Link: HighWire Press -- Medline Abstract.
The overall MRSA carriage rate on admission was 6.7%. Rapid tests led to a reduction in median reporting time from admission, from 46 to 22 hours (P<0.001). Rapid testing also reduced the number of inappropriate pre-emptive isolation days between the control and intervention arms (399 v 277, P<0.001).
Link: HighWire Press -- Medline Abstract.
OBJECTIVE: To determine whether introducing a rapid test for meticillin resistant Staphylococcus aureus (MRSA) screening leads to a reduction in MRSA acquisition on hospital general wards. DESIGN: Cluster randomised crossover trial. SETTING: Medical, surgical, elderly care, and oncology wards of a London teaching hospital on two sites. MAIN OUTCOME MEASURE: MRSA acquisition rate (proportion of patients negative for MRSA who became MRSA positive). PARTICIPANTS: All patients admitted to the study wards who were MRSA negative on admission and screened for MRSA on discharge. INTERVENTION: Rapid polymerase chain reaction based screening test for MRSA compared with conventional culture. RESULTS: Of 9608 patients admitted to study wards, 8374 met entry criteria and 6888 had full data (82.3%); 3335 in the control arm and 3553 in the rapid test arm. The overall MRSA carriage rate on admission was 6.7%. Rapid tests led to a reduction in median reporting time from admission, from 46 to 22 hours (P<0.001). Rapid testing also reduced the number of inappropriate pre-emptive isolation days between the control and intervention arms (399 v 277, P<0.001). This was not seen in other measurements of resource use. MRSA was acquired by 108 (3.2%) patients in the control arm and 99 (2.8%) in the intervention arm. When predefined confounding factors were taken into account the adjusted odds ratio was 0.91 (95% confidence interval 0.61 to 1.234). Rates of MRSA transmission, wound infection, and bacteraemia were not statistically different between the two arms. CONCLUSION: A rapid test for MRSA led to the quick receipt of results and had an impact on bed usage. No evidence was found of a significant reduction in MRSA acquisition and on these data it is unlikely that the increased costs of rapid tests can be justified compared with alternative control measures against MRSA. TRIAL REGISTRATION: Clinical controlled trials ISRCTN75590122 [controlled-trials.com].
Link: MyFox Gulf Coast | MRSA - it's deadly and very common.
It's something you would think health leaders would want to keep a close eye on. Yet health departments in Mobile and Baldwin counties say they really don't have a way to identify who has it." "Although we see it as a problem, from a public health standpoint there's not a whole lot we can do with limited personnel and limited resources in terms of tracking them," explained Dr. Kevin Green with USA Hospital. Dr. Green says unlike West Nile, mad cow, or even the mumps or measles, MRSA is not considered a reportable disease. It's so common that it wouldn't do you much good to record all the cases because you would end up with entirely too much data. Much like if you were to track the common cold. Still it's scary stuff when you consider how MRSA spreads…Anyone who's in a skin-to-skin contact situation like in daycares, hospital, and just about anyone who plays sports has the risk of being infected.
Link: Bloodstream infections may increase risk for MRSA mortality.
ATLANTA — Patients with bloodstream infections caused by invasive methicillin-resistant Staphylococcus aureus were nearly four times more likely to die from infection after 180 days than patients who had other types of MRSA infections, according to study results presented at the International Conference on Emerging Infectious Diseases, held here in March. After only 30 days, patients with bloodstream infections caused by MRSA were at an increased mortality risk, according to data from the Active Bacterial Core surveillance component of the Emerging Infections Program in Davidson County, Tennessee. This state had the second highest incidence of invasive MRSA infection of nine sites included in 2005 surveillance data from a national emerging infections program, according to study researchers. [bar]
Results. Among 1687 samples collected, MRSA colonization rates were 2.41% (2/83) for peritoneal dialysis patients and 2.36% (12/509) for haemodialysis patients. Five (5/14) subjects subsequently had MRSA infection. The clinical MRSA isolates had the same molecular type as the colonized strains of the same person, indicating MRSA colonization preceded clinical infection. Significantly higher MRSA nasal carriage rates were observed among family members of HCWs than family members of dialysis patients (P = 0.0024). Only three major clones were observed. Pulmonary diseases (OR: 4.873, 95% CI: 1.668–14.235), recent admission to a hospital (OR: 2.797, 95% CI: 1.291–6.059) and recent antibiotics usage (OR: 2.319, 95% CI: 1.053–5.104) were also significantly associated with MRSA carriage. Conclusion. Transmission of MRSA among dialysis patients, HCWs and their family members in a dialysis unit could be inferred. Monitoring and eradication of MRSA from patients, HCWs and their family members should be considered to prevent continuous spread between healthcare facilities and the community.
Link: The Shawnee Dispatch / Great strides help family cope.
In July 2005, however, he got a lung infection he couldn’t seem to shake. When it was clear this was not a routine infection, Dalton was hospitalized, and the family learned he had developed MRSA, or a methicillin-resistant Staphylococcus aureus infection. “It’s not uncommon as a phase or progression of CF, when they develop different lung bacterias, and unfortunately since it’s antibiotic-resistant, it’s very difficult to manage,” Jennifer said. “It has caused his pulmonary function to decrease a great deal, which is why he’s now home-schooled.” And every now and then, too much of the infection builds up, which means a return to the hospital. In the past two years on average, Dalton is in the hospital every three months, anywhere from 10 to 17 days at a time. “It’s a constant, chronic condition, and so it’s a daily, constant work to try to keep his lungs healthy,” Jennifer said. The only method of fighting the MRSA is to get as much of it out of Dalton’s lungs as possible. So he takes inhaled medications that try to thin secretions so he can cough them up and respiratory therapy that includes a vibrating vest that shakes his body with different frequencies to loosen the secretions in his lungs so he can cough them up.
Link: ABC News: Docs Fear Deadly Combo of Flu, MRSA.
"It is well known that community-acquired staph pneumonia is much more common in patients who have influenza," he says. "This has not changed." But when it does happen, the results can be disastrous. Infectious disease experts say spikes in this kind of co-incidence of influenza and drug-resistant bugs have happened in the past, with devastating results even for many healthy individuals. "The association of influenza viral infection disrupting the mucosa to permit secondary bacterial infection is not new," says Dr. Jerome Klein, professor of pediatrics at Boston University School of Medicine. "This is what happened in the influenza pandemic in 1957, which was co-incident with a pandemic of multidrug resistant staphylococcal infections. Not only were the elderly and immunocompromised prone to the combination, but otherwise healthy individuals were felled with substantial morbidity and mortality."
Link: Flu, MRSA Could Be Deadly Mix For Kids - As Seen On NewsCenter 5 Story - WCVB Boston.
Two children who died from flu in the state were found to have both the flu and MRSA, and officials are worried that there may be a link. MRSA was formerly found mostly in hospitals, but now is being found in healthy children and adults who carry the germ in their noses and throats. They don't know it, and there's no obvious harm, but doctors believe that people who are co-infected -- meaning they have both flu and MRSA -- are more likely to die. They're calling it "fluMRSA" and of the 74 children who died of flu nationwide in 2006 and 2007, 22 of them also had staph infection and most of those were MRSA cases. In Massachusetts, of the four children who died, two had MRSA. At the state health department lab, researchers are working with the Centers for Disease Control and Prevention to activate a monitoring network so they can track those with fluMRSA to detect any kind of trends.
Link: HighWire Press -- Medline Abstract.
Background. @nbsp; A community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection has been defined as an MRSA infection in a patient who lacks specific risk factors for healthcare exposure. We sought to determine whether the absence or presence of these risk factors still predicts the phenotypic or genotypic characteristics of MRSA strains. Methods. @nbsp; All clinical MRSA isolates were prospectively collected at the University of Chicago Hospitals from July 2004 through June 2005. Patients were interviewed and/or their medical records were reviewed. Isolates underwent genotyping and susceptibility testing. Data on patients and isolates were stratified in accordance with 8 frequently cited criteria for the identification of CA-MRSA and compared for concordance. Results. @nbsp; Among 616 unique patients from whom MRSA isolates were recovered, 404 (65.6%) had risk factors for healthcare exposure. Of the 404 isolates recovered from these patients, 166 (41.1%) were clindamycin susceptible, 190 (47.0%) carried staphylococcal cassette chromosome mec (SCCmec) type IV, 145 (35.9%) carried the Panton-Valentine leukocidin genes (PVL(+)), and 162 (40.1%) were identified as sequence type (ST) 8 by multilocus sequence typing (MLST), all of which are characteristics commonly attributed to CA-MRSA strains. Conclusions. @nbsp; Association with the healthcare environment now has little predictive value for distinguishing patients with infection due to multidrug resistant MRSA isolates from those infected by CA-MRSA isolates, that is, isolates that are clindamycin-susceptible, PVL(+), ST8, and/or contain SCCmec type IV. Defining CA-MRSA by the absence of risk factors for healthcare exposure greatly underestimates the burden of epidemic CA-MRSA disease.
Link: The Deadly Intersection of the Flu and MRSA
ABC News and the Boston Globe have run reports highlighting the potential threat of co-infection of influenza and MRSA. Influenza kills at least 35,000 people in the US every year. This year’s influenza vaccine was less effective against the strains common this year. Each year the selection of vaccine type is a guessing game and mortality from flu will likely be higher this year. Methicillin-resistant Staphylococcus aureus (MRSA) is a superbug that is resistant to common antibiotics because it is the product of the over use of common antibiotics. While MRSA can be successfully treated, for now, the likelihood of higher mortality rates when flu and MSRA are experienced concurrently is a near certainty. The co-infection of viral and bacterial infections points to a serious problem that may grow difficult to control. The rise of not only MSRA but also more and more antibiotic resistant strains of common and once deadly infections coupled with a potent viral illness such as bird flu, SARS or drug resistant TB could result in a health catastrophe. Is this a perfect storm? All signs point to that direction. Drug resistant strains of infections continue to evolve, more diseases are jumping from animals to humans, the development of new antibiotics and anti-virals are difficullt and offers poor returns to developers, and the community is slowly losing its herd immunity due to misinformation about vaccination.
A short introduction from Dave Roberts
This 12 minute introduction will help you grasp the key facts and the key issues surrounding drug resistant staph aureus (mersa, mursa)
