MRSA Infection

MRSA pneumonia: current and future treatment options

ScienceDirect - International Journal of Antimicrobial Agents : Antimicrobial treatment of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) pneumonia: current and future options.

Meticillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of nosocomial pneumonia. Inadequate or inappropriate antimicrobial therapy, often caused by antimicrobial resistance, is associated with increased mortality for these infections. Agents currently recommended for the treatment of MRSA pneumonia include vancomycin and linezolid in the USA, and vancomycin, linezolid, teicoplanin and quinupristin/dalfopristin in Europe. Antimicrobials such as tigecycline and daptomycin, although approved for the treatment of some MRSA infections, have not demonstrated efficacy equivalent to the approved agents for MRSA pneumonia. Further agents lack data from randomised controlled trials (e.g. fosfomycin, fusidic acid or rifampicin in combination with vancomycin). Antimicrobial agents that have recently been approved or are being investigated as treatments for MRSA infections include the lipoglycopeptides telavancin (approved for the treatment of complicated skin and skin-structure infections in the USA and Canada), dalbavancin and oritavancin, the cephalosporins ceftobiprole and ceftaroline, and the dihydrofolate reductase inhibitor iclaprim. To be an effective treatment for MRSA pneumonia, antimicrobial agents must have activity against antimicrobial-resistant S. aureus, penetrate well into the lung, have a low potential for resistance development and have a good safety profile. Here, the available data for current and potential future MRSA pneumonia antimicrobials are reviewed and discussed.

MRSA & Flu - The Key Facts

Link: CDC Warning of Dangerous, MRSA-Related Pneumonia in Kids.

Staph has caused fatal pneumonia in at least 24 young and healthy people during the 2006-2007 flu season.  US researchers warn that doctors need to be on the alert for a drug-resistant form of staph called methicillin-resistant Staphylococcus aureus or MRSA that leads to life-threatening pneumonia.

Staph infections are posing a deadly new threat in the form of MRSA pneumonia. Following the deaths of at least 24 young and healthy people during the 2006-2007 flu season. doctors have been asked to bear in mind that the multi drug resistant staph MRSA may be behind 4 out of 5 the staph pneumonia cases that they see.

With some infections killing within 4 days some patients are not being fully diagnosed and treated. In some cases – about a third - the MRSA pneumonia follows a bout of influenza. Staph is a challenge to anyone suffering from influenza, but the stakes are raised considerably in populations where the drug resistant varieties of MRSA are being carried by in excess of 10% of children and young people. The staph pneumonia patients’ average age is often around 16.

Those recovering from a recent flu are about twice as likely to die. Staph is capable of reaching the lungs, often after colonising the nose. The flu virus shuts down the normal defences of the lung and the staph bacteria then flourishes.

Drug Treatment
Failure rates of 40% have been reported for vancomycin, the drug of choice for difficult cases of MRSA. With new strains of MRSA needing bigger doses and poor penetration into epithelial cell lining fluid by the drug some are looking to the more expensive Linezolid. (Zyvox) for MRSA pneumonia cases. Trials have produced mixed results but some studies indicate Linezolid is more effective.

Swine flu sparks fears over MRSA

The Press Association: Swine flu sparks fears over MRSA.

A second wave of swine flu hitting Britain could lead to a rise in MRSA infections, medics have warned. A team of health experts said a swine flu pandemic would see a rise in hospital admissions and run the risk of a rise in MRSA. The MRSA Working Group, together with National Concern for Healthcare Infection and the Patients Association, is calling for the early discharge of patients from hospital to try and prevent a rise in the killer superbug. They said when hospital bed occupancy rates were high, MRSA infection rates increased. The group has written to all NHS hospital staff, reminding them to review their policy for the early discharge of MRSA patients.

Swine flu & MRSA a deadly duo

Swine flu hits 900 people every day as cases double - Scotsman.com News.

SWINE flu could combine with the MRSA superbug with deadly effects, experts are warning. The flu virus interferes with the body's ability to get rid of MRSA. This means the bug can get into the lungs and lead to patients suffering pneumonia in combination with flu infection. Such cases have been seen in Australia, which has experienced higher levels of swine flu during its winter season. The issue will be discussed at a specialist forum in France next week. Microbiologist Hugh Pennington said Staphylococcus aureus infections had occurred with flu during the pandemic of 1957. "With MRSA, it would be even more difficult to treat than with staphylococcus, and that is bad enough," he said.

Nurses vulnerable to MRSA/Flu complications

London Free Press - Local News- Nurses allege unsafe conditions.

Unsafe working conditions contributed to the death last January of a nurse who contracted a super-bug infection at London's Victoria Hospital, the Ontario Nurses' Association alleges. The nurses' union is appealing a Labour Ministry inspector's decision not to issue orders against London Health Sciences Centre in connection with the nurse's death. The critical-care trauma nurse had been caring for a patient infected with methicillin-resistant Staphylococcus aureus (MRSA), an infectious super-bug that's difficult to treat. The patient later died. The nurse became ill and died six days later from complications of influenza. MRSA was deemed a contributing factor. "There's no question in our minds that the employer did fail to provide a safe working environment," ONA president Linda Haslam-Stroud said yesterday as the ONA announced its appeal. Haslam-Stroud said there were several serious gaps in the system, including patient-screening procedures, staff training, defective equipment and risk assessment.

More evidence of MRSA involvement in H1N1 flu

More evidence of MRSA involvement in H1N1 flu | GlobalPost.

At the ICAAC meeting two weeks ago (more on that soon), KK Johnson et al of the Women's and Children's Hospital of Buffalo, N.Y., along with researchers from two other institutions, described two severe and ultimately fatal infections with H1N1 complicated by community-strain MRSA. The victims were children, a 9-year-old girl and a 15-year-old boy, who arrived at the emergency room several days after being seen for mild flu symptoms. Both children died of necrotizing pneumonia, one 11 days after being hospitalized and one 3 days. Cite (no link available): K.K. Johnson, H. Faden, P. Joshi, J. F. Fasanello, L. J. Hernan, B.P.Fuhrman, R.C.Welliver, J.K. Sharp and J. J. Schentag, "Two Fatal Pediatric Cases of Pandemic H1N1/09 Influenza Complicated by Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA)," poster G1-1558a. Finally, there is one recent paper that is online, and it describes MRSA necrotizing pneumonia plus flu in an adult, not a child. It comes from Hong Kong, from a group that were the first to describe SARS pneumonia and thus have a lot of experience in surfing the early wave sof a pandemic. In this new paper in the Journal of Infection, they describe the death from necrotizing pneumonia of a healthy 42-year-old man who was in the hospital only 48 hours. They believe this is the first H1N1+MRSA death to be recorded in the medical literature, and so they use the opportunity to issue a warning to doctors: If a flu patient arrives with what appears to be secondary pneumonia, drugs that can treat MRSA must be prescribed, or the infection will flourish unchecked and death will result. The cite is: Cheng VCC, et al., Fatal co-infection with swine origin influenza virus A/H1N1 and community-acquired methicillin-resistant Staphylococcus aureus, J Infect (2009), doi:10.1016/j.jinf.2009.08.021.

Flu & MRSA as child killer

Link: Effect Measure : Flu as child killer.

Staph pneumonia is not a new phenomenon; from 3% to 10% of pneumonias that begin outside hospitals have been attributed to staph, but those pneumonias tend to occur in the elderly and immune-impaired. And the severity of simultaneous staph and flu infections has been documented after each influenza pandemic, in which large numbers of deaths were attributed to bacterial pneumonia. But the staph pneumonias recorded by the new reporting system represent an apparently new development, because they occurred in previously healthy children infected with a seasonal flu virus that presumably does less damage to the lungs and immune response than a novel pandemic one. And they appear to be occurring at the same time as a rapid rise in MRSA colonization in the United States, which doubled between 2001 and 2004. (Maryn McKenna, CIDRAP News)

MRSA deaths from Influenza jump 500% in 3 years

Link: Influenza-Associated Pediatric Mortality in the United States: Increase of Staphylococcus aureus Coinfection -- Finelli et al. 122 (4): 805 -- Pediatrics.

RESULTS. During the 2004–2007 influenza seasons, 166 influenza-associated pediatric deaths were reported (n = 47, 46, and 73, respectively). Median age of the children was 5 years. Children often progressed rapidly to death; 45% died within 72 hours of onset, including 43% who died at home or in an emergency department. Of 90 children who were recommended for influenza vaccination, only 5 (6%) were fully vaccinated. Reports of bacterial coinfection increased substantially from 2004–2005 to 2006–2007 (6%, 15%, and 34%, respectively).  Influenza-associated pediatric mortality is rare, but the proportion of S aureus coinfection identified increased fivefold over the past 3 seasons. Research is needed to identify risk factors for influenza coinfection with invasive bacteria and to determine the impact of influenza vaccination and antiviral agents in preventing pediatric mortality.

Major pandemic flu would hit MRSA carriers hard

Link: The 1918-1919 pandemic influenza revisited: a new perspective based on old information.

Clearly it is equally necessary to stockpile antibiotics effective against primarily community-acquired organisms causing post-influenza pneumonia today, including both MSSA and MRSA. Much more consideration needs to be given to the possible role of pneumococcal and possibly other bacterial vaccines as part of pandemic preparedness.

Hand Hygiene Habits a Flu and MRSA Risk

Link: Hand Hygiene Habits Remain Stagnant; National Clean Hands Week is Sept. 21-27, 2008.

Despite the threat of getting sick during cold and flu season, fewer Americans say they are regularly washing their hands. The fourth Clean Hands Report Card®, issued by the Soap and Detergent Association (SDA), gives Americans a “C-minus” for their hand hygiene habits, the same grade they received back in 2006. The Report Card is based on a series of hygiene-related questions asked of 916 Americans during a telephone survey conducted in August 2008 by Echo Research.  Among the findings of SDA’s 2008 survey: · Only 85 percent say they always wash their hands after going to the bathroom (down from 92 percent in 2006). · 46 percent of respondents wash their hands 15 seconds or less.  The Centers for Disease Control and Prevention (CDC) and SDA recommends washing with soap at least 15 to 20 seconds. · 39 percent surveyed seldom or never wash their hands after coughing or sneezing (compared to 36 percent in 2006).  · 35 percent don’t always wash before eating lunch (in 2006, 31 percent failed to wash up before lunch.

Smokers will be more vulnerable to MRSA and Flu complications

Link: Cigarette Smoke Makes Flu, Other Viral Infections Worse.

Until recently, scientists haven't been able to explain why smokers have more exaggerated responses to viral infections. Smokers have been more likely than non-smokers to die during previous influenza epidemics and are more prone to chronic obstructive pulmonary disease (COPD). Furthermore, children who are exposed to second-hand smoke have more severe responses when infected with respiratory synctial virus. The prevailing view has been that cigarette smoke decreases anti-viral responses. Their experiments showed that the immune systems of mice exposed to cigarette smoke from as little as two cigarettes a day for two weeks overreacted when they were also exposed to a mimic of the flu virus. The mice's immune systems cleared the virus normally but the exaggerated inflammation caused increased levels of tissue damage.