MRSA (Mersa, Staph) Questions

MRSA: The issues for Gay Men

Link: MRSA: An Update on Virulent Staph Infection :: EDGE Boston.

What is known is that MRSA is a particularly virulent form of staph that has indeed made inroads in the gay world in recent years. While it has taken a toll generally--100,000 cases with a scary 25 percent of those cases resulting in death--gay me have been coming down with MRSA in large numbers. Experts attribute this a few factors. First of all, let’s face it: It’s true that many gay men have more sex than some other people. And MRSA can be transmitted through sexual contact, just as it can from any skin-on-skin contact. Also, MRSA is one of the many diseases that HIV-positive people are more likely to contract. Gay men also like to go to the gym and are known to frequent steam rooms and saunas--all excellent carriers of MRSA. Dr. Douglas Gurley, an Atlanta doctor with a mostly gay practice, points to shaving the groin, which exposes it to infection. And finally, gay men are more proactive in their health, so they notice and get treated for MRSA.

Doctors concern over USA 300 in European gay community

Link: Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008.

CA-MRSA "USA300", the most widely spread CA-MRSA strain in the US [6], has been detected in Germany since 2005 [7]. This clonal lineage is characterised by multilocus sequence type (MLST) ST8, spa-sequence type t008, SCCmec IVa, the presence of an additional arginine decomposition pathway (arginine catabolic mobile element (ACME) on a staphylococcal cassette chromosome (SCC)-element) with arcA as marker gene, and macrolide-resistance coded by the msrA (efflux pump) and mphB (phosphorylation) genes [7,8]. The contribution of ACME to virulence has been shown in a rabbit model [9]. The capacity of CA-MRSA "USA300" to cause invasive infections seems not to be due to production of the Panton-Valentine leukocidin cytotoxin, but rather to the synthesis of a large number of small phenol-soluble peptides, which are able to recruit and lyse neutrophilic granulocytes [10]. Here we report a case of infection with CA-MRSA ST8 ("USA300") in an HIV-positive 35-year-old MSM patient in Cologne, Germany. The isolate originated from an infected cyst in the upper abdominal area, which opened spontaneously. The patient suffered from acquired immunodeficiency syndrome (AIDS). His CD4+ T-cell count was 200/microlitre with a fully suppressed virus load due to HIV treatment. A specimen from the cyst was taken for microbiological diagnostics. Primary topical treatment was performed by instillation of Leukase beads containing trypsin, framycetin sulphate and lidocaine hydrochloride (Merck, Vienna). After obtaining the microbiology results, oral doxycyclin (200 mg per day) was included in the treatment. The infection had healed completely after 14 days. Nasal swabs were negative for MRSA. The isolate exhibited the typical characteristics of CA-MRSA ST8 ("USA300", see above). It was resistant to oxacillin, erythromycin, ciprofloxacin, moxifloxacin and susceptible to gentamicin, oxytetracycline, clindamycin, rifampicin, cotrimoxazole, fusidic acid, linezolid, fosfomycin, tigecycline and daptomycin. As shown in the US, CA-MRSA ST8 ("USA300") may spread rapidly in MSM communities [3]. European doctors caring for HIV-positive patients and MSM with skin and soft tissue infections should be aware of the possibility of CA-MRSA in order to provide proper care and prevent further spread. Targeted measures include proper bacteriological diagnosis of skin and soft tissue infections in patients attending dermatological and surgical practises, as well as in HIV-positive patients. When MRSA is detected, it is likely that the infection is caused by a CA-MRSA strain. Early recognition of CA-MRSA ST8 ("USA300") is possible by PCR detection of the lukS-lukF and arcA genes [11]. Confirmation is obtained by additional typing such as spa-typing, MLST, and SCCmec [7]. Further spread can be prevented by personal, environmental and health care hygienic measures [12,13].

Gay and bi men’s health forum addresses MRSA

Link: Gay and bi men’s health forum addresses MRSA, HIV and increasing syphilis rates :: EDGE Boston.

A Feb. 13 health forum at Club Café sponsored by Fenway Community Health proved that there’s a fine line between keeping medical providers informed about issues in gay and bi men’s health and perpetuating anti-gay stereotypes. At the top of the forum’s agenda was Methicillin-resistant Staphylococcus aureus, more commonly known as MRSA. Last month international media reported on a study showing that gay and bi men in Boston and San Francisco were at higher than average risk for acquiring a multi-drug resistant form of MRSA, which causes abscesses and ulcerations and which if left untreated can be life-threatening, and that among those men it may have been sexually transmitted. Critics at the time argued that many of those stories sensationalized the study and played into the stereotype of gay men as spreaders of disease (see "MRSA media panic," Jan. 24, 2008). Panelists at the Club Café dialogue critiqued the media coverage and talked about the myths and realities of MRSA within the gay community. But the Fenway’s Dr. Ken Mayer, one of the researchers involved in the study and one of the evening’s panelists, said his colleagues at University of California-San Francisco had good intentions in publicizing the study. He said the publicity was aimed at clinicians to make them aware that their gay and bi male patients infected with MRSA may have the multi-drug resistant strain and that they should take that into account when determining how to treat the infection.

After linking new strain of staph to gay men, university scrambles to clarify

Link: After linking new strain of staph to gay men, university scrambles to clarify - International Herald Tribune.

I think we were looking at this from a scientific point of view and not projecting any political impact," he said. "We were focusing on the data. You want to make sure it's as right as possible and written up in a form that reviewers would understand what you're trying to say, and do it in a clear manner so it's not subject to misinterpretation. Which is what happened later, it appears." One of the major sore points for some critics was a quote attributed to the report's lead author, Bien Diep, a researcher who said he was concerned about "a potential spread of this strain into the general population." Diep, 29, said on Friday he regretted not being more thorough in communicating his research to reporters. He said that the term "general population" was part of medical jargon used in the report, which did not translate well.

New USA300 strain the New HIV

Link: BBC NEWS | Health | Deadly new form of MRSA emerges.

Professor Mark Enright, from Imperial College and St Mary's Hospital, London, Britain's leading authority on MRSA, said: "It's quite surprising that the figures are so high. "We do know that the USA300 strain is extremely good at spreading between people through skin-to-skin contact. "The main reservoir for this infection is gay men, drug users, and those involved in contact sports, like wrestling. Having lots of sexual partners and making skin contact with a large number of different people helps the infection to spread. "In the US it is already moving into the wider community." Roger Pebody, of the Terrence Higgins Trust, said: "This is not the new HIV. "What we are seeing is the emergence of an infection that can be passed on through close skin to skin contact, including sex. "It is worrying that one in ten of the American cases are resistant to antibiotics, but most cases are treatable."

2 cases of Extra Strength CA MRSA in UK

Link: 'Flesh-eating' MRSA strain threatens Britain - Telegraph.

Although only two cases of the lethal strain - which is a new form of a recently identified MRSA strain known as USA300 - have been recorded in the UK, experts fear it may only be a matter of time before it becomes established in Britain.

Super strength CA MRSA clustered in SF gay community

Link: Aidsmap | New multi-drug resistant MRSA strain disproportionately affecting gay, HIV-positive men.

Overall incidence of MRSA in San Francisco was estimated to be 275 cases per 100,000 people. However, overall the incidence of the newly-identified multidrug-resistant MRSA was much lower, at 26 cases per 100,000. When the investigators examined the incidence of multidrug-resistant MRSA based on the area of residence within San Francisco, they found that the highest incidence of multidrug-resistant MRSA (170 cases per 100,000) was in the zip code that included the Castro district, which has a higher proportion of gay men than any other part of San Francisco. They then examined the prevalence of multidrug-resistant MRSA in the 183 HIV-positive patients with MRSA at a San Francisco HIV clinic, and found that 30 (16%) were infected with multidrug-resistant MRSA. In multivariate analysis, sex between men was a highly statistically significant risk factor for having multidrug-resistant MRSA (relative risk, 13.2; p < 0.001).

New MRSA strain resisting more drugs

Link: Aidsmap | New multi-drug resistant MRSA strain disproportionately affecting gay, HIV-positive men.

A 2006 study tracking MRSA infections in patients admitted to an HIV hospital ward in San Francisco between 1996 to 2005, found that one community-acquired strain, USA300, first identified in 2002 made up 93% of MRSA by 2005. The current study has found a multidrug-resistant genotype of this MRSA strain that is resistant to treatment with pencillins, erythromycin, clindamycin, tetracycline, mupirocin, and Cipro-like antibiotics. However, it is still susceptible to older antibiotics, such as co-trimoxazole and may also resolve by simply draining the infected boil without the use of any antibiotics. Only in the most extreme – and rare – cases is the infection life-threatening.

New MRSA Superbug More Prevalent Among Sexually Active Gay Men

Link: New MRSA Superbug More Prevalent Among Sexually Active Gay Men.

The study was in two parts: a population-based survey of 9 San Francisco hospitals and a cross-sectional study in 2 outpatient clinics in San Francisco and Boston. The data reviewed related to culture proven cases of MRSA infections spanning 2004 to 2006. The researchers looked for: risk factors, annual incidence and spatial clustering for infection by multidrug-resistant USA300. The strain of MRSA in the samples were identified using a range of methods such as: DNA sequencing (establishing the pattern of nucleotides in the DNA), polymerase chain reaction assays (amplifying DNA to help identify it), and pulse field gel electrophoresis (looking at very large DNA molecules). The results for San Francisco showed that:     * The overall incidence of USA300 infection in San Francisco was 26 cases per 100,000 of the population (ranging from 16 to 36).     * The incidence was higher in 8 adjacent neighbourhoods (identified by ZIP codes) that had a higher proportion of male same-sex couples.     * Men who have sex with men were 13 times more likely to be infected with USA300.     * This risk was independent of previous history of MRSA infection or use of clindamycin (an antibiotic used to treat MRSA).     * The risk also appeared to be independent of HIV infection.     * USA300 infection mostly occurred in the buttocks, genitals, or perineum (the area between the anus and the penis). The results for Boston showed that multi-drug resistant USA300 strains were recovered only from men who have sex with men.

HIV males - 1 in 3 with MRSA suffer chronic infection

Link: Arch Intern Med -- High Recurrence Rate of CA-MRSA Skin and Soft Tissue Infections, Dec 10/24, 2007, Skiest and Cooper 167 (22): 2527.

We read with interest the study by Shastry et al1 describing community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) in men who have sex with men. Their study included 100 men with SSTIs due to MRSA; the majority of their cohort was seropositive for human immunodeficiency virus (HIV) (mean CD4 cell count, 497 cells/�L). Shastry et al1 report a high rate of recurrent MRSA SSTIs; 27 of 87 patients (31%) had a recurrence, of which 18 had a recurrence at a new site. Thus, 21% had a recurrence of MRSA SSTI at a new site.