MRSA, Mersa, Staph, Staff Infection, Treatment & Symptoms

CA MRSA infection hitting a different generation

Knowing symptoms of MRSA infection can be key in treating superbug - St. Petersburg Times.

The Centers for Disease Control and Prevention estimates that 14 percent of people with MRSA have the community-associated strain. Many are young. A Minnesota study found that the average age of a CA-MRSA patient is 23, compared to 68 for other MRSA patients. Starting in the late 1990s, most cases of CA-MRSA were linked to places like gyms and schools where people are in close proximity and might share exercise equipment, bathroom and shower facilities, razors, towels, uniforms and other clothing. Athletes in high-contact sports such as football and wrestling were found to be at particular risk, but so were people who failed to wipe down shared surfaces in gyms like weight benches, bike seats and padded mats for floor exercises. The bacteria can survive on damp towels and surfaces for days or weeks. More troubling, CA-MRSA seems to have invaded hospitals. A study in the December issue of Emerging Infectious Diseases suggests health care workers, who often move between outpatient clinics and in-patient hospital rooms, may be dragging the bacteria with them and infecting hospitalized patients.

Report Finds Community MRSA causing more than skin infections

Report Finds Invasive MRSA Infections on the Rise in Iowa - Increase of community-associated infections, particularly USA300, seen as unique public threat - Modern Medicine.

The researchers found that from 1999 to 2005 through 2006, the proportion of MRSA isolates from invasive infections that were either USA300 or USA400 isolates increased significantly, and that these isolates were resistant to at least three non-β-lactam antimicrobial drug classes. They also found that in 2006, community-associated MRSA infections were more likely to occur during the summer, and that residents younger than age 69 years were at increased risk (odds ratio, 5.1). "Our study demonstrated that community-associated MRSA no longer causes only skin and soft tissue infections but now causes an increased proportion of invasive infections in a rural state," the authors conclude. "This finding is particularly disconcerting in light of the severity of these infections and the reports of necrotizing pneumonia caused by USA300 after influenza or influenza-like illness. Surveillance systems must continue to monitor the number and incidence of infections caused by USA300 and to monitor these isolates for changes in antimicrobial susceptibility. The relationship between seasons and community-associated MRSA warrants further study."

65% of MRSA caught in Community?

Hospital superbug in deadly spread.

THE killer ''golden staph'' superbug is a growing problem not only in Australian hospitals but in the community at large, new research has found.

For the first time, experts have tracked data across the country of infections with Staphylococcus aureus, in both the form that can be treated with penicillin, and the more dangerous antibiotic-resistant form known as MRSA.

The results showed that almost two-thirds of the 1994 infections from June 2007 to May 2008 were picked up in the community. One in 10 of those infected died within a week, and one in five within a month.

MRSA Staph Infections Grow in Metro

MyFox Kansas City | MRSA Staph Infections Grow in Metro.

That little spot turned into a mass of infection on the thigh, and then on his shin. The diagnosis was MRSA, a staph bacteria that's resistant to certain antibiotics that used to stop it. Although MRSA isn't getting a much attention as it did last fell, the number of people in the community who are becoming infected with MRSA has continued to steadily grow, according to Dr. Joel McKinsey. McKinsey is a specialist at Research Medical Center. He said cases are being diagnosed and treated sooner. But, there's also concern the enemy is getting more evasive and more resistant. "We have to be mindful of the fact that even antibiotics that we're used to treating MRSA with may become ineffecive over time," said Dr. McKinsey. There is some good news. New antibiotics are being tested to fight MRSA in both kids and adults. Current antibiotics worked for Brandon, but it wasn't easy. He was in the hospital for two days. Then, he needed an IV drip at home. He missed a month of work. And, he got married. But, he and his bride had to cancel their Caribbean honeymoon. He and Dr. McKinsey encourage others to keep an eye on cuts, nicks, or what you may think is just an ingrown hair. If it worsens, get medical help. "It might just save your life or save a limb," said Foster. He feels fortunate he only has scars from MRSA. Good handwashing is key to preventing MRSA. Also, don't share towels and other personal items. And, Dr. McKinsey says avoid using antibiotics when you have viral infections. That may help prevent more resistance.

Common staph germs getting stronger, more widespread

Common staph germs getting stronger, more widespread | ajc.com.

Now, the germs causing outbreaks in schools, on sports teams and in other social situations are posing a growing threat. A CDC study found that at least 10 percent of cases involving the most common community strain were able to evade the antibiotics typically used to treat them. “They’re becoming more resistant and they’re coming into the hospitals,” where they swap gene components with other bacteria and grow even more dangerous, said Dr. Keith Klugman, an infectious disease expert at Emory University. “It’s really a major epidemic.” The germ is methicillin-resistant Staphylococcus aureus, or MRSA. People can carry it on their skin or in their noses with no symptoms and still infect others - the reason many hospitals isolate and test new patients to see if they harbor the bug. MRSA mostly causes skin infections. Cleveland Browns tight end Kellen Winslow was just hospitalized for a staph infection, his second in recent years, and the team reportedly has had at least six cases in the past three years.

1 in 5 CA MRSA cases need hospital care

APUA: What is CA-MRSA.

Today, in the U.S. a little more than 10% of all MRSA infections are CA-MRSA. This form causes serious skin and soft tissue infections in otherwise healthy persons who have not been recently hospitalized or undergone invasive medical procedures. Hospitalization is required in approximately one out of five cases. CA-MRSA has been identified most frequently among specific populations, including prisoners, athletes, children, men who have sex with men, military recruits, Pacific Islanders, Alaskan Natives and Native Americans. A major difference between the two types of MRSA is that the community form (CA-MRSA) possesses a potent toxin called Panton-Valentine leukocidin, which attacks infection-fighting white blood cells called leukocytes. The most serious form of CA-MRSA infection causes necrotizing fasciitis, a severe, rapidly progressing and life-threatening skin infection. The CA-MRSA are genetically distinguishable from hospital associated MRSA. In the US, two clones (strains) of staph, called USA300 and USA400, are associated with the community MRSA (CA-MRSA). USA300 has emerged as the most prominent clone and is not found among hospital strains. It was not observed before the year 2000, when multiple other clones existed.

Kuwait has 2 CA MRSA Strains

Link: Genetic Lineages of Community-Associated Methicillin-Resistant Staphylococcus aureus in Kuwait Hospitals -- Udo et al. 46 (10): 3514 -- Journal of Clinical Microbiology.

Twenty-six community-associated methicillin-resistant Staphylococcus aureus (CAMSRA) isolates were characterized by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and screened for accessory gene regulator (agr), capsular polysaccharide (cap), and Panton-Valentine leucocidin (PVL) genes. They exhibited five PFGE patterns (types A to E). The majority were PFGE type A (12 isolates) or type B (8 isolates). MLST showed that PFGE type A isolates belonged to sequence type 80 (ST80), while the PFGE type B isolates were ST30. The ST80 and ST30 clones contained agr allotype 3, cap type 8, and PVL. The results showed that two internationally recognized CAMRSA clones are dominant in Kuwait hospitals.

Prisoners experience Chronic MRSA

Link: Predominance of Methicillin-Resistant Staphylococcus aureus among Pathogens Causing Skin and Soft Tissue Infections in a Large Urban Jail: Risk Factors and Recurrence Rates -- David et al. 46 (10): 3222 -- Journal of Clinical Microbiology.

In the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains emerged as pathogens outside of the health care environment. Epidemic foci of CA-MRSA infections were reported in jails and prisons, but risk factors for MRSA infection there are not known. All skin and soft tissue infections (SSTIs) cultured in the Cook County Jail in March 2004 to August 2005 were reviewed. Demographic and clinical risk factors were compared among patients with methicillin-susceptible S. aureus (MSSA) SSTIs and those with MRSA SSTIs. Antibiotic susceptibilities were recorded, and we performed multilocus sequence typing on a sample of MRSA isolates. There were 378 SSTIs from different patients requiring culture, of which 240 (63.5%) were of MRSA and 43 (11.4%) were of MSSA; 84.8% of S. aureus isolates were MRSA. MRSA- and MSSA-infected patients were similar with regard to age, gender, ethnicity, previous exposure to the jail, and comorbidities. In the 12 months prior to the index culture, MRSA patients were more likely to have received a β-lactam antibiotic (25% versus 9%; P = 0.02). Among 26 MRSA strains, 24 (92%) had the sequence type 8 (ST8) genotype. Within 6 months, 14% (95% confidence interval, 8.7% to 22.3%) of MRSA SSTI patients in the jail had a recurrent SSTI compared with 8.8% (95% confidence interval, 2.1% to 32.6%) of MSSA SSTI patients (P = 0.004). MRSA is the predominant cause of SSTIs requiring culture in the jail. Few risk factors differentiated MRSA from MSSA SSTIs, and detainee patients with MRSA SSTIs are at high risk for recurrent SSTIs.

CA MRSA in Greece

Link: Eurosurveillance - View Article.

A total of 959 individuals (874 males) aged 18 to 60 years (mean age 33) were enrolled in the study. Nine of the 959 participants (0.94%, 95% confidence interval [CI] 0.33% to 1.55%) were colonised with MRSA. All MRSA carriers were males. Two of the colonised individuals were smokers. One of the MRSA carriers reported systematic use of inhaled corticosteroids during the two months preceding enrolment. Another carrier had been treated with antibiotics two months prior to sampling. Three of the colonised individuals had been admitted to different hospitals at least once in the year before enrolment in the study. Two of them had been hospitalised in medical wards while the third one had been admitted to a surgical ward. In two MRSA carriers none of the investigated risk factors was identified. Among the demographic and clinical variables, prior hospitalisation and use of inhaled corticosteroids appeared to be correlated with an increased risk for MRSA colonisation (P<0.01) (Table 1).

Japanese concern over CA MRSA

Link: Molecular epidemiology and antimicrobial susceptibilities of 273 exfoliative toxin-encoding-gene-positive Staphylococcus aureus isolates from patients with impetigo in Japan -- Nakaminami et al. 57 (10): 1251 -- Journal of Medical Microbiology.

The molecular epidemiology and antimicrobial susceptibilities of 273 Staphylococcus aureus isolates positive for the exfoliative toxin-encoding gene obtained from patients with impetigo in Japan in 2006 were studied. The mecA gene was detected in 74 meticillin-resistant S. aureus (MRSA) and 23 meticillin-susceptible S. aureus (MSSA) isolates. All isolates with the staphylococcal cassette chromosome (SCC) mec were classified into type IV (92.8 %, 90/97) or V (7.2 %, 7/97). The ET-encoding gene etb was found primarily in strains with mecA (87.7 %, 71/81), whilst eta (86.6 %, 161/186) was detected mainly in strains without mecA. The chromosomal enterotoxin-encoding gene cluster egc was found in 83.0 % of strains with eta, whilst no enterotoxin-encoding gene was detected in strains with only etb. PFGE showed that each strain carrying eta, etb and etd could be classified into distinct groups. The susceptibility profiles of MRSA to antimicrobial agents excluding β-lactams were similar to those of MSSA. Gentamicin- and clarithromycin-resistant strains were frequently found for both MRSA and MSSA. The aminoglycoside-resistance gene aacA–aphD was detected in 97.3 % of MRSA and 85.4 % of MSSA. Additionally, the macrolide-resistance gene ermA or ermC was detected in 67.6 % of MRSA and 71.4 % of MSSA. Therefore, these results suggest that SCCmec types IV or V have spread, particularly in MSSA carrying etb in the community.

Not enough lab techs to keep track of CA MRSA

Link: BBC NEWS | Health | Fears voiced over new superbugs.

A leading microbiologist says he fears a major outbreak of new strains of community superbugs unless public monitoring is given more resources. Professor Hugh Pennington told the BBC the Health Protection Agency lacked the staff for the greater surveillance of such virulent and mutating bacteria. "If we do neglect these bugs, we neglect them at our peril," he said. The government's leading infection adviser said he was assured its monitors could cope with the workload. Concerns are growing among microbiologists about PVL (Panton-Valentine leukocidin), produced by some bacteria from the family Staphylococcus and which destroys white blood cells.

burns patients hard hit by MRSA

Link: HighWire Press -- Medline Abstract.

Community-associated methicillin-resistant Staphylococcus aureus (MRSA), particularly USA300, is a major pathogen in the outpatient setting. We suspected that USA300 had been introduced into our burn-trauma unit (BTU) when three burn patients presented with numerous simultaneous abscesses. We did molecular typing on 206 MRSA isolates from all patients on the BTU who had MRSA isolated from either nares cultures or clinical specimens obtained between April 11, 2002 and October 24, 2006. We reviewed medical records for all patients who had USA300 and for 75 control patients. Twenty-five of 206 (12.1%) patients who were colonized (n = 3) or infected (n = 22) with MRSA had USA300. Thirteen patients had abscesses drained surgically and eight had necrotizing fasciitis excised. Seven patients had burns (mean burn size 11.8 +/- 3.4%), of who four (66.7%) acquired numerous simultaneous (3-33) abscesses. Fourteen patients acquired USA300 outside of the BTU, and three acquired this strain on the BTU. Cases were more likely to have been hospitalized or to have had an operation in the 6 months before they were hospitalized than were controls (P = .001 for both). To our knowledge, this is the first study to describe numerous simultaneous MRSA abscesses in burn patients. The MRSA strain USA300 may be introduced onto burn units from the community by patients admitted with skin and soft tissue infections, especially abscesses and necrotizing fasciitis. Burn patients may be at risk for numerous abscesses with USA300, because they have open wounds and their immune systems may be compromised.

CA MRSA to0 become the dominant infection?

Link: HighWire Press -- Medline Abstract.

Community-associated MRSA (CA-MRSA) strains have emerged in Uruguay. We reviewed Staphylococcus aureus isolates from a large healthcare facility in Montevideo (center A) and obtained information from 3 additional hospitals on patients infected with CA-MRSA. An infection was defined as healthcare-onset if the culture was obtained >48 hours after hospital admission. At center A, the proportion of S. aureus infections caused by CA-MRSA increased from 4% to 23% over 2 years; the proportion caused by healthcare-associated MRSA (HA-MRSA) decreased from 25% to 5%. Of 182 patients infected with CA-MRSA, 38 (21%) had healthcare-onset infections. Pulsed-field gel electrophoresis determined that 22 (92%) of 24 isolates were USA1100, a community strain. CA-MRSA has emerged in Uruguay and appears to have replaced HA-MRSA strains at 1 healthcare facility. In addition, CA-MRSA appears to cause healthcare-onset infections, a finding that emphasizes the need for infection control measures to prevent transmission within healthcare settings.

Treating CA MRSA

Link: HighWire Press -- Medline Abstract.

With the significant increase in the incidents of community-acquired methicillin-resistant S. aureus (CA-MRSA), it's important for ED managers to be conversant not only in hospital-acquired MRSA, but also this less lethal version. Here are some recommendations: The appropriate treatment for an abscess, the most common manifestation of CA-MRSA, is surgery. If an antibiotic is deemed necessary, the most effective against CA-MRSA is trimethoprim/ sulfamethoxazole. You may wish to culture all abscesses to determine the precise nature of the bacterium.

Possible MRSA Outbreak Probed At Water Park Under Construction

Link: MyFox Philadelphia | Possible MRSA Outbreak Probed At Water Park Under Construction.

The New Jersey Department of Health confirmed Wednesday that it's investigating a possible MRSA outbreak at a construction site in Mount Laurel. Workers claim at least five of them have been infected. They're working at an indoor water park on Route 73. A regional epidemiologist was at the site Wednesday to conduct some tests. The results haven't come back.

Antibiotic-resistant infections challenge Beaufort Memorial Hospital

Link: The Beaufort Gazette: Antibiotic-resistant infections challenge Beaufort Memorial Hospital.

"It seems to mostly be healthy, young people (who come in already infected). It's really throughout the county," said Bev Yoder, the hospital's infection control nurse. "We saw an increase about three to four months ago where it really seemed to be more than we expected to see." In 2007, there were about two or three cases per month. This year, it's up to three or four per month, primarily methicillin-resistant Staphylococcus aureus, or MRSA; vanocomycin-resistant Enterococci, or VRE; and Clostridium difficile. MRSA may show up as a boil that looks similar to a spider bite while the other infections often manifest as severe, debilitating diarrhea. The increase of incoming patients with bacterial infections might come from closer monitoring. In March, the hospital began using nasal swabs to test patients for infections who were admitted to the intensive care unit or were coming from a place other than home. Beaufort Memorial also can act much more quickly to treat the infections, thanks to a new $60,000 machine that can identify the bacterial infections almost immediately, compared to waiting a couple of days for cultures to ferment.

400% increase in MRSA among Children of Urban Poor

Link: UCSF Study Shows Sharp National Rise in Skin Infections, MRSA Suspected.

During that time period, office and emergency room visits for all skin infections rose from 8.6 million nationwide to 14.2 million, according to Adam Hersh, MD, PhD, lead author on the paper and a fellow in the divisions of general pediatrics and of pediatric infectious diseases at UCSF. The vast majority of that increase was attributable to visits for abscesses or cellulitis, which Hersh called the hallmark signs of infections from the variety of staph bacteria known as MRSA, or methicillin-resistant Staphylococcus aureus. Those infections rose from 4.6 million to 9.6 million during the study period. “This shows that community-acquired MRSA infections are occurring nationwide and affect all subsets of the population,” Hersh said. “But there clearly are some subsets that are disproportionately affected, such as children.“ The increase was predominantly seen among children and among patients who visit emergency rooms in urban areas at so-called safety net hospitals. Those are hospitals in which at least half of the patients receive Medicaid or are uninsured. From 1997 to 2005, the number of visits for abscesses or cellulitis nearly quadrupled in safety-net emergency departments, from 1.3 people per 1,000 total population to 4.9. Among children, the incidence nearly tripled from 10.1 patients per 1,000 children to 27.6. By contrast, incident rates among patients older than 45 rose less than 50 percent, from 27.9 to 41.3 patients per 1,000 adults in that age group.

CA MRSA still more treatable

Link: Associations between the Genotype of Staphylococcus aureus Bloodstream Isolates and the Clinical Characteristics and Outcomes of Bacteremic Patients -- Lalani et al., 10.1128/JCM.00905-08 -- Journal of Clinical Microbiology.

We investigated associations between the genotypic and phenotypic features of S. aureus bloodstream isolates and clinical characteristics of bacteremic patients enrolled in a Phase III trial of S. aureus bacteremia and endocarditis. Isolates underwent pulsed field gel electrophoresis, PCR for 33 putative virulence genes and screening for heteroresistant glycopeptide intermediate S. aureus (hGISA). Two hundred and thirty isolates (141 methicillin-susceptible S. aureus [MSSA], and 89 methicillin-resistant S. aureus [MRSA]) were analyzed. North American and European S. aureus isolates differed in their genotypic characteristics. Overall, 26% of the MRSA bloodstream isolates were USA 300. Patients with USA 300 MRSA bacteremia were more likely to be injection drug users (61% vs. 15%; p <0.001), to have right-sided endocarditis (39% vs. 9%; p=0.002), and to be cured of right-sided endocarditis (100% vs. 33%; p=0.01) than patients with non-USA 300 MRSA bacteremia. Patients with persistent bacteremia were less likely to be infected with Panton-Valentine leukocidin (pvl)-constitutive MRSA (19% vs. 56%; p=0.005). Although 7/89 MRSA isolates (8%) exhibited the hGISA phenotype, no association with persistent bacteremia, daptomycin resistance, or bacterial genotype was observed. This study suggests that the virulence gene profiles of S. aureus bloodstream isolates from North America and Europe differ significantly. In this study of bloodstream isolates collected as part of a multinational randomized clinical trial, USA 300 and pvl-constitutive MRSA were associated with better clinical outcomes.

CA MRSA Replacing HA MRSA as Threat to Cystic Fibrosis Children

Link: Complex Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolates From Children With Cystic Fibrosis in the Era of Epidemic Community-Associated Methicillin-Resistant S aureus -- Glikman et al. 133 (6): 1381 -- Chest.

Results: A total of 22 of 34 MRSA isolates (64.7%) from patients with CF belonged to clonal complex (CC) 5 and contained SCCmec II, so-called health-care associated MRSA (HA-MRSA) strains. Nine of 34 MRSA strains (26.5%) were CC 8, and contained SCCmec IV, so-called community-associated MRSA (CA-MRSA) strains. The CA-MRSA strains tended to be isolated from newly colonized CF patients. In contrast, CC8 isolates predominated among the non-CF patients (294 of 331 patients; 88.8%). MRSA isolates from children with CF were more likely to be resistant to clindamycin (65% vs 19%, respectively) and ciprofloxacin (62% vs 17%, respectively) compared with strains from non-CF patients (p < 0.001). There was no difference in the rate of pvl+ isolate recovery from children with CF undergoing a surveillance culture (7 of 23 children) compared with those with pulmonary exacerbation (3 of 11 children; p = 1.0). Conclusions: Both CA-MRSA (CC8) isolates and HA-MRSA (CC5) isolates populate the respiratory tracts of children with CF. HA-MRSA isolates predominated, but CA-MRSA strains predominated among CF patients with newly acquired MRSA strains and among the non-CF patients. The presence of CA-MRSA strains in children with CF was not associated with exacerbation or necrotizing pneumonia.

CA MRSA growing in London

Link: HighWire Press -- Medline Abstract.

We used ciprofloxacin susceptibility as a phenotypic marker of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a London hospital collection of MRSA isolates from inpatients, outpatients and primary-care clinics during 2000-2006. Four-hundred and fifty-eight ciprofloxacin-susceptible (Cip-S) MRSA isolates were reported; antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) type, spa type and the presence of Panton-Valentine leukocidin (PVL) genes were determined for all 194 surviving Cip-S MRSA isolates. Multilocus sequence typing and pulsed-field gel electrophoresis were performed on representative isolates. Clinical and epidemiological features of Cip-S MRSA infections were consistent with CA-MRSA, the incidence of which increased markedly during the study period from 49 in 2000 to 102 in 2006. Most (82.0%) of the surviving Cip-S MRSA isolates were SCCmec IV and 25.3% were PVL-positive. Considerable clonal heterogeneity was noted among the recovered isolates, including the t044/ST80-IV European clone and the PVL-negative t127/ST1-IV clone; PVL-positive t008/ST8-IV (USA300) isolates were rare. Ciprofloxacin susceptibility is a useful screening marker of CA-MRSA strains in London, which are more frequent than previously thought and whose incidence is increasing.