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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.”