MRSA, Staph, Staff, Mersa, Methicillin Resistant Staphylococcus Aureus Symptoms & Treatment

EU investigating MRSA in pigs

Link: Animals: MRSA: 12 May 2008: Written answers (TheyWorkForYou.com).

Jonathan R Shaw (Parliamentary Under-Secretary (Marine, Landscape and Rural Affairs) and Minister for the South East), Department for Environment, Food and Rural Affairs; Chatham & Aylesford, Labour) | Hansard source Methicillin-resistant Staphylococcus aureus (MRSA) has not been detected in farmed livestock in the UK and there is no current evidence that food-producing animals form a reservoir of infection in the UK. The organism has been isolated from dairy cows, pigs and chickens outside the UK, as well as in companion animals (including cats, dogs and horses) both in the UK and elsewhere. Ongoing monitoring of the international picture is being maintained. A 12-month long study to provide an initial overview of the presence of MRSA in breeding pig herds across Europe began in January 2008. This is being carried out under Community legislation. It is anticipated that the results of this study will be published in mid 2009 and that they will inform the direction of future work by DEFRA. DEFRA's Antimicrobial Resistance Co-ordination (DARC) Group continues to provide guidance on policy relating to antimicrobial resistance. The membership of the DARC Group reflects a partnership approach and includes representatives from many organisations involved in both human and animal health throughout the UK. DARC created a MRSA sub-group in 2005, through which DEFRA is assisting and encouraging various initiatives relating to MRSA from the Bella Moss Foundation (a UK registered charity promoting awareness of MRSA in animals), industry and the veterinary profession. DEFRA has funded research to better understand the epidemiology of MRSA in companion animals and livestock and any role it may play in human infections.

Antimicrobial resistance--animals and the environment

Link: The 2008 Garrod Lecture: Antimicrobial resistance--animals and the environment -- Lord Soulsby of Swaffham Prior, 10.1093/jac/dkn183 -- Journal of Antimicrobial Chemotherapy.

The evolution of resistance to microbes is one of the most significant problems in modern medicine, posing serious threats to human and animal health. The early work on the use of antibiotics to bacterial infections gave much hope that infectious diseases were no longer a problem, especially in the human field. However, as their use, indeed over-use, progressed, resistance (both monoresistance and multiresistance), which was often transferable between different strains and species of bacteria, emerged. In addition, the situation is increasingly complex, as various mechanisms of resistance, including a wide range of β-lactamases, are now complicating the issue. The use of antibiotics in animals, especially those used for growth promotion, has come in for serious criticism, especially those where their use should be reserved for difficult human infections. To lend control, certain antibiotic growth promoters have been banned from use in the EU and the UK. Antimicrobial resistance is not confined to bacteria but occurs in viruses, protozoa and helminths. In many of these, the mechanism of resistance is unknown, and hence their control is still in question. It is likely, however, that the mechanisms are no less complicated than those pertaining to bacteria.

10% 0f dogs MRSA carriers?

Link: Beware of Fido: chief vet warns of the risk of disease transmission - Times Online.

Some 10 per cent of dogs are thought to carry the superbug MRSA. Research by a team at Liverpool University Veterinary School showed that many dog owners appeared unaware of, or unconcerned about any health risks from their pet. According to a survey of 260 households in a semi-rural town in the South Wirral, where most pets were labradors or Jack Russells, almost 20 per cent of the animals slept in the bedroom and 14 per cent on a person’s bed. Dr Landeg’s warning also coincides with a review of pet travel rules on the Continent by the European Commission.

Cat reinfects owner with MRSA

Link: The Bay Area Reporter Online | Keeping you and your pets healthy.

Include on that list the overly-hyped infection MRSA, methicillin-resistant Staphylococcus aureus. The family cat was the source of a recurring MRSA infection in an otherwise healthy German woman, according to a report published in the New England Journal of Medicine in March. The woman developed multiple deep skin abscesses caused by MRSA. She was treated but the infection came back. Screening found the bug in the nose of other family members, even though they had no signs of active infections. They were treated, but the mother s abscesses came back. In desperation the doctor swabbed the throats of the three family cats, and one of them came back positive for MRSA. The bacteria sample from the cat had the same patterns of drug resistance seen in the mother. The animal was treated and so was the woman. This time her sores cleared up for good. She was no longer being reinfected by others in the household. Veterinarians first noticed MRSA in the milk of a cow in 1972, but reports of the infection in all types of animals really have exploded in the last five years, said Jeff Bender, a professor of veterinary public health at the University of Minnesota. "Typically pets clear this rather rapidly, in a couple of weeks, as long as there is not reinfection," said J. Scott Weese, a professor at the Ontario Veterinary College at the University of Guelph, in Canada. "If you see long-term colonization, usually it is because it is passing between different individuals in the household, humans or animals."

Beware of the dog: you may catch MRSA

Link: Beware of the dog: you may catch MRSA - Times Online.

They might be man’s best friend, but dogs should be sold with a health warning, a study suggests. Letting a dog lick your face, picking up its mess or allowing it to sleep on your bed could put you at risk of catching salmonella, campylobacter or MRSA. Research commissioned by the Department for Environment, Food and Rural Affairs (Defra) from the University of Liverpool Veterinary School, has identified health risks in the interaction between man and dog. The findings, published in The Veterinary Record, may enrage the country’s 6.5 million dog owners. Men, in particular, may have to learn cleaner habits because it seems they have a problem picking up dog mess. Risks of infection from dog to Man at present are low.

Understanding MRSA. (Mersa or Staph)

Ask an MRSA question * MRSA News * MRSA in your locality

MRSA Watch has gathered over 4500 articles on MRSA into a unique directory - see A-Z  guide in right hand column. Click on coloured text in the MRSA Basics guide below for more information on a specific subject.  The site is updated daily. Scroll down past the guide for specific information about aspects of MRSA

We also have an information packed audio introduction will help you grasp the key facts and the key issues surrounding MRSA

Simple staph aureus (SA) bacteria, (mrsa is not a virus), can be found on the bodies of up to 30% of the general population. It caused many problems before the use of antibiotics made wound recovery a safer process. Hospital acquired staph is generally resistant to several antibiotics but especially Methicillin, hence the name MRSA. This is found in about 1% of the population but in some pockets of the population this figure can be much higher.

Image from Komo News

Community Acquired MRSA (CA MRSA) is a different strain of MRSA, mainly causes skin infections and is treatable by more drugs at this time. CA MRSA (sometimes known as Mersa or Mursa) is more infectious and some strains of it are more destructive - should it become resistant to more antibiotics it could pose a considerable public health risk. Many people carry or are 'colonised' by staph bacteria but only suffer when they have another illness.

The colonisation stage carries no symptoms. Many only suffer MRSA as an infection of an existing wound. In recent times however some types of CA MRSA have begun to cause significant skin infections in otherwise healthy patients. The entry point is often a tiny cut, graze or exisiting skin condition.

How do people catch MRSA?
There are several ways it is believed to spread.

• Hand carriage - this is why hospital staff are encouraged to wash their hands after each patient.
• Contaminated surfaces - this is why clean hospital wards are vital.
• Via medical instruments - this is why many now have special coatings or have silver elements. This discourages lingering residues and/or kills external infection entering the wound
• Via airborne particles - MRSA often resides in the nasal passages and can spread with colds and flu as a secondary infection that may be dormant for some while.
• Shared items - Families or other close knit groups sharing a facility such as military personnel, a sports team or prison inmates may share hygiene items such as towels etc. This is another vector for the spread of the bacteria
• Needles - Drug users sharing needles may be passing on MRSA alongside HIV or Hepatitis C. The same could be said of tattoo artists who do not have strict hygiene regimes.
• Sexual Intimacy - the nose, groin and underarms are key colonisation areas for the bacteria. Sex workers and the habitually promiscous will be super spreaders in a society in much the same way as they are for AIDS.

How is it treated?
There are 3 key treatment regimes that are commonly used.

• For those who are colonised - a nasal treatment and a skin wash. This is often the strategy when MRSA is rare or prior to an operation as a means of preventing infection. Where MRSA is common some doctors will not suggest decolonisation as many will be recolonised within months within the local community. Some deep seated - throat and intestine - colonisation may require drug treatment.
• For those who have a potential or active bloodstream infection - drugs such as Vancomycin, Linezolid or Daptomycin.
• For those with infected wounds - special honey, silver bandages, garlic preparations and tea tree oil are all believed to be effective in killing MRSA in a wound. Many who have the skin infections common with CA MRSA simply need incision and drainage of the infected area and good hygiene while it heals. Antibiotics are not always needed.

How can it be prevented
The media often focus on clean hospitals and clean hands as a key to combating MRSA. Others believe that this will only cut cases by 30% and that a diverse strategy is vital and will include:

• Clean Wards - especially surfaces and keyboards.
• Staff Screening - are they super carriers?
• Patient Screening - so that they can be decolonised and to avoid self infection.
• Hospital Equipment - because it can take the infection deep into a wound.
• Air Hygiene - to help prevent nasal colonisation
• Hand Hygiene - to prevent transport from patient to patient via staff hands
  
• Antibiotic Restraint - because resistance grows from over prescription
• The Food Chain - is resistance also provoked by over use in the animals that we eat?
• Patient Isolation - this helps lessen the potential risk of airborne infection
• Lifestyle Choices - needle injected drugs and multiple sexual partners help spread chronic illnesses that emerge slowly.

What can I do

• Stay informed - this site and several others can help you do this. The A-Z guide in the right hand column will give you in depth information on over 50 aspects of MRSA from over 4000 articles, news items and academic papers.
  
• Ask others via our MRSA Watch forum
• Act locally by becoming involved in patient advocacy or patient/hospital forums
• Seek justice - do you need to take legal action because of neligence or do we all need to speak up for communities who are being hit by CA MRSA but are underinsured and often powerless.

MRSA Headlines

Doctors urge caution over hospital animal visits

Link: The Canadian Press: Hedgehogs bad, Labradors good: group issues new advice for hospital pet visits.

Hedgehogs, prairie dogs, non-human primates and alpacas shouldn't be making rounds in hospitals and long-term care facilities, according to new infection control advice for popular animal visitation programs. Therapy animals shouldn't be permitted access to patients' bathrooms, where they could pick up bugs like Clostridium difficile by licking surfaces or drinking from toilet bowls. And animals at high risk of carrying salmonella - turtles and dogs fed a raw food diet - should be barred from participating in animal therapy programs, the guidelines say. The lengthy list of recommendations, recently published in the American Journal of Infection Control, was the product of a consensus conference held in Toronto in January 2007. The conference, which drew in animal and human health experts, therapy animal program operators and infection control specialists, was sponsored by the Public Health Agency of Canada and the University of Guelph's Centre for Public Health and Zoonoses. (Zoonoses are the diseases that move back and forth between two-and four-legged animals.) The idea behind the guidelines is to minimize the risk that visiting animals will spread more than love as they make their way from patient to patient.

11% Dutch pork is contaminated with MRSA bacteria

Link: Pig Progress | Pig News | 11% pork is contaminated with MRSA bacteria.

A recent study carried out by the risk department of the Dutch Food and Consumer Product Safety Authority (VWA) revealed that 11% of meat products in the retail sector is contaminated with the hospital bacteria ‘MRSA’. In 84% of the cases, the nt-MRSA (non-typable MRSA), which affects pigs, calves and livestock farmers is present. MRSA is the name given to a group of bacteria that belong to the Staphylococcus aureus (SA) family of bacteria. The people who are most at risk of becoming either colonised or infected with MRSA are those in close contact with people who may be carrying the bacteria, for example in hospital wards that care for ill people. Nt-MRSA is a clone of MRSA. According to the Authority, meat does not contribute to the spread of the bacteria, which is resistant to most antibiotics. However, nt-MRSA can be spread where livestock is kept.

Pig MRSA spreading into humans in Holland

Link: First outbreak of methicillin-resistant Staphylococcus aureus ST398 in a Dutch hospital, June 2007.

In June 2007, MRSA was cultured from a diabetic foot ulcer of a patient on a surgical ward. Subsequent screening of contacts among patients and healthcare workers revealed four additional patients with MRSA infection and/or colonisation and five healthcare workers who carried MRSA. Two of the five affected patients (one with prostate carcinoma and one with a diabetic foot) were successfully decolonised with mupirocin nasal ointment, chlorhexidine wash, and treatment with trimetoprim/rifampicin. A further colonised patient with a gastro-intestinal malignancy and two patients with infected diabetic foot ulcers remained colonised, despite several decolonisation regimens. Of 238 healthcare workers who were screened, five were colonised in the nose and/or throat and had no skin conditions. All five have been treated with mupirocin nasal ointment and chlorhexidine wash and successfully decolonised. All strains were resistant to tetracycline and non-typable by PFGE. Spa-typing showed that all strains were spa-type t567. This spa-type corresponds to MLST type 398, a type previously found in pigs. None of the patients had had contact with pigs or veal calves. One healthcare worker lived on the grounds of a pig farm but neither she nor her partner came into contact with pigs themselves. While we presume that this health care worker was the source of the infection, this could not be proven. Permission to sample the pigs on this farm was not granted. Conclusions The NT-MRSA strain responsible for this outbreak was spa-type t567, which corresponds to MLST type ST398, the clonal complex to which most of NT-MRSA strains belong. This outbreak shows that transmission on a larger scale than a one-on-one transmission between caretaker and patient can occur with NT-MRSA in a hospital setting.

MRSA spreading from Animals to Humans

Link: HighWire Press -- Medline Abstract.

In 2003 in the Netherlands, a new methicillin-resistant Staphylococcus aureus (MRSA) strain emerged that could not be typed with Sma1 pulsed-field gel electrophoresis (NT-MRSA). The association of NT-MRSA in humans with a reservoir in animals was investigated. The frequency of NT-MRSA increased from 0% in 2002 to >21% after intensified surveillance was implemented in July 2006. Geographically, NT-MRSA clustered with pig farming. A case-control study showed that carriers of NT-MRSA were more often pig or cattle farmers (pig farmers odds ratio [OR] 12.2, 95% confidence interval [CI] 3.1-48.6; cattle farmers OR 19.7, 95% CI 2.3-169.5). Molecular typing showed that the NT-MRSA strains belonged to a new clonal complex, ST 398. This study shows that MRSA from an animal reservoir has recently entered the human population and is now responsible for >20% of all MRSA in the Netherlands.