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Link: Academic Emergency Medicine.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasingly common in the emergency department (ED). Institutional identification and alert generation of MRSA status from any source usually mean the maintenance of that alert in perpetuity. This has created an increase in use of empiric vancomycin therapy for patients with new infections and a previous MRSA alert. Objective: To determine the infectious etiology of wound cultures in patients with MRSA alerts presenting to the ED. Methods: This was a historical cohort study using an ED administrative database. All patients presenting to an urban Canadian tertiary care ED (60,000 visits/year) between Jan 2003 and Jan 2005 with a discharge diagnosis of skin and soft tissue infection (SSTI) (International Classification of Diseases, 9th Revision [ICD-9] 682.9) were included. Linkage with the hospital microbiology database allowed identification of a) all patients with a previous MRSA alert and b) culture results for those patients who had wound cultures while in the ED. Results: 144 patients with a preexisting MRSA alert had subsequent wound cultures in the ED. Of patients who were MRSA-positive >1 year, 34% were MRSA-positive on repeat culture versus 62.6% of those patients who were MRSA-positive for < 1 year (odds ratio [OR] = 3.2; 95% confidence interval [95% CI] = 1.4-5.7). In 76 patients with an existing MRSA alert who were diagnosed with cellulitis or abscess, 58% were MRSA-positive and 42% were MRSA-negative. Conclusions: MRSA alerts do not predict the likelihood of having MRSA-positive ED wound culture. The further the length of time from the generation of an MRSA alert, the greater the likelihood that the infection is not from MRSA.
Link: Mirror.co.uk
Mmmmmm ....... Back to medical school for the Mirror boys. How do they think the bug gets into the upper respitory tract where most colonization takes place?
SCARES over nasty new diseases could prove a goldmine for the people behind a website called medical-masks.co.uk, run by Berkshire company The Ability Organisation. It is touting surgical face masks on the back of bird flu, the SARS virus and hospital "superbug" MRSA, charging �19.99 plus VAT for a box of 50. Just so you know, the main route of infection for MRSA is through the skin - so a mask will be useless.
Link: Stuff.co.nz:
Australian scientists are warning family doctors to look out for virulent new strains of drug-resistant bacteria – a public health risk that is becoming a world-wide problem. Infection rates of the usually hospital-acquired infection MRSA, commonly called golden staph, have almost doubled in the community since 2000 in Australia, according to research published in this week's edition of The Australian Medical Journal. Researchers say those most at risk are people involved in contact sports such as rugby and wrestling. Christchurch microbiologist Ben Harris said MRSA was a worldwide problem and was already found in about 8 per cent of Auckland residents. Christchurch was fortunate to have very little community-acquired MRSA, he said. "It's partially good luck that's kept it out of Christchurch, partially good management and also geographical isolation. But it will come. It's like a weed." Harris said the huge volumes of antibiotics used in New Zealand and overseas – for medical purposes and in agriculture and horticulture – promoted antibiotic resistance in bacteria
Link: Tattoo, Piercing And Breast Implantation Infections.
The main health complications associated with piercing and tattooing include infections, pathologic healing, allergic reactions, tissue damages, bleeding and odonto-stomatologic lesions. Local bacterial infections are rare after tattooing but develop frequently from piercings, although they are usually minor. Between 10 to 20% of piercings are associated with local benign bacterial infection, according to the results of the few available studies on the topic. Typical symptoms of a local bacterial infection are redness, swelling, fever and pain. The main pathogens causing local infections, e.g. suppuration or abscesses, are Staphylococcus aureus, group A streptococcus and Pseudomonas spp. Impetigo has also been identified and is caused by Streptococcus pyogenes. These infections may become chronic and lead to local pyogenic granuloma (also called botryomycoma). Bacterial infections occurring as a result of piercing rarely spread and rarely lead to severe or life-threatening infections. Erysipelas and cellulitis have been observed with S. aureus and S. pyogenes aetiology. Anecdotal case reports of leprosy, tuberculosis, syphilis, chancroid and tetanus have also been published in recent years.
Link: Sniffing out superbugs.
Scientists at the Society for General Microbiology’s 158th Meeting at the University of Warwick, UK, heard today that one in five people carries a permanent dose of the superbug and another three in five have it sometimes. The organisms are usually harmless but become dangerous when they get into the bloodstream through injury - especially when the victim may have been weakened by surgery or illness. A research team led by Professor Tim Foster from the Moyne Institute of Preventative Medicine at Trinity College, Dublin, experimented with ways to prevent a protein on the surface of the superbug - called clumping factor B - sticking to nasal skin cells. They found that vaccinating mice with variations and extracts from clumping factor B strongly reduced the amount of bacteria in their noses, raising hopes of a similar approach for humans. "This would give us a non-antibiotic method of preventing hospital staff and patients from carrying the bacteria in their noses, or at least reducing the amounts of bacteria they can spread," Professor Foster said.
Link: Annals of Family Medicine.
An estimated 86.9 million persons (32.40% of the population) were colonized with S aureus. The prevalence of MRSA among S aureus isolates was 2.58%, for an estimated population carriage of MRSA of 0.84% or 2.2 million persons. Among individuals with S aureus isolates, individuals aged 65 years or older had the highest MRSA prevalence (8.28%). Among all the racial/ethnic groups studied, Hispanics had the highest prevalence of colonization with S aureus but, when colonized, were less likely to have MRSA.
Link: Nephrology Dialysis Transplantation.
Methicillin-resistant Staphylococcus aureus (MRSA) infections have represented a serious burden in the USA and in Japan for years [1,2]. The incidence of MRSA is especially high in intensive care units (ICUs). MRSA is also becoming more prevalent in Europe, but with significant differences in the frequency of MRSA between single countries [3]. Patient-to-patient transmission in healthcare settings, usually via contaminated hands, clothes, or equipment of healthcare workers, has been a major factor accounting for the increase in MRSA incidence and prevalence in acute care facilities. More and more patients become MRSA-positive,
Link: Infection and Immunity.
The primary niche for S. aureus in humans is the nares, and nasal carriage is a documented risk factor for staphylococcal infection. Previous studies with rodent models of nasal colonization have implicated capsule and teichoic acid as staphylococcal surface factors that promote colonization. In this study, a mouse model of nasal colonization was utilized to demonstrate that S. aureus mutants that lack clumping factor A, collagen binding protein, fibronectin binding proteins A and B, polysaccharide intercellular adhesin, or the accessory gene regulator colonized as well as wild-type strains colonized. In contrast, mutants deficient in sortase A or clumping factor B (ClfB) showed reduced nasal colonization. Mice immunized intranasally with killed S. aureus cells showed reduced nasal colonization compared with control animals. Likewise, mice that were immunized systemically or intranasally with a recombinant vaccine composed of domain A of ClfB exhibited lower levels of colonization than control animals exhibited. A ClfB monoclonal antibody (MAb) inhibited S. aureus binding to mouse cytokeratin 10. Passive immunization of mice with this MAb resulted in reduced nasal colonization compared with the colonization observed after immunization with an isotype-matched control antibody. The mouse immunization studies demonstrate that ClfB is an attractive component for inclusion in a vaccine to reduce S. aureus nasal colonization in humans, which in turn may diminish the risk of staphylococcal infection. As targets for vaccine development and antimicrobial intervention are assessed, rodent nasal colonization models may be invaluable.
Link: Practical experience
Purpose: To present the range of diseases produced by a methicillin-resistant strain of Staphylococcus aureus (MRSA). To assess the efficacy of procedures likely to cure MRSA infections and possibly to eradicate colonization. Methods: Clinical trial studying the course of MRSA infections or colonization of in-patients, treated at the Department of Infectious Diseases of the Teaching Hospital Na Bulovce, Prague, between 1 January 2004 and 31 August 2005. The trial also took into account the results of these patients follow-up as out-patients. Results: Included in the trial were 59 patients-22 presenting MRSA infections and 37 MRSA colonization. In 14 patients we found simultaneous colonization in several anatomical sites, while in 15 patients we saw, in addition to the MRSA infection, colonization at another site. Among the infections most frequent were infections of soft tissues (11), while colonization occured chiefly in the nasal mucosa (14) and in skin defects (8). In the treatment of mild infections we had good results with co-trimoxazole, in the treatment of colonizations mupirocine in the form of ointment (Bactroban ung.). During a six-month follow-up of 25 MRSA-positive patients at our Out-patient Dpt. we saw the disappearance of the MRSA strain in 7 subjects (28 %). Conclusion: In a significant proportion of MRSA-positive patients the MRSA strain disappears either after treatment or spontaneously. The development of MRSA colonization may be studied in out-patient follow-up.
Link: Journal of Clinical Microbiology.
By analyzing the colonization of the anterior nares in cardiothoracic surgery patients on admission, nasal cocolonization by methicillin-susceptible Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci was detected in 8/235 (3.4%) specimens. Consequently, in a low-methicillin-resistant S. aureus (MRSA) setting, a molecular MRSA screening test targeting the mecA gene and an S. aureus-specific gene in parallel and applied directly to clinical specimens would be associated with an unacceptable positive predictive value of about 40%.
Link: HighWire Press -- Medline Abstract.
In the last few years, a dramatic increase of Methicillin-resistant Staphylococcus aureus (MRSA) detection in German hospitals can be recognized. Under this enormous pressure it is very important for infection control teams to assess the epidemiologic situation correctly. Therefore, a prospective multicenter hospital-based surveillance of MRSA cases was executed in four university hospitals with 1017-1333 beds in Germany. Routine surveillance data were recorded of all patients with MRSA isolates from clinical samples or screening cultures. Patients had been colonized or infected with MRSA during their hospital stay. In 2002 between 183 and 291 MRSA cases were treated in the respective hospitals (between 0.53 and 0.96 MRSA cases per 1000 patient days). Of these, 44.4% were MRSA infections. The most frequent type of MRSA infections were wound infections (56.9%) followed by pneumonia (21.0%) and bloodstream infections (15.1%). Of the infected patients 51.5% were already infected at admission. The median duration of isolation of MRSA patients in private rooms was between 11 and 16 days. Altogether 21,665 isolation days were observed in four hospitals; this means 1.52% of all patient days. On average, 9.0% of roommates were identified as MRSA carriers. Due to the high percentage of imported cases, the four university hospitals introduced a general screening for MRSA at admission in all ICUs and some further departments as well as an automatic alert system for readmitted patient with MRSA during their last hospital stay.
Link: News & Star.
This doesn't mean the figures are the same in the general population - but it suggest the scale of the challenge
NEARLY one in ten of the patients admitted to north Cumbria’s community hospitals over a three-month period were carrying the MRSA superbug, a survey has revealed. Health chiefs carried out the survey in an attempt to uncover the hidden scale of the MRSA problem at cottage hospitals in Alston, Brampton, Cockermouth, Millom, Keswick and Maryport. They found that 42 patients whose infections may have remained undetected were carrying the bug. In a report considered by north Cumbria Primary Care Trust, which manages the hospitals, healthcare governance director Tina Long underlined why the survey was needed. She wrote: “This information reinforces the need for standard infection control precautions to be taken with all patients and clients, and will lead to increased vigilance by ward staff.” In all cases, the infected patients were successfully treated and the risk of cross-infection reduced.
Link: BMJ.
...... but few develop infection. The report below is supposed to offer comfort - few develop full blown infection. But it's chilling because it casually mentions staff as infection agents and the possibility of high rates in the general population. The bigger the colonisation pool the more likely that some of us will succumb.
A significant proportion (50%) of MRSA from blood cultures, in patients newly admitted to hospital, were not suggestive of generalised infection. The source of the MRSA could be skin colonisation of the patient contaminating the blood cultures, or even the medical or nursing staff taking the blood cultures in the hectic environment of acute admissions. The 49% contamination rate for all blood cultures in accident and emergency further supports these results. These data highlight that blood culture results should be interpreted in context with the patient's general condition, subsequent progress, and MRSA status determined by screening.
Link: Growth in Cecal Mucus
Intestinal colonization by methicillin-resistant Staphylococcus aureus (MRSA) is common in some groups of hospitalized patients and has been associated with an increased risk of staphylococcal infection. We tested the hypothesis that growth of MRSA in the colonic mucus layer is required for establishment of intestinal colonization. Mice treated with oral streptomycin before oral administration of MRSA developed persistent intestinal colonization, and the cecal mucus layer contained high concentrations of MRSA. MRSA strains grew rapidly when inoculated into cecal mucus in vitro but were unable to replicate under anaerobic conditions in cecal contents of saline- or streptomycin-treated mice. Oral vancomycin treatment reduced the density of 1 MRSA strain in stool but had no effect on a second strain. These results suggest that the cecal mucus layer provides an important niche that facilitates intestinal colonization by MRSA. Oral nonabsorbed antibiotics may be ineffective in eradicating some MRSA strains from the intestinal tract.
Link: HighWire Press -- Medline Abstract.
OBJECTIVES: To describe an outbreak of hospital-acquired MRSA in a NICU and to identify the risk factors for, outcomes of, and interventions that eliminated it. SETTING: An 18-bed, level III-IV NICU in a community hospital. METHODS: Interventions to control MRSA included active surveillance, aggressive contact isolation, and cohorting and de-colonization of infants and HCWs with MRSA. A case-control study was performed to compare infants with and without MRSA. RESULTS: A cluster of 6 cases of MRSA infection between September and October 2001 represented an increased attack rate of 21.2% compared with 5.3% in the previous months. Active surveillance identified unsuspected MRSA colonization in 6 (21.4%) of 28 patients and 6 (5.5%) of 110 HCWs screened. They were all successfully decolonized. There was an increased risk of MRSA colonization and infection among infants with low birth weight or younger gestational age. Multiple gestation was associated with an increased risk of colonization (OR, 37.5; CI95, 3.9-363.1) and infection (OR, 5.36; CI95, 1.37-20.96). Gavage feeding (OR, 10.33; CI95, 1.28-83.37) and intubation (OR, 5.97; CI95, 1.22-29.31) were associated with increased risk of infection. Infants with MRSA infection had a significantly longer hospital stay than infants without MRSA (51.83 vs 21.46 days; P = .003). Rep-PCR with mec typing and PVL analysis confirmed the presence of a single common strain of hospital-acquired MRSA. CONCLUSION: Active surveillance, aggressive implementation of contact isolation, cohorting, and decolonization effectively eradicated MRSA from the NICU for 2 1/2 years following the outbreak.
Background. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of disease. This study is a cross-sectional survey and molecular epidemiologic analysis of nasal colonization by S. aureus in homeless and runaway youths, an underserved population at high risk for staphylococcal disease.Results. Of the 308 study participants, 27.6% carried S. aureus, and 6.2% carried MRSA. Subgroups of individuals with increased MRSA carriage rates were also at highest risk for community-associated MRSA infection; these subgroups included individuals with either HIV infection or AIDS, injection drug users, patients with abscesses, and those recently hospitalized. .Conclusions. Comparison of MRSA strains from asymptomatic carriers versus concurrently collected community-associated clinical strains from patients treated at local health-care facilities allowed for the identification of 3 population dynamics of nasal strains of MRSA: (1) endemic clones--for example, ST8:C and ST59:P--sustained asymptomatic carriage and infection over prolonged periods; (2) an epidemic clone, ST8:S, demonstrated enhanced capacity for rapid transmission and widespread infections; and (3) an outbreak clone, ST30:Z (USA1100), was highly infectious but exhibited poor asymptomatic transmission.
Link: Scotsman.com
Much of the MRSA in our hospitals is due to a vicious circle of re-admission of patients who acquired MRSA in a recent hospital admission but were discharged with no symptoms and without it ever being diagnosed. Between 1 and 5 per cent of people being admitted to acute hospitals are probably currently colonised with MRSA, and at least 50 per cent of these are not known about prior to admission screening. With the most rapid possible turnaround of admission swabs by conventional methods, it is often still 48 hours before we are able to identify and barrier-nurse patients who are shown to be MRSA positive. A lot of cross-infection can occur in that period, so new guidelines encourage a risk assessment, with proactive separation of high-risk patients immediately after this assessment on admission. It can easily be seen how rapid molecular-based screening for MRSA on admission would be a major help, with results available in two to four hours. A related, unresolved issue is whether long-stay patients should be screened regularly, perhaps weekly, if they are at high risk of acquiring MRSA, and whether patients should routinely be screened at discharge with a view to "decolonisation" if they are shown to be carrying MRSA. Up to 10 per cent of patients discharged to the community could be colonised with MRSA and yet not display any symptoms.
Link: Antimicrobial Agents and Chemotherapy.
Nasal carriage of Staphylococcus aureus is an important risk factor for S. aureus infections. Mupirocin nasal ointment is presently the treatment of choice for decolonizing the anterior nares. However, recent clinical trials show limited benefit from mupirocin prophylaxis in preventing nosocomial S. aureus infections, probably due to (re)colonization from extranasal carriage sites. Therefore, we studied the effectiveness of mupirocin nasal ointment treatment on the dynamics of S. aureus nasal and extranasal carriage. Twenty noncarriers, 26 intermittent carriers, and 16 persistent carriers had nasal, throat, and perineum samples taken 1 day before and 5 weeks after mupirocin treatment (twice daily for 5 days) and assessed for growth of S. aureus. The identities of cultured strains were assessed by restriction fragment length polymorphisms of the coagulase and protein A genes. The overall carriage rate (either nasal, pharyngeal, or perineal carrier or a combination) was significantly reduced after mupirocin treatment from 30 to 17 carriers (P = 0.003). Of the 17 carriers, 10 (60%) were still colonized with their old strain, 6 (35%) were colonized with an exogenous strain, and 1 (5%) was colonized with both. Two noncarriers became carriers after treatment. The acquisition of exogenous strains after mupirocin treatment is a common phenomenon. The finding warrants the use of mupirocin only in proven carriers for decolonization purposes. Mupirocin is effective overall in decolonizing nasal carriers but less effective in decolonizing extranasal sites.
Link: HighWire Press -- Medline Abstract.
This was a case-control study. MRSA carriage was identified in 102 of 127 residents of the facility's nursing unit. Two swabs were taken: one from the anterior nares and one from the largest skin lesion. If no skin lesions were present, the axillae and the groin area were swabbed. Data were collected regarding gender, age, length of stay in the facility, underlying conditions, functional status, presence of wounds or pressure sores, presence of catheters, antibiotic treatments, and hospital admissions. RESULTS: We detected MRSA in 12 participants. Risk factors independently and significantly associated with MRSA colonization on the multivariate analysis were antibiotic treatments within 1 month before the investigation (odds ratio, 5.087; 95% confidence interval, 1.02 to 25.48; P = .048) and multiple hospital admissions in the 3 months before the investigation (odds ratio, 6.277; 95% confidence interval, 1.31 to 30.05; P = .022). CONCLUSIONS: This is the first assessment of risk factors for colonization with MRSA in an LTCF in Slovenia. MRSA poses a problem in this LTCE Our observations may be valuable in implementing active surveillance cultures in infection control programs in Slovenian LTCFs.
could kill MRSaLink: Control of MRSA rates in hospitals - Comment - Times Online.
The overall colonisation of patients is far higher. Stopping patients from developing bacteraemia is one thing (and not to be disparaged) but it is far more important to develop ways of stopping the spread of skin contamination, and I fear that this latter is actually a worsening problem. On my unit we have, for over three years, operated a strict policy of exclusion or isolation if transfer is unavoidable. Together with a strict treatment policy, this has kept the prevalence of MRSA to very low levels — all the more remarkable because patients with chronic neurological diseases are a high-risk group. Protocols such as these are unachievable on general wards if staff numbers are low and where pressures on acute beds result in frequent moves of patients between wards.
Link: HighWire Press -- Medline Abstract.
The aim of this study was to measure the rate of Staphylococcus aureus nasal colonization among attendees of the 13th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), particularly with regard to methicillin-resistant (MRSA) strains. The 31.4% rate of Staphylococcus aureus colonization detected among the participants was in line with colonization rates reported previously for healthcare workers. A statistical difference was found between the rates of Staphylococcus aureus carriage in physicians (37.4%) and non-physicians (21.7%) but not between males (35.0%) and females (28.9%). Only one participant (a Belgian physician) was found to carry MRSA. Surprisingly, the rate of methicillin-susceptible Staphylococcus aureus carriage was significantly higher among participants from countries with a low prevalence of MRSA.
Link: HighWire Press -- Medline Abstract.
This is actually quite a major item if it can be supported by other research. It seems to suggest that patients are not getting MRSA from cross contamination from other patients during a hospital stay and that other factors need to be considered.
During a 10-week period, surveillance cultures were performed for 158 patients. Fifty-five patients (34.8%) were colonized with MSSA, and 9 (5.7%) were colonized with MRSA. Sixty-two patients were colonized before admission to the hospital (53 had MSSA, and 9 had MRSA). Two patients appeared to have acquired MSSA in the MICU, but, on the basis of genotyping analysis, we determined that this was not the result of cross-acquisition. CONCLUSION: Surveillance cultures and genotyping of MRSA and MSSA isolates demonstrated the absence of cross-transmission among patients in the MICU, despite ongoing introduction of these pathogens. Reporting culture results and isolating colonized patients, as suggested by some guidelines, would have falsely suggested the success of such infection-control policies.
Link: HighWire Press -- Medline Abstract.
The present study demonstrates that the nasal carriage rate of Staphylococcus aureus was 40% in Jordanian healthy young adult population, and 19% of nasal S. aureus and 57% of clinical isolates over the same period were resistant to oxacillin (MRSA), respectively. The mecA gene was detected in all MRSA isolates in both groups. Most of MRSA isolates were multiresistant to three antibiotic classes (beta-lactams, aminoglycosides, macrolides-lincosamides). This result suggests a serious problem may be encountered in treatment of staphylococcal infections in Jordan.
Link: Journal of Clinical Microbiology.
A total of 1,838 subjects from the community and 393 subjects from health care-related facilities in Taiwan were evaluated for the prevalence of nasal Staphylococcus aureus colonization and to identify risk factors associated with S. aureus and methicillin-resistant S. aureus (MRSA) colonization. In conclusion, a high prevalence of MRSA colonization was observed among people with no relationship to the hospital setting. The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics in Taiwan highlights the importance of the problem of antibiotic selective pressure. Our results indicate that both the clonal spread of MRSA and the transmission of hospital isolates contribute to the high MRSA burden in the community.
Link: HighWire Press -- Medline Abstract.
In conclusion, a high prevalence of MRSA colonization was observed among people with no relationship to the hospital setting. The high level of multiple-drug resistance among community MRSA strains in association with the previously reported excessive use of antibiotics in Taiwan highlights the importance of the problem of antibiotic selective pressure. Our results indicate that both the clonal spread of MRSA and the transmission of hospital isolates contribute to the high MRSA burden in the community.
Link: HighWire Press -- Medline Abstract.
Although reports of isolation of methicillin-resistant Staphylococcus aureus (MRSA) from patients admitted from the community have increased, few studies have investigated colonization of healthy subjects. This study aimed to determine community levels of MRSA in Hong Kong. Nasal swabs from a cross section of young adults and family units were cultured for MRSA. Antibiotic sensitivities and risk factors for carriage were determined and clonal relationships were investigated by pulsed-field gel electrophoresis (PFGE). Overall carriage was low (1.4%), and associated with health-care exposures (OR 13.56, 95% CI 1.11-165.21). Subjects working in health care yielded multi-resistant MRSA strains, but isolates from non-hospital-exposed subjects were methicillin-resistant only.
Link: HighWire Press -- Medline Abstract.
MRSA isolates were also significantly higher among S. aureus isolates from the nasal cavities of urban subjects (22.98%) as compared to rural ones (11.11%). Maximum nasal carriage was present in the age group upto 9 years (20.23%) with decrease in the age groups 10-19, 20-29 and 30-39 years followed by small rise in the older subjects. Conclusion: The nasal S. aureus carriage as well as methicillin resistance among these isolates are more common in urban community.
HighWire -- Medline Abstract
A study has been carried out at a large teaching hospital to estimate how often the gloves of a healthcare worker are contaminated with MRSA after contact with a colonized patient. The effectiveness of handwashing procedures to decontaminate the health professionals' hands was also investigated, together with how well different healthcare professional groups complied with handwashing procedures. The study showed that about 17% (9-25%) of contacts between a healthcare worker and a MRSA-colonized patient results in transmission of MRSA from a patient to the gloves of a healthcare worker. Different health professional groups have different rates of compliance with infection control procedures. Non-contact staff (cleaners, food services) had the shortest handwashing times. In this study, glove use compliance rates were 75% or above in all healthcare worker groups except doctors whose compliance was only 27%.
MRSA colonization of nares, either present at admission to the hospital or acquired during hospitalization, increases the risk for MRSA infection. Identifying MRSA colonization at admission could target a high-risk population that may benefit from interventions to decrease the risk for subsequent MRSA infection
This short extract is from a longer study on those entering hospital with MRSA colonisation. Well worth a read - backs up the screening and iisolation strategy.
Scotsman.com News - Scotland - Aberdeen - Geriatric ward closes after superbug colonises patients
A GERIATRIC ward at an Aberdeenshire hospital has been closed to new admissions because of an outbreak of the potentially fatal superbug, MRSA among the elderly patients. Eight of the 13 patients in the Ravenscraig ward at the Ugie Community Hospital in Peterhead have been found to be carriers of the bacteria, although none of the patients is actually infected. It is the first outbreak of its kind in a hospital in the Banff and Buchan area.
A spokesman for NHS Grampian stressed yesterday that none of the patients was suffering illness as a result of carrying the potentially fatal bacteria. He said: "These patients have been colonised by the bacteria. They are carrying the bug rather than being infected by MRSA." The spokesman continued: "The ward is operating normally, although we are not admitting any new patients. "Routine hygiene precautions are being taken. Visitors to the ward are very welcome and we are asking them to wash their hands before they arrive and to wash their hands after they leave." He added: "The other patients in the ward have not been isolated. There is a huge difference between colonisation and having MRSA infection."
HighWire -- Medline Abstract
This study in a maternity context examines the impact of chlorhexidine in hygiene processes
HighWire -- Medline Abstract
This Tiawanese study suggested that all the children treated had the same strain of MRSA. All of these studies beg the question as to what the health authorities are doing to help avert a situation where the majority of the population are colonised by MRSA
This is what one Liverpool doctor claims:
He insisted the high infection rate was partly because of patients who are referred to the centre who already have the virus. "Broadly speaking, half of the patients who have MRSA are admitted with it. We are not in a position to refuse these patients because they have MRSA." He later told the Daily Post that his long-term aim was to have 50% of beds in both the old and new sections of the hospital in individual bedrooms.Click the link for the whole story
Journal of Antimicrobial Chemotherapy
Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) often colonize the anterior nares, and nasal carriage remains the main source of bacterial dissemination. The aim of this study was to assess the in vivo activity of the lantibiotic mersacidin against MRSA colonizing nasal epithelia.
Methods: The efficiency of mersacidin in the eradication of MRSA was tested employing mice pre-treated with hydrocortisone and inoculated intranasally either three or six times with a bacterial suspension.
Results: In mersacidin-treated animals, pre-colonized with MRSA, bacteria could not be detected in blood, lungs, liver, kidney, spleen or nasal scrapings and there were no lesions manifested after intraperitoneal drug application. Blood samples from infected mice obtained 2 h after mersacidin therapy revealed anti-MRSA activity in a serum bactericidal test. Moreover, elevated interleukin-1ß and tumour necrosis factor-{alpha} titres were noticed in the pre-infected but not in cured animals. In contrast, mersacidin did not induce differences in the cytokine profiles of treated uninfected control mice.
ICDDR,B: Publication
The nasal carriage of S. aureus was 29.6% among the healthy individuals, while it was 44.4% among the healthcare workers. The colonization rate may range from 10% to more than 40% in normal adult population (7). Our figure of 29.6% correlates well within this. The nasal colonization rate of 44.4% is on the higher side probably due to nosocomial exposure among the healthcare workers. Data reported in other studies in tertiary care centres show a similar incidence
J. Antimicrob. Chemother
In the mouse rhinitis model, mersacidin was able to eradicate MRSA colonization. The site of action (epithelium versus blood) of mersacidin needs to be further explored.
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)
