MRSA Infection

The end of post-op prophylactic antibiotics?

Controversies in Hospital Infection Prevention: The end of post-op prophylactic antibiotics?.

One of the best approaches we have for dealing with in-hospital antimicrobial resistance is stewardship - using antibiotics only when the patient is most likely to benefit. It's been known for a long time that there is little benefit in extending prophylactic antibiotics beyond the end of surgery, yet this practice still persists. Imamura et al. just published an RCT in Lancet ID that examined the possible benefits of extending prophylaxis in patients with gastric cancer undergoing distal gastrectomy for cure.

Cold Plasma to Fight MRSA?

Healthcare investing: 5 underserved medical problems.

MRSA infections: There’s no shortage of drug companies taking aim at drug-resistant infections such as MRSA, but there are other ways of attacking the problem. At least two startups — Sterionics and Plasma Technologies — are developing treatments for drug-resistant bacteria that use cold plasma technology. Plasma is a partially ionized gas that is sometimes used to disinfect and sterilize surgical equipment in cabinets, as well as for other industrial applications. The substance kills bacteria by interfering with their DNA, but it’s typically so hot that it would damage human tissue. That’s where cold plasma comes in.

Intensive care patients need nutrients to fight MRSA

Early ICU Energy Deficit Is a Risk Factor for Staphylococcus aureus Ventilator-Associated Pneumonia.

Background: Caloric insufficiency during the first week of ICU stay has been associated with increased infection rates. The connection between specific pathogens and host nutritional status in the ICU is not well known. This study was undertaken to determine the impact of patients’ early in-ICU energy balance on the pathogens responsible for ventilator-associated pneumonia (VAP).  Conclusions: Early ICU energy deficit is an independent determinant for acquiring S aureus VAP in patients on acute prolonged mechanical ventilation.

More research needed to aid Cystic Fibrosis patients with MRSA

HighWire Medline Abstract.

BACKGROUND: Staphylococcus aureus (S. aureus) is one of the earliest bacteria detected in infants and children with cystic fibrosis (CF). The rise of methicillin resistant S. aureus (MRSA) in the last 10years has caused a lot of attention to this organism. RESULTS: The aim of this review is to provide a general overview of methicillin sensitive S. aureus (MSSA) and MRSA, discuss special aspects of S. aureus in cystic fibrosis, and to review treatment concepts. Microbiology of the organism will be reviewed along with data regarding the epidemiology of both MSSA and MRSA. Antibiotic treatments both in regards to acute management and eradication of MSSA and MRSA will be reviewed. Prophylaxis of MSSA in CF remains controversial. Treatment with anti-staphylococcal agents reduces the infection rate with MSSA but may lead to a higher rate of infection with P. aeruginosa. In regards to MRSA, there is a paucity of clinical data regarding approaches to eradication. CONCLUSIONS: To advance the care of CF patients, controlled clinical trials are urgently needed to find the optimal approach to treating CF patients who are infected with either MSSA or MRSA.

Low-energy shock waves aid antibiotics against MRSA

Low-energy shock waves enhance the susceptibility of staphylococcal biofilms to antimicrobial agents in vitro -- Wanner et al. 93-B (6): 824 -- Journal of Bone and Joint Surgery - British Volume.

Biofilm-associated infections in wounds or on implants are difficult to treat. Eradication of the bacteria is nearly always impossible, despite the use of specific antibiotics. The bactericidal effects of high-energy extracorporeal shock waves on Staphylococcus aureus have been reported, but the effect of low-energy shock waves on staphylococci and staphylococcal biofilms has not been investigated. In this study, biofilms grown on stainless steel washers were examined by electron microscopy. We tested ten experimental groups with Staph. aureus-coated washers and eight groups with Staph. epidermidis. The biofilm-cultured washers were exposed to low-energy shock waves at 0.16 mJ/mm2 for 500 impulses. The washers were then treated with cefuroxime, rifampicin and fosfomycin, both alone and in combination. All tests were carried out in triplicate. Viable cells were counted to determine the bactericidal effect. The control groups of Staph. aureus and Staph. epidermidis revealed a cell count of 6 x 108 colony-forming units/ml. Complete eradication was achieved using the combination of antibiotic therapy (single antibiotic in Staph. aureus, a combination in Staph. epidermidis) and shock wave application (p < 0.01). We conclude that shock waves combined with antibiotics could be tested in an in vitro model of infection.

MRSA-caused pneumonia treatment - Vibativ - receives positive opinion

Hospital Pharmacy Europe - MRSA-caused pneumonia treatment receives positive opinion.

Astellas Pharma Europe Ltd., has announced that the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) adopted a positive opinion, recommending the granting of marketing authorisation for VIBATIV (telavancin hydrochloride) for the treatment for adults with nosocomial (hospital-acquired) pneumonia, including ventilator associated pneumonia known or suspected to be caused by MRSA (methicillin resistant Staphylococcus aureus). VIBATIV should be used only in situations where it is known or suspected that other alternatives are not suitable. VIBATIV is a bactericidal, once-daily injectable lipoglycopeptide antibiotic developed by Theravance, Inc..

Treating MRSA Skin and Soft Tissue Infections

Treating MRSA Skin and Soft Tissue Infections -- New Guidelines: Treating MRSA Skin and Soft Tissue Infections.

Early this year, the Infectious Diseases Society of America published its first-ever recommendations for the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA).[1] The guidelines appeared in the February 2011 issue of Clinical Infectious Diseases. The stated purpose of the MRSA treatment guidelines was to provide recommendations on the management of the most common clinical syndromes encountered in both adult and pediatric patients with MRSA infection. One of the most common of these is the MRSA skin and soft tissue infection (STTI).

See the link above for more

New MRSA guidelines highlight a dearth of evidence

New MRSA guidelines highlight a dearth of evidence : The Lancet Infectious Diseases.

The principal recommendations of the new US guidelines are broadly in accordance with UK guidelines ......why do the guidelines also not include meticillin-susceptible S aureus (MSSA), to cover the whole spectrum of antibiotic susceptibility? After all, MSSA causes upwards of 70% of all serious S aureus infections. The new US guidelines are perhaps the more complete, providing clear advice on paediatric and neonatal disease and endocarditis, bacteraemia, and complex disease associated with bacteraemia. But one thing that stands out in both sets of guidelines, and is highlighted by a review on the management of S aureus bacteraemia by Guy Thwaites and colleagues in this issue, on numerous questions of management, the strength of recommendation is weakened by a lack of high-quality evidence.

MRSA otorrhea: the right drugs are key

MRSA otorrhea: A case series and review of the lit... [Ear Nose Throat J. 2011] - PubMed result.

Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly common cause of difficult-to-treat head and neck infections. We report a retrospective analysis of 3 cases of MRSA otorrhea treated in our clinic between 2007 and 2009. Culture analysis of otorrhea isolates revealed MRSA infections with identical drug sensitivities. Treatment success was achieved using combinations of linezolid with gentamicin ear drops for 3 to 4 weeks or trimethoprim/sulfamethoxazole (TMP/SMX) with gentamicin drops for 6 weeks. This study illustrates the importance of determining individual drug sensitivities for optimal treatment and maintaining current knowledge of the local MRSA strains.

Treatment of S. Aureus Bacteremia With Emphasis on MRSA

Treatment of S. Aureus Bacteremia With Emphasis on MRSA: Abstract and Introduction.

Staphylococcus aureus bacteremia (SAB) is an urgent medical problem due to its growing frequency and its poor associated outcome. As healthcare delivery increasingly involves invasive procedures and implantable devices, the number of patients at risk for SAB and its complications is likely to grow. Compounding this problem is the growing prevalence of methicillin-resistant S. aureus (MRSA) and the dwindling efficacy of vancomycin, long the treatment of choice for this pathogen. Despite the recent availability of several new antibiotics for S. aureus, new strategies for treatment and prevention are required for this serious, common cause of human infection.

Read the whole detailed paper at the link below

Careful Cleaning of Child MRSA wounds as effective as drugs?

Careful Cleaning of Children’s Skin Wounds Key to Healing, Regardless of Antibiotic Choice.

When it comes to curing skin infected with the antibiotic-resistant bacterium MRSA (methicillin-resistant Staphylococcus aureus), timely and proper wound cleaning and draining may be more important than the choice of antibiotic, according to a new Johns Hopkins Children’s Center study. The work is published in the March issue of Pediatrics.

Read the whole article at the link above

MRSA Treatment Guidelines

If you sometimes feel that your medical practitioner may not know enough about your staph or MRSA infection it can be tempting to show them material from the internet - such as material from this site. We stand by what we write but you may get a better response if you show them the USA CDC guidelines - which you can download here

First guidelines for treating MRSA - a big positive for patients

News break: First guidelines for treating MRSA | Wired Science | Wired.com.

They went to doctors who didn’t recognize the infection, didn’t prescribe drugs that worked, didn’t have anything to offer when the infection recurred — a whole panoply of errors. It was a lesson for me in how long it can take news of a new medical development to percolate through the clinical community, especially to primary-care practitioners — people who don’t have a channel for new news because they don’t work for an academic medical center or belong to a specialty society that puts out a journal or at least a substantial newsletter. But it was also a lesson on how few agreed-upon standards of practice there were for treating MRSA. For many presentations, there was no evidence refer to; clinicians were thrown back onto poring through the literature, or on making educated guesses based on their past experience. As of this week, that should change. The Infectious Diseases Society of America has publshed the first-ever clinical practice guidelines for treating MRSA in adults and children. It’s a substantial document, 38 pages (in the advance access section of Clinical Infectious Diseases) and should be a tremendous resource for patients and their physicians. (I know of one patient who printed it out yesterday and took it to an office visit — only to find the physician had just downloaded a copy himself.)

Combination drugs part of MRSA answer?

HighWire Medline Abstract.

Methicillin-resistant Staphylococcus aureus (MRSA) is a substantial contributor to morbidity and mortality. In search of a natural products capable of inhibiting this multidrug resistant bacteria, we have investigated the antimicrobial activity of emodin (EM) isolated from Rheum palmatum L. (Polygonaceae) against 17 different strains of the bacterium. New antimicrobial activity was found using the paper disc diffusion method, agar dilution as well as checkerboard method. Against the 17 strains, the disc diffusion test was in the range of 18-30?mm, and the minimum inhibitory concentrations (MICs) of EM were in the range of 1.5-25 ?g/mL. From those results we performed the checkerboard test to determine the synergism of EM in combination with ampicillin (AM) or oxacillin (OX) against all strains. The combined activity of EM and two antimicrobial agents (AM, OX) against all strains resulted in a fractional inhibitory concentrations index (FICI) ranging from 0.37-0.5 and from 0.37-0.75, respectively. The effect of EM with AM and OX was found to be synergistic or partially synergistic. We found that EM reduced the MICs of AM and OX. EM and in combination with AM or OX could lead to the development of new combination antibiotics against MRSA infection.

MRSA and Immune Comprimised Patients

HighWire Medline Abstract.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen causing serious morbidity and mortality in immunosuppressed patients. Antineoplastic chemotherapy causes immunosuppression, and thus there is concern whether such patients should proceed to therapy without delay or dose reduction. There are presently no guidelines with appropriate provisions for antineoplastic chemotherapy in cancer patients with MRSA colonization or infection. PATIENTS AND METHODS: We retrospectively analyzed the clinical outcome of all 27 patients with known MRSA infection or colonization undergoing antineoplastic chemotherapy for solid or hematological malignancies in our institution. RESULTS: In our patients, MRSA was detected at multiple sites. 11 patients were found to be colonized with MRSA, whereas 16 patients had colonization and/or infection. MRSA sepsis occurred in 12 cases. Interestingly, at the time of MRSA sepsis, neutrophil counts were less than 500/?l in 42% of our patients. However, fatal complications due to MRSA occurred in only 2 patients. Among patients with MRSA sepsis, the mortality rate was 14%. CONCLUSIONS: Our results with a limited number of patients support the contention that antineoplastic chemotherapy may well be administered to patients with MRSA and should not necessarily lead to dose reduction or treatment delay, especially in cases with curative intent.

MRSA - Why you need to do your own research

Quick Printing Magazine Article: Quick Consultant.

What about “the worst of times?” Well, I spent the entire month of August with a high level of anxiety, anger, and frustration. Somehow, somewhere I contracted a serious staph infection called MRSA. MRSA is resistant to most antibiotics, and those that can be used to treat the disease have many strong side affects. Left untreated or misdiagnosed you can die from an MRSA infection. As the month of August progressed, and as I sought out help from general practitioners and orthopedic surgeons, it became clear that I had reached, as Dickens said, “the epoch of incredulity.” During the month of August I discovered that my family physician is only good for writing prescriptions and wouldn’t know how to incise a small infection if he tried. I encountered an orthopedic surgeon who declined to treat the infection and suggested instead that I visit the emergency room at the local hospital. He then had the nerve to invoice the insurance company for $375 for this worthless piece of advice. When I told my doctor I wanted a second opinion he recommended another surgeon upstairs. When I called that office to make sure my appointment had been made the nurse told me they don’t treat MRSA patients and that I should visit an infectious disease specialist instead. By the time I saw the latter, it had become a comedy of errors and the infection had gotten worse. The infectious disease specialist basically told me that the drugs I had been prescribed at the dosages given had been totally inadequate for treating MRSA. Instead of getting better, it was getting worse. Consequently, I needed five days of infusion with an antibiotic 100 times stronger than what I was taking orally. As I sit here today typing this column, my anxiety and frustration levels are still at an all time high. I completed the infusion a few days ago, but I am now back to double doses of another antibiotic. At high dosage levels, antibiotics can cause numerous side effects, including high levels of anxiety. By the way, don’t ever let anyone ever tell you that you can’t detect if you have high blood pressure. Hogwash! I can. And despite taking blood pressure medication, I can tell you my blood pressure is probably 160/90—all of this as a result of the drugs and frustration of trying to fight a serious infection and find competent doctors. Anyway, the primary lesson I learned from this episode also applies to the “best of times” portion of this column. While undergoing treatment, I was told time and again by other patients and nurses that patients need to become their own healthcare advocates. You need to be very knowledgeable regarding all medication and treatments prescribed, and don’t hesitate to ask questions.

Treatment protocols for infections, MRSA vary throughout Europe

Treatment protocols for infections, MRSA vary throughout Europe.

According to Robert Townsend, MBCHB, MSc, DTMH, FRCPath, a consultant microbiologist with Sheffield Teaching Hospitals in Sheffield, U.K., there often may be no step-by-step protocol specifically designed to combat or manage MRSA infections, so all trusts should adopt a search-and-destroy approach to MRSA cases. “Strictly speaking, we do not have any fixed antibiotic protocols for the management of MRSA infections,” Townsend told Orthopaedics Today Europe. “Our guideline, for example, simply says to contact the microbiologist. “We do, however, operate a search-and-destroy screening protocol to all admissions to the trust,” he added. Townsend said, a screen protocol means that surgery can be delayed to allow de-colonization or performed under appropriate antibiotic prophylaxes. “This would not, however, prevent infection acquired on the ward postoperatively,” he said. “This is where good hand hygiene and high compliance rates with hand hygiene audits come in.”

Aspirin ingredient makes life easier for MRSA bacteria

Salicylic Acid Diminishes Staphylococcus aureus Capsular Polysaccharide Type 5 Expression -- Alvarez et al. 78 (3): 1339 -- Infection and Immunity.

Collectively, our data demonstrate that exposure of encapsulated S. aureus strains to low concentrations of SAL reduced CP production, thus unmasking surface adhesins and leading to an increased capacity of staphylococci to invade epithelial cells. The high capacity of internalization of the encapsulated S. aureus strains induced by SAL pretreatment may contribute to the persistence of bacteria in certain hosts.

Statins boost infection fightback?

More at: Controversies in Hospital Infection Prevention: Statins and surgical site infections.

A large retrospective cohort study in the October issue of Archives of Surgery demonstrates that preoperative statin use was not associated with a decreased risk of surgical site infections (SSI). Patients were matched on procedure, hospital, and surgeon. However, for the subgroup of patients who did develop a SSI, the risk for death was 17% lower in those on statins.

Assume the worst re MRSA and your patients warns foot specialist

Handbook of Lower Extremity Infections » Blog Archive » Escalation vs. De-escalation Therapy.

During the History, I even specifically asked him “Have you or any of your family members ever had MRSA”. Now, you pretty much have to be living under a rock not to have heard about MRSA given all of the press coverage. His answer to me was a simple “What’s that”. With this History and that response I turned to the Resident and basically stated that I would “eat my hat” if this guy has MRSA. We started him on non-MRSA coverage. Well, I think you can imagine what happened. 48 hours later the C&S was returned as CA-MRSA (Picture below is from after initial I&D by my podiatric surgical colleague). From this point on I have started to practice DE-ESCALATION therapy. I start the vast majority of my patients, particularly those being hospitalized, as if they have MRSA and will de-escalate to remove the MRSA therapy if MSSA or no staph is found. Frankly, I don’t remember the last time I was even ABLE to de-escalate. That is how prevalent MRSA is in our local hospital.