MRSA, Mersa, Staph, Staff Infection, Treatment & Symptoms

Aggressive decolonizing cannot combat reinfection potential

Link: HighWire Press -- Medline Abstract.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that primarily manifests as uncomplicated skin and soft tissue infections. We conducted a cluster randomized, double-blind, placebo-controlled trial to determine whether targeted intranasal mupirocin therapy in CA-MRSA colonized soldiers could prevent infection in the treated individual and prevent new colonization and infection within their study groups. We screened 3447 soldiers comprising 14 training classes for CA-MRSA colonization from January to December 2005. Despite CA-MRSA eradication in colonized participants, this study showed no decrease in infections in the either mupirocin-treated individuals or within their study group. Furthermore, CA-MRSA eradication did not prevent new colonization within the study group.

'No Change' to Training after Marine's MRSA Toxin Death

Link: Scotsman.com News

The larger question is - are they going to test all his military collegues to try and discover thhe prevelance of CA MRSA in his troop

Training of Royal Marines will not change following the death of a teenage recruit infected with an MRSA-linked toxin, the Royal Navy said today. Richard Campbell-Smith, 18, died days after reportedly suffering cuts to his legs while on a run at the Commando Training Centre in Lympstone, Devon. His inquest heard the cause of death was Panton Valentine Leukocidin (PVL), a toxin linked to the “superbug” MRSA, which is thought to have entered his body through the scratches. A spokesman for the Health Protection Agency (HPA) today said PVL was “extremely rare”, adding: “It’s not something you’re routinely going to get running through brambles.”

Marine trainee killed by superbug in graze

Link: Marine trainee killed by superbug in graze.

A young soldier who died after scratching his leg on a bush while out running was killed by a mutated superbug, an inquest heard yesterday. Richard Campbell-Smith, 18, was training to become a Royal Marine when he picked up the deadly toxin. He was 28 weeks in to his 32-week programme at the Commando Training Centre at Lympstone, Devon, when he became ill after running on Woodbury Common on October 31 last year. It is thought the infection entered his bloodstream after he suffered bad blisters on his feet and cuts to his legs. Yesterday, the microbiologist who gave expert testimony at the inquest into his death said it was the worst bug she had ever seen. Dr Marina Morgan of the Royal Devon and Exeter hospital also revealed that she had seen two examples in nine weeks and wanted to alert the public and medical profession to the dangers. The lethal toxin - Panton-Valentine leukocidin (PVL) - has been recorded in America, France and Australia. It kills off white blood cells, leaving the victim unable to fight the infection and is often found in people who have contracted community acquired MRSA.

MRSA and CA MRSA the dominant SA infections

Link: Emerging Infections with Community-Associated Methicillin-Resistant Staphylococcus aureus in Outpatients at an Army Community Hospital..

The incidence of MRSA in our population increased from 12% of S. aureus isolates in 1998 to 43% in 2003. In 2003, MRSA was cultured from 76 different patients. Isolates of MRSA were often resistant to erythromycin (91%), although resistance to other agents was less common: Ciprofloxacin (14%), levofloxacin (14%), clindamycin (3%), tetracycline (3%), and trimethoprim sulfamethoxazole (1%). No isolates were resistant to vancomycin, gentamicin, nitrofurantoin, or rifampin. Six CA-MRSA isolates were compared by pulsedfield gel electrophoresis (PFGE). Five were PFGE type USA300, and one was PFGE type USA100, based on the U.S. Centers for Disease Control and Prevention (CDC) classification scheme. The five USA300 isolates carried SCCmec type IV, and the USA100 carried SCCmec II. None of the isolates were positive by PCR for genes encoding enterotoxins A-E and H, or toxic shock syndrome toxin (TSST-1), but the five USA300 isolates carried the gene coding for Panton-Valentine leukocidin toxin. Conclusions: The incidence of MRSA at our institution is increasing. Isolates of MRSA show resistance patterns and microbiologic characteristics consistent with CA-MRSA isolates from the United States. Clinicians should consider the possibility of CA-MRSA in patients with softtissue infections who do not respond to initial therapy with beta-lactam antimicrobial agents.

MRSA figures in Military Hospitals

Link: Mrsa: 21 Feb 2005: Written answers (TheyWorkForYou.com).

The majority of secondary care for armed forces personnel is now provided at Ministry of Defence Hospital Units (MDHUs) which are based within NHS Trust hospitals around the UK. MRSA numbers are now monitored by the Infection Control Teams of each NHS Trust under the direction of a Consultant Microbiologist, not the MOD. The Department therefore does not hold these records. Royal hospital Haslar is currently an exception to this. Since April 2001 it has been run in partnership with Portsmouth hospital Trust. The number of cases of MRSA at Royal hospital Haslar are only available from the year 2000. Due to reasons of medical confidentiality, numbers are not broken down below five.

Mrsa: 23 Feb 2005: Written answers (TheyWorkForYou.com)

Link: Mrsa: 23 Feb 2005: Written answers (TheyWorkForYou.com).

Simon Hughes (North Southwark & Bermondsey, LDem) Hansard source

To ask the Secretary of State for Defence what (a) advice has been given and (b) precautions are taken against the spread of MRSA" >MRSA in military ambulances; and if he will make a statement.

Ivor Caplin (Hove, Lab) Hansard source
The majority of secondary care for armed forces personnel is provided at Ministry of Defence hospital units within host NHS hospitals. Ambulances used for transfer fall under the local health authority and will adhere to the procedures and precautions laid down by the local health authority. Some military ambulances are retained by armed forces medical centres. Guidelines to prevent the spread of infection are provided at a single service level. These include staff protection and ambulance disinfection. The guidelines are in line with the current procedures recommended by the local health authorities.

Click link above for more

MRSA in Military Hospitals

Link: Mrsa: 21 Feb 2005: Written answers (TheyWorkForYou.com).

Simon Hughes (North Southwark & Bermondsey, LDem) Hansard source To ask the Secretary of State for Defence how many cases of MRSA" >MRSA have been recorded in Ministry of Defence hospitals since 1997; and if he will make a statement.

Click the link above for the answer

Bartlett Infectious Diseases Review

Link: Bartlett

This appears to be one of the few prospective studies of the natural history of colonization with CA-MRSA, and the conclusion is that it is associated with a high risk of soft-tissue abscess and furunculosis, which suggests that CA-MRSA is more virulent than MSSA. Of particular interest is the observation that 5 of the 6 subjects who were hospitalized due to the severity of soft-tissue infections had PVL-positive strains of CA-MRSA. The major risk for colonization was antibiotic use within the prior 6 months, which applied to 17 of 24 (71%) of the 24 colonized patients. This report adds to a gathering database on CA-MRSA that now shows rather consistently that this is clonal; the predominant strain in the United States is "USA 300" by molecular typing; the mechanism of methicillin resistance is mec IV; most strains are sensitive to multiple antibiotics other than beta-lactams, including TMP-SMX and tetracycline; most possess genes for production of PVL, which is a possible virulence factor; and the characteristic infections are predominantly soft-tissue abscesses and to a lesser extent necrotizing pneumonia superimposed on influenza. The importance of this report is that it supports the concept that nasal colonization is infrequent but poses a significant risk for subsequent soft-tissue infection that is often severe, requiring hospitalization and incisional drainage.

CA MRSA more virulent

HighWire -- Medline Abstract
In this prospective observational study, we evaluated 812 US Army soldiers to determine the prevalence of and risk factors for CA-MRSA colonization and the changes in colonization rate over time, as well as to determine the clinical significance of CA-MRSA colonization. Demographic data and swab samples from the nares for S. aureus Conclusions. CA-MRSA colonization with PVL-positive strains was associated with a significant risk of soft-tissue infection, suggesting that CA-MRSA may be more virulent than MSSA. Previous antibiotic use may play a role in CA-MRSA colonization.

Risk of MRSA among Military Trainees

Journal of Clinical Microbiology
Classical MRSA factors such as hospital visits or antibiotic use were not thought to be factors in the MRSA outbreak in a military camp. This extract hints at the causes but for those keen to know you will have to buy the entire article.

Risk Factors for Community-Associated MRSA among Military Trainees

Journal of Clinical Microbiology
An outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections was observed in a population of U.S. military trainees in the summer of 2002. A questionnaire was developed and administered to 206 trainees, 22 of whom had MRSA infections. Factors associated with infection were described by multivariable logistic regression modeling and included having a roommate in training with a prior skin infection (odds ratio [OR] = 3.44) or having a family member or friend who worked in a health care setting (OR = 2.79). Previous antibiotic use, hospitalization, or health problems were not associated with MRSA infection. This outbreak of MRSA skin infections in an otherwise-healthy, well-defined, military population provided an opportunity to describe risk factors for CA-MRSA which may help focus prevention efforts in this and other communities.

Community-Acquired MRSA in Soldiers

Medscape
MRSA in the military was only contained by a new hygiene routine. This article highlights the risk to all involved in physically traumatic environments and living in close proximity