstrates its global spread.
Link: The growth of MRSA in Holland.
Analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolates in the Netherlands in 2003 revealed that 8% of the hospital isolates carried the loci for Panton-Valentine leukocidin (PVL). Molecular subtyping showed that most Dutch PVL-MRSA genotypes corresponded to well-documented global epidemic types. The most common PVL-MRSA genotypes were sequence type ST8, ST22, ST30, ST59 and ST80. MRSA with ST8 increased in the Netherlands from 1% in 2002 to 17% in 2003. It is emphasised that PVL-MRSA might not only emerge in the community, but also in the hospital environment.
Link: KWTX.
Patients with skin infections caused by methicillin-resistant Staphylococcus aureus, or MRSA are showing up in increasing numbers in Bell County clinics and hospitals, a Fort Hood doctor says. "In the past year, community-acquired MRSA has expanded in our region,” said Dr. Gary Holmes, chief of infectious diseases at Darnall Army Community Hospital. “At least two large hospital microbiology laboratories in Bell County, including the Darnall Army Community Hospital laboratory, are reporting between 60 and 75 percent of all Staph aureus isolates to be MRSA," Holmes said. "We alerted our providers last summer so we are able to recognize and treat patients quickly." Almost all patients with MRSA are coming in from the community, not from hospital-acquired infections as was most common five years ago,” he said.
Link: ABC News:
Up until recently, doctors hadn't seen MRSA in healthy young people outside the hospital, said Dr. Richard Daum of University of Chicago Hospitals. "MRSA is a denizen of the hospital," he said. "It lives here." But now, 65 percent of the staphylococcus infections coming into his emergency room in otherwise healthy kids are MRSA, he said. To him, that rate of growth is alarmingly fast — a cause for concern. MRSA is resistant to anywhere from 15 to 30 different antibiotics. That means when it's detected, a doctor has only a very small number of compounds at hand that are able to kill it. Daum said he has seen some patients with MRSA that are worse off for having seen a doctor that could not recognize it. The patients were treated with regular antibiotics — and that gave the germ more time to do damage in the body. "We've seen a lot of kids that come in here that needed intensive care and in fact have died that have started off by being out in the community, where they get an old treatment and then come in here having failed it," he said.
Link: HighWire Press -- Medline Abstract.
In conclusion, a high prevalence of MRSA colonization was observed among people with no relationship to the hospital setting. The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics in Taiwan highlights the importance of the problem of antibiotic selective pressure. Our results indicate that both the clonal spread of MRSA and the transmission of hospital isolates contribute to the high MRSA burden in the community.
Link: MercedSun-Star.com
LOS ANGELES (AP) - A highly contagious staph infection sweeping through county jails, infecting at least 4,000 inmates, is now spreading rapidly in the community and officials warn it's a growing threat to public health. "We've seen it in hospitals, among sports teams, and physicians report seeing it to an increasing degree in their practices," Dr. Jonathan E. Fielding, the county's public health officer, said Monday. "It's the same bug we've seen before, but it's a strain that is now resistant to the most commonly used antibiotics." The number of county jail inmates infected with the painful skin infection has gone from about 50 cases a month in 2002 to more than 200 a month. More than 4,000 jail cases have been identified since the outbreak began. Cases of methicillin-resistant staphylococcus aureus are also increasing in the state prison system. "It's a pretty common occurrence. What we've found is that a lot of inmates are coming from the county jails into the prisons with MRSA," said Margot Bach, spokeswoman for the California Department of Corrections.
Link: Medical News.
For their prospective case series, Dr. Frazee's group obtained cultures from the anterior nares and infection site of patients with necrotizing soft tissue infections, wound infections, ulcers, septic bursitis or abscess. Patients with cellulitis were also tested, although cultures from the infection sites were not obtained. Included were 137 consecutive patients presenting at their ED. Of 119 S. aureus isolates from infection sites and nares, 75% were MRSA, the authors report. Overall, MRSA was present in 51% of infection site cultures. Of the 85 MRSA isolates that underwent genotyping, 99% possessed the SCCmedIV allele, which the authors note is associated with community associated MRSA. Antibiotic susceptibility testing was performed on 89 MRSA isolates: 100% were susceptible to vancomycin and trimethoprim/sulfamethoxazole, 94% were susceptible to clindamycin, 86% to tetracycline and 57% to levofloxacin. Multivariate analysis revealed that the predictors most strongly associated with MRSA infection were furunculosis (odds ratio 28.6) and white race (odds ratio 3.8). Recent hospitalization, recent antibiotic use, and injection drug use were not significantly associated with the infection.
Link: ABC News.
Among patients treated at urban public hospital emergency rooms for skin and soft-tissue infections, more and more often the cause appears to be the antibiotic-resistant 'superbug' known as MRSA, new research shows. MRSA — methicillin resistant Staphylococcus aureus — is not killed by penicillin-type drugs, so these kinds of antibiotics can no longer be considered standard treatment for wounds and abscesses, Dr. Bradley W. Frazee and colleagues suggest in the Annals of Emergency Medicine. Frazee's team at Alameda County Medical Center in Oakland, California, obtained cultures from 137 patients who came to their emergency department with such infections. Staph aureus was identified in 119 infection sites, and the bacterium was the methicillin-resistant type in 75 percent of cases, the authors report. Overall, MRSA was present in 51 percent of infection site cultures.
Link: HighWire Press -- Medline Abstract.
This study compares in vitro antimicrobial resistance development between strains of Staphylococcus aureus including newly described community-acquired methicillin-resistant strains (CA-MRSA). High-level resistance developed in all strains of S. aureus after exposure to rifampicin and gentamicin and in some strains after fusidic acid exposure, independent of methicillin resistance phenotype. Resistance did not develop after exposure to clindamycin, cotrimoxazole, ciprofloxacin, linezolid, or vancomycin. These results have important implications for therapy of CA-MRSA infections.
Link: MedicalPost.com
This is a very important article - click the link above for the whole story
In particular, researchers in San Francisco have documented an "alarming" prevalence of community-acquired MRSA in hospitalized patients. Since 2000, there has been an "exploding prevalence" of MRSA, largely fuelled by the epidemic spread of a single clone (known as ST8:USA300) in the community."The early consequences of an escalating epidemic of community-acquired MRSA infections involved the spread of the epidemic clone into the hospital environment and the development of multidrug resistance," Diep said. The researchers found that result when they first screened laboratory reports from January 2000 to June 2004, and came up with more than 2,500 cases of MRSA. They then performed a detailed analysis of a random sample of 389 patient isolates. The sample was stratified according to hospital- or community-onset of infection, as defined by the time of each patient's first MRSA culture.During that period, community-acquired MRSA accounted for more than 81% of unique infections, and 42% of the community patients required hospitalization.
Link: Observer-Reporter.
High school principal Brian Jackson said each night, custodians sanitize the high school, which includes wiping down desks and doorknobs. Once a week, locker rooms are cleaned with an antibacterial spray, and hand sanitizers have also been stocked in locker rooms, bathrooms and computer labs. Richard McGarvey, state Department of Health spokesman, said staph infections, including MRSA, are fairly common. There's no way to track the number of outbreaks, because staph infections are not considered reportable in Pennsylvania, McGarvey said. In October, Mt. Lebanon High School confirmed cases of MRSA that had broken out within the district's athletic department.
Link: deseretnews.com | Drugs and bugs.
MRSA once originated primarily in hospitals and nursing homes, where antibiotics were commonly used. Now they're showing up in the community and sending people to hospitals, the infection already onboard. "What's happened beginning about four to five years ago is a change in some types of resistant organisms shifting from being primarily located in hospitalized patients to becoming more of a problem in communities. One that has done that successfully is MRSA," said Dr. Matthew Samore, associate professor in the Division of Clinical Epidemiology at the University of Utah. "This is also a ubiquitous organism that lives on skin, in the nose, all around us. It causes problems when it gets into the wrong place. What makes MRSA particularly challenging is that it is something that is resistant to almost all drugs." What was considered the "big gun" for MRSA — vancomycin — has in some cases been rendered worthless because some of the bacteria are now becoming resistant to it as well, said Dr. Patrick Luedtke, deputy state epidemiologist in the Utah Department of Health. So MRSA is becoming VRSA, which is even harder to treat.
Link: American Medical News.
Washington -- A new strain of methicillin-resistant Staphylococcus aureus has settled into some communities, and physicians everywhere are being warned to keep an eye out for it. While infection with MRSA is well-known in hospitals, the new strain of resistant bacteria is found among people without traditional risk factors. Dubbed community-associated MRSA, or CA-MRSA, by the Centers for Disease Control and Prevention, the bacteria differ genetically from the more familiar hospital-acquired MRSA, said researchers at the Interscience Conference on Antimicrobial Agents and Chemotherapy held Oct. 30 to Nov. 2 in Washington, D.C. CA-MRSA is infecting seemingly healthy people, often children, and causing primarily skin and soft-tissue lesions such as boils, abscesses and cellulitis, which are frequently misdiagnosed as spider bites.
Link: Turf Burns May Spread Dangerous Infection.
Of the 100 players studied, those with turf burns had an infection risk seven times higher than their scraped teammates. The team's 25 body-shaving players, who shaved at least one body area besides the face, were six times more likely to get MRSA infections. The players may not have noticed the cuts but they were an open door for MRSA. Cornerbacks and wide receivers, who frequently come into contact with other players, accounted for most cases. Improperly treated whirlpools could also have helped spread the bacteria. "Players who reported sharing the cold whirlpool in the training room with another athlete were two times as likely to have an MRSA infection," write the researchers. The researchers write that "because of the increasing reports of virulent community-acquired MRSA infection nationwide, athletes and coaching staff should note the special risks associated with athletes, and common sense prevention guidelines should be implemented."
Seguin Gazette-Enterprise
Nearly every day at least one patient comes to the Guadalupe Valley Hospital emergency room to have a sore or infected bite checked out. One day last week, Family Nurse Practitioner Karol Holman treated 10 cases. “I would say anyone who has a boil or abscess should go see their doctor,” Holman said. “We are seeing a lot more Methicillin-resistant staphylococcus aureus (MRSA), which is harder to treat.” The emergency room doctors test most staph infections to see if it’s MRSA and what antibiotics will be effective against it. Holman said since staph is so widespread and contagious, this is one time when sharing is not a good thing
Journal of Clinical Investigation
In Purcell’s study, 94% of the infections were localized to the skin. "We had a much smaller percentage of invasive infections and only 1 case of the necrotizing fasciitis," Purcell said. "Our greatest concern was that the skin infections were becoming more and more common. Furthermore, the community-acquired MRSA strains have more of an ability to cause these kinds of infections than the non-MRSA strains."
Purcell believes that the data from his and the other studies suggest a real need to think carefully about how antibiotics are used now as compared to a few years ago. CA-MRSA can be treated with several currently used antibiotics but is resistant to first-generation cephalosporins, which, not long ago, were the front-line antibiotics. Most doctors now generally use clindamyosin or rimethoprim-sulfamethoxazole first for these skin infections, and these are still suitable for MRSA. Purcell did note, however, that they are seeing that some CA-MRSA infections "have inducible clindamyosin resistance, so we need to determine what percentage of the MRSA have this inducible resistance. In our area [Corpus Christi], about 20% of the community-acquired MRSA are showing an inducible clindamyosin resistance. Usually, it doesn’t seem to matter for treating localized skin infections, but it is more important for treating the more invasive infections. There you want to use the most effective antibiotic first."
Purcell explained that because the epidemic had begun only in the last several years, clinicians may not yet have changed their treatment strategies. "I don’t know that everybody has changed their empiric antibody use because they haven’t needed to. But we are finding fewer and fewer communities now where most of the colonies are methicillin susceptible."
(There's alot more at the link above)
Sunderland Today
A HIT-SQUAD to prevent the spread of infections such as MRSA in the community has been set up on Wearside. A five-strong team will teach patients and NHS workers how to help keep infections out of their homes, doctors and dental surgeries, health centres, pharmacies, and opticians. It will also work with patients and staff to draw up tougher measures to combat healthcare-related infections.
People were being given a chance to have their say on the issue at public events in Houghton today and Sunderland tomorrow. The new team consists of dental practice manager, Cheryl Anderson, infection control nurse, Janet Farline, staff nurse, Doreen Hammond, patient representative, Nichola Summerville and clinical governance facilitator, Jill Hollis.
It has been set up by Sunderland Teaching Primary Care Trust (TPCT) as part of a national programme to tackle healthcare-related infections.
Janet said: "We are one of 10 teams across the country that is carrying out this work. Preventing healthcare-related infection is everyone's business.
Galveston County Daily News
LA MARQUE — Chris Greenwald, 25, was standing in his garage Tuesday afternoon with some others from the neighborhood. One by one they lifted their T-shirt sleeves or peeled back bandages. But it wasn’t to brag about sports injuries or macho scars. The young men were comparing jellybean-sized bumps on their bodies. Some — like Greenwald — had infections pushing up against the skin. The neighbors say they are suffering from or had suffered from a strain of staph infection their doctors identified as MRSA — or Methicillin-resistant Staphylococcus aureus.
WTOV9.com
Three cases of the skin disease MRSA have shown up this month alone. Columbiana County Health leaders tell NEWS 9 all three cases were people who had recently gotten tattoos, and they believe an unlicensed tattoo artist is responsible for the infections. A news release from the Columbiana County Health Department says the MRSA cases have been traced back to an unlicensed and apparently unsafe tattoo artist, using the same cloth to wipe blood away from the tattoo work areas on the patients' skin. The MRSA infections all showed up in the area of the tattoos.
Rocky Mountain News
"We've seen a dramatic increase in infections" the past year, Price said. Before 2000, outbreaks of methicillin-resistant staphylococcus aureus were limited mostly to hospital settings, she said. Now, in metro Denver, more than half of the cases are outside hospitals. The first half of this year, Denver Health has seen 76 MRSA cases in the community, versus just 10 the last half of 1999. In 1999, just 10 percent of the staph infections were resistant to methicillin, a common antibiotic, Price said. This year, 50 percent of the cases are.
TheDenverChannel.com
Some Denver Broncos and other NFL players are among the thousands of people who have been hit by what health experts call a new super bug. It's a bacterial infection dubbed 'Mersa.' That's an acronym for Methicillin Resistant Staphylococcus aureus. If you love a good workout, Mersa loves you. Until recently, Mersa, or MRSA, was pretty much confined to hospitals. "It will attack anyone," said Steve Antonopolus, the Denver Broncos trainer. "With the growth of this resistant organisim in the community, we'll see more and more of this -- not less and less," said Dr. Carolyn Tillquist, of Porter Hospital.
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(phillyBurbs.com)
About 20 students at the University of Maryland, Eastern Shore were found to have staph infections they caught at the school's gym earlier this month. Officials in Johnston and Caddo counties in Oklahoma reported about 40 cases in several cities, causing a high school football game to be canceled this month. And more than two dozen students were sickened in September at East Peoria High School in Illinois.
Officials at the schools in Ambridge and Mt. Lebanon said they are disinfecting locker areas, and now forbid players to share towels and equipment. Players are being told to clean their equipment at home each day.
Medscape
Below is the conclusion of a very detailed analysis of the impact of MRSA. The whole article is worth reading for those keen to understand the full extent of the current research
Compared with MSSA, MRSA is associated with worse outcomes, including longer hospital and ICU stays, longer durations of mechanical ventilation, and higher mortality rates. In addition, the cost of treating patients with bacteremia due to MRSA is higher. Inadequate antibiotic therapy is common, is associated with significant mortality, and perhaps explains why outcomes in MRSA infection are so poor. Emerging data suggest that therapy with vancomycin is less than optimal; treatment failure and mortality rates are substantial whether the cause of bacteremia is MRSA or MSSA. Because MRSA is far more common in healthcare-related or nosocomial bacteremia than in community-acquired bacteremia, empiric antibiotic therapy for patients with healthcare-related bacteremia should include coverage for MRSA.
HighWire -- Medline Abstract
In this prospective observational study, we evaluated 812 US Army soldiers to determine the prevalence of and risk factors for CA-MRSA colonization and the changes in colonization rate over time, as well as to determine the clinical significance of CA-MRSA colonization. Demographic data and swab samples from the nares for S. aureus Conclusions. CA-MRSA colonization with PVL-positive strains was associated with a significant risk of soft-tissue infection, suggesting that CA-MRSA may be more virulent than MSSA. Previous antibiotic use may play a role in CA-MRSA colonization.
MRSA colonization of nares, either present at admission to the hospital or acquired during hospitalization, increases the risk for MRSA infection. Identifying MRSA colonization at admission could target a high-risk population that may benefit from interventions to decrease the risk for subsequent MRSA infection
This short extract is from a longer study on those entering hospital with MRSA colonisation. Well worth a read - backs up the screening and iisolation strategy.
Medscape
"MRSA is emerging in the community as a cause of skin and soft-tissue disease, and during last year's influenza season we were seeing it emerge potentially as a cause of pneumonia," said Jeffrey C. Hageman, MHS, an epidemiologist with the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), in an interview with Medscape. "Right now I think individual risk is low: we have 17 cases in our series, 15 of those were methicillin-resistant Staphylococcus aureus. The surprising fact is that community-acquired pneumonias generally affect those older than 65 years old. The group that we have, the average age is 21 years old, and these are also people that lack underlying disease for the most part," Dr. Hageman said.
Dr. Hageman and colleagues looked at data on 17 patients with community-acquired pneumonia from nine states, of whom 15 (88%) were found to have MRSA infections. The investigators looked at clinical findings, medical history, laboratory data, and pneumonia outcomes. The median patient age was 20.6 years.
HighWire
Community-associated MRSA were more likely to be synergistically inhibited by combinations of vancomycin and gentamicin versus vancomycin alone compared to inhibition associated with hospital-acquired strains.
Scranton Times Tribune
At least one Mid Valley High School football player may have developed a case of a penicillin-resistant strain of a staph infection, according to Mid Valley Superintendent Robert Crotti. Staph infections, one of the most common skin infections in the United States and usually treated with penicillin, have cropped up in the Wilkes-Barre area and at the Throop high school over the past few weeks. At least six football players who played at Wilkes-Barre Memorial Stadium developed infections, and Dr. Crotti said at least eight players at Mid Valley had developed skin conditions similar to staph infections.
Reuters
This is a must read article. Below is only a short extract
What's particularly worrisome, one researcher told Reuters Health, is that these infections are being acquired in the community -- not the hospital, as has been the usual case until now. In Corpus Christi, Texas, the occurrence of community-acquired MRSA infections in children, which started occurring in the 1990s, "has now reached epidemic proportions," Dr. Kevin Purcell and colleagues warned..In 1999, there were 9 cases of community-acquired MRSA documented at Driscoll Children's Hospital. The number jumped to 36 in 2000, 105 in 2001, 278 in 2002, and 459 in 2003. Purcell told Reuters Health that among 1002 cases of MRSA skin infections seen in Corpus Christi children between 1990-2003, 93 percent occurred outside the hospital, and 98 percent of these children had no risk factors that would increase their likelihood of catching MRSA.
"Ninety-four percent of the community-acquired MRSA cases were localized infections of the skin and soft tissues, meaning that 6 percent were invasive and potentially life-threatening infections (e.g. sepsis, pneumonia, toxic shock syndrome)," he said. Nearly all of the MRSA infections were susceptible to other antibiotics
WTOV9.com
Methicillin Resistant Staphylococcus Aureus; it's known in the medical community as MRSA (mer-sa). It has health officials a bit concerned because the bacteria is usually seen in hospitals amongst ill patients. But now it's being reported in two West Virginia high schools. Surprisingly, 40% of humans have it on their skin in a dormant state. Marshall County's Health physician Dr. Kenneth Allen, told NEWS 9 that it's actually wide spread through out the community. "The skin can protect you from the bacteria if it's in tact. But if the skin is broken, you could get infected. " said Allen. And if the bacteria infects your blood or your organs, it could lead to death. So far a half a dozen football players in Mason and Roane counties were treated for infections. But to date, it has been reported in Marshall and Calhoun counties as well. High school athletes are at a slightly greater risk because of the environment in which they work.
Infectious Disease News
Community MRSA has a different genetic make up to MRSA. It is starting to leak into the hospital system. It may be more infectious than the hospital variety
A study conducted by the Minnesota Department of Public Heath found that 12% of MRSA cases were community-associated. The median age was much younger in the community group (23 years as opposed to 68 years) and 75% of the community isolates were from skin sources. In contrast, many cases of health care–associated MRSA were from respiratory sources (22%) or from urine (20%).Certain staphylococcal virulence factors and toxins were more likely found in CA-MRSA isolates than in health care-associated isolates including Panton-Valentine leukocidin and enterotoxins A, C, H and K.
“We are starting to see reports of hospital transmissions of CA-MRSA,” Lynfield said. In recent reports, several postpartum women developed skin and soft-tissue infections: five women had to be rehospitalized and three underwent drainage. “Pulsed-field gel electrophoresis [PFGE] showed that the isolate was indistinguishable to the CA-MRSA strain MW2,” Lynfield said.
Antimicrobial Agents and Chemotherapy
This study employs time-kill techniques to examine the most common drug combinations used in the therapy of methicillin-resistant Staphylococcus aureus (MRSA) infections, vancomycin plus either gentamicin or rifampin. Community-associated MRSA were more likely to be synergistically inhibited by combinations of vancomycin and gentamicin versus vancomycin alone compared to inhibition associated with hospital-acquired strains.
Arch Surg --
This research looks at the prevelance of MRSA amongst the homeless and injection drug users and concludes that MRSA, acquired in the community, is at epidemic levels in this group
Journal of Clinical Microbiology
Classical MRSA factors such as hospital visits or antibiotic use were not thought to be factors in the MRSA outbreak in a military camp. This extract hints at the causes but for those keen to know you will have to buy the entire article.
HighWire -- Medline Abstract
This Tiawanese study suggested that all the children treated had the same strain of MRSA. All of these studies beg the question as to what the health authorities are doing to help avert a situation where the majority of the population are colonised by MRSA
The Standard
Community MRSA case in Hong Kong - Full Story
At The Everett Clinic, 467 patients have tested positive for the super bug since the beginning of the year. The bug is called MRSA (Methicillin-Resistant Staphylococcus Aureas). It's a bacteria so strong, it doesn't need a cut or scrape to get inside your body. It can actually puncture your skin, causing what looks like an insect bite.
This feature examines the rise of community acquired MRSA in Seattle. A key debate within the MRSA discussion relates to the growth of MRSA outside hospitals and the rate of colonization in the population
HeraldNet: Tough bacteria worries doctors
Two years ago, about 1 in 8 clinic patients with an infection who were tested had MRSA bacteria that were resistant to antibiotics, he said. "Now it's nearly every other one." Part of the increase, he acknowledged, is because doctors are testing more for the bacterial infection. The Everett Clinic, with nine medical clinics and two outpatient surgery centers, has 270,000 patients. Positive test results are being found in patients at all the clinics. "I believe there truly is more of this than there was," he said. "It's not a city of Everett problem. It's a state of Washington, and now, a national problem."
Another overview of CA-MRSA in an American community
Lampasas Dispatch Record
In the past, MRSA was associated almost exclusively with hospital and nursing-home patients. In recent years, however, an increasing number of reports of MRSA in communities -- including Lampasas -- have emerged. Jennifer Rodges, family nurse/practitioner with Family Medicine Rural Health Clinic, said an average of six patients per month have been diagnosed with MRSA thus far this year.
Staphylococcus aureus is a common bacteria found on the skin, said Mrs. Rodges. "Everyone has bacteria on their skin; it just doesn't always cause infection." When skin is cut or scraped, she said, the bacteria can enter the body and cause a skin infection. "The problem is when the bacteria are resistant to antibiotics, as is the case with MRSA," she explained.
Part of a longer article with some helpful advice. Click link above
HighWire -- Medline Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is emerging as a cause of skin and soft-tissue infections in persons who have little or no contact with health-care settings. The majority of these infections are mild, involving skin and soft tissue; however, certain cases can progress to invasive tissue infections, bacteremia, and death. Transmission of MRSA has been reported most frequently in certain populations (e.g., children, sports participants, or jail inmates). Persons in the American Indian or Alaska Native population in the United States and aboriginals and Pacific Islanders (PIs) in Australia have high rates of MRSA colonization and infection. In 2003, clinicians reported an increased number of skin abscesses caused by MRSA among patients examined in ambulatory care settings. ...........
Euro Surveillance
Analysis of community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) from Germany producing the Panton-Valentine leukocidin revealed a unique SmaI-macrorestriction pattern, different from epidemic nosocomial strains. This molecular pattern corresponds to those shown in c-MRSA strains from other countries in the European Union. All isolates exhibited resistance to fusidic acid, which is coded by the far-1 gene. From data on geographical dissemination and time of occurrence, this strain appears to have emerged in Germany in the second half of 2002, and so an already wider dissemination is likely. The emergence of MRSA with resistance to fusidic acid is a first sign of the emergence of a PVL-positive MRSA clone.
STUFF
Virulent new strains of the MRSA superbug have scientists worried it may soon burst through hospital doors and spread into the community. A new strain that spreads by skin contact is infecting thousands of people across the globe. The bug has been in New Zealand communities for several years, but scientists say overseas trends suggest it may be becoming more dangerous
J. Antimicrob. Chemother
There is increasing concern about the growing resistance of pathogenic bacteria in the environment, and their ecotoxic effects. Increasingly, antibiotic resistance is seen as an ecological problem. This includes both the ecology of resistance genes and that of the resistant bacteria themselves
people.co.uk
Top MRSA expert Dr Chris Malyszewicz warned: "I am not surprised the bug is on the Government's own doorstep. "Ministers are not doing enough. Unless they really sit up and take notice we could end up with an epidemic on the scale of a medieval plague. "People's lives are at stake here. There is a chance it could be endemic and unstoppable."A People investigation revealed in May how MRSA is rampant in Britain's hospitals. But our new survey shows it has spread to High Street food chains used by millions of families every day despite their intensive cleaning programmes.
Journal of Urban Health
Although antibiotics in the United States are to be prescribed by a health care provider, the extent to which they are obtained by other means is not known. The purpose of this article is to describe a survey of the availability of nonprescription antibiotics in neighborhood independent businesses in several Manhattan, New York, neighborhoods. A survey was conducted of 101 stores in three neighborhoods—one primarily Hispanic; one primarily black, non-Hispanic; and one primarily white, non-Hispanic.
11th Annual International Symposium on Staphylococci & Staphylococcal Infections
CHARLESTON, S.C., July 19 /PRNewswire/ -- The 11th Annual International Symposium on Staphylococci and Staphylococcal Infections (ISSSI) will be held at the North Charleston Convention Center in Charleston, South Carolina on October 24-27, 2004, uniting the world's most respected scientists and clinicians as they share research findings, new treatments, and strategies to combat what is becoming a worldwide public health crisis.
Medscape
The community strains also appear to be highly transmissible. "There is something about the community strain of MRSA that, when given the right circumstances and group characteristics, makes for very efficient transmission of the bacteria," Dr. Jernigan said.
Straits Times
A drug-resistant 'superbug' found in hospitals has a close cousin that is infecting thousands across the United States and Britain, disease experts said. Methicillin-resistant Staphylococcus Aureus or MRSA can become fatal if not treated with the right antibiotics, said Dr Daniel Jernigan of the US Centres for Disease Control and Prevention (CDC). 'MRSA is showing up in places it had never been seen before'
CDC
This is an excellent FAQ by the leading USA disease agency. Another must read
Medscape
Doctors may be missing MRSA in children because they are looking for a hospital link to the infection to recognise it as MRSA rather than simple 'staph'. The subsquent delay in effective treatment could be a problem for many. This article also hints as do others that many infections could be best treated without drugs if caught early.
Medscape
MRSA in the military was only contained by a new hygiene routine. This article highlights the risk to all involved in physically traumatic environments and living in close proximity
NY Times
This is a tough peice of journalism which suggests that your GP or MD may not be up to speed with respect to community acquirred MRSA (CAMRSA) and that deaths may result. Well researched and in depth article. It also asks queations about the possibility that CAMRSA may be more prevelant than we know because it is not a 'reportable' disease.
Bartlett Infectious Diseases Review: June 15, 2004
This is a technical article that comments on both VRSA and Community MRSA. The genetic make up of this strain is different from the common hospital version but the role of antibiotics is clear. Worth reading slowly
Firemen worried about MRSA
With up to 30% of the population colonised by MRSA but showing no symptoms fear spreads about how it might be caught in the community
Non Hospital MRSA rises in New York
This reflects a study conducted throughout New York. The possibility of simple contagious MRSA not related to injury is a worrying one
Do we really know how bad it is?
This Australian feature suggests that the data we have may be underestimating the extent of the problem. The growth of MRSA caught outside the hospital is also a growing story in it's own right
End looms for antibiotics era
This is a must read. It looks at how Roche have stopped research into antibiotics and refers to the rise of community acquired MRSA
