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

Blood changes test can help stop sepsis before it begins

Link: The pre-symptomatic prediction of sepsis in intensive care unit patients: a pilot study -- Lukaszewski et al., 10.1128/CVI.00486-07 -- Clinical and Vaccine Immunology.

Post-operative or post-traumatic sepsis remains one of the leading causes of morbidity and mortality in hospital populations, especially in populations in intensive care units (ICUs). Central to the successful control of sepsis-associated infections is the ability to rapidly diagnose and treat disease. The ability to identify sepsis patients before they show any symptoms would have major benefits for the healthcare of ICU patients. In this study ninety-two ICU patients, who had undergone procedures that increased the risk of developing sepsis, were recruited upon admission. Blood samples were taken daily until either a clinical diagnosis of sepsis was made or until the patient was discharged from ICU. In addition to standard clinical and laboratory parameter testing, the expression of Interleukins (IL) -1{beta}, -6, -8, -10, Tumour necrosis factor (TNF)-{alpha}, FasL and CCL2 mRNA was also measured by real-time RT-PCR. Analysis of the data using a non-linear technique (neural network analysis) demonstrated discernible differences prior to the onset of overt sepsis. Neural networks using cytokine and chemokine data were able to correctly predict patient outcome in an average 83.09% of patient cases between 4 and 1 days before clinical diagnosis with high sensitivity and selectivity (91.43% and 80.20%, respectively). The neural network also had a predictive accuracy of 94.55% when data from 22 healthy volunteers was analysed in conjunction with the ICU patient data. Our observations from this pilot study indicate that it may be possible to predict the onset of sepsis in a mixed patient population using a panel of just 7 biomarkers.

Some bone cement more anti infection

Link: Orthopaedic bone cement: DO WE KNOW WHAT WE ARE USING? -- Bridgens et al. 90-B (5): 643 -- Journal of Bone and Joint Surgery - British Volume.

Bone cements produced by different manufacturers vary in their mechanical properties and antibiotic elution characteristics. Small changes in the formulation of a bone cement, which may not be apparent to surgeons, can also affect these properties. The supplier of Palacos bone cement with added gentamicin changed in 2005. We carried out a study to examine the mechanical characteristics and antibiotic elution of Schering-Plough Palacos, Heraeus Palacos and Depuy CMW Smartset bone cements. Both Heraeus Palacos and Smartset bone cements performed significantly better than Schering-Plough Palacos in terms of mechanical characteristics, with and without additional vancomycin (p < 0.001). All cements show a deterioration in flexural strength with increasing addition of vancomycin, albeit staying above ISO minimum levels. Both Heraeus Palacos and Smartset elute significantly more gentamicin cumulatively than Schering-Plough Palacos. Smartset elutes significantly more vancomycin cumulatively than Heraeus Palacos. The improved antibiotic elution characteristics of Smartset and Heraeus Palacos are not associated with a deterioration in mechanical properties. Although marketed as the ‘original’ Palacos, Heraeus Palacos has significantly altered mechanical and antibiotic elution characteristics compared with the most commonly-used previous version.

Selective antimicrobial activity of maggots

Link: Selective antimicrobial activity of maggots against pathogenic bacteria -- Jaklic et al. 57 (5): 617 -- Journal of Medical Microbiology.

Maggot therapy, also known as biosurgery, is an ancient method for the healing of chronic infected wounds. Although clinicians have reported on the beneficial activities of the Lucilia sericata larvae that have been used for healing chronic wounds, the selectivity of this therapy against the different pathogenic micro-organisms that are found in chronic wounds has never been analysed. In the present study, we have investigated the in vitro activities of larval excreta/secreta both against selected bacterial strains that frequently occur in chronically infected wounds, and against bacteria isolated directly from the larvae and their excreta/secreta. Additionally, the antibacterial activities were investigated in in vivo studies, by comparing bacterial diversity in wounds before and after the application of L. sericata larvae. In conclusion, larval therapy is highly recommended, particularly for the treatment of wounds infected with Gram-positive bacteria, like Staphylococcus aureus, but less so for wounds infected with Gram-negative bacteria, especially Proteus spp. and Pseudomonas spp. strains. Bacteria from the genus Vagococcus were resistant to the maggot excreta/secreta.

Stitches Laced With Bacteria-killing Viruses Could Fight Back MRSA

Link: Stitches Laced With Bacteria-killing Viruses Could Fight Back MRSA.

MRSA is hard to treat because the bacteria have developed resistance to the penicillin drug family.Now Glasgow experts in the UK offer a way out. Strathclyde University researchers have bonded infection-fighting agents to materials such as nylon. Sutures, the thread used to stitch up patients during operations, could host the viruses - reducing the chance of patients developing an infection. In tests, the agents killed 96% of MRSA strains from people in three hospitals. Dr Janice Spencer, from the University of Strathclyde, said: "Some bacteria-specific viruses - called bacteriophages - have been used in the past to help clear up infections caused by bacteria. "However, their use died out when antibiotics like penicillin and methicillin became widely available. "We are looking at them again now that multiple antibiotic resistant strains of bacteria have become such a problem in hospitals." The research team has also developed a device that allows rapid detection of MRSA on contaminated surfaces.

New anti-infective coatings of medical implants show promise

Link: New anti-infective coatings of medical implants based on lipid-like drug carriers -- Matl et al., 10.1128/AAC.01438-07 -- Antimicrobial Agents and Chemotherapy.

Implantable devices are highly susceptible to infection and therefore a major risk in surgery. The present work presents a novel strategy to prevent formation of a biofilm on PTFE grafts. Methods: PTFE grafts were coated with gentamicin and teicoplanin incorporated in different lipid-like carriers under aseptic conditions in a dipping process. Poly-D, L-lactic acid, tocopherol acetate, the diglyceride Softisan®649 and the triglyceride Dynasan®118 were used as drug carriers. Drug release kinetics, anti-infective characteristics, biocompatibility and haemocompatibility of developed coatings were studied. Results: All coatings showed an initial drug burst followed by a low continuous drug release over 96 hours. The dimension of release kinetics depended on the carrier used. All coated prostheses reduced bacterial growth even beyond pathologically relevant concentrations drastically over 24 hours. Different cytotoxic levels could be observed bringing up tocopherol acetate as the most promising biocompatible carrier. A possible reason for the highly cytotoxic effect of Softisan®649 could be assessed by demonstrating incorporated lipids in the cell soma with the Oil Red O staining. The performance of tromboelastography studies, ELISA assays and an amidolytic substrate assay could confirm haemocompatibility of individual coatings. Conclusions: The development and in-vitro studies of described biodegradable drug delivery systems highlight the most important requirements for an effective as well as compatible anti-infective equipment of PTFE grafts. Through continuous local release, high drug levels can be obtained at only the targeted area, physiological bacterial proliferation can completely be inhibited while at the same time biocompatibility as well as haemocompatibility can be ensured.

Wound treatment - a guide

Link: JCN Online - Journal.

The modern wound care nurse is overwhelmed with a range of products, gadgets, devices and therapies that claim to improve the management of wounds. From topical negative therapy to live maggots, protease modulating therapies to electrical stimulation, the merits of which are often poorly understood, misused and, in some cases, lack evidence of efficacy. This article will attempt to demystify a few of these concepts and suggest the ways that they can be best utilised for the benefit of the patient. Sources of information National guidance, position documents, anecdotal reports and personal experience are all useful guides to the development of good practice in wound care and should be accessed by all practitioners involved in treating wounds. The National Institute for Health and Clinical Excellence (NICE), European Wound Management Association (EWMA), European Pressure Ulcer Advisory Panel (EPUAP), Tissue Viability Society (TVS), Wound Care Society (WCS) and now the World Union of Wound Healing Societies (WUWHS) all explore these issues and produce valuable guidance. Wound care companies are also excellent sources of clinical data and information about individual dressings and therapies.

Click the link above for a great guide

New bone polymer reduces MRSA risk

Link: Ceremed's OSTENE(R) Stops Bone Bleeding Without Added Risk of Surgical Infection, New Study Finds: Financial News - Yahoo! Finance.

New polymer material designed to stop bone bleeding in surgery reduces the risk of surgical infection, according to a new animal study to be published in the February 2008 issue of Clinical Orthopaedics and Related Research (CORR). The study has implications for lowering the risk of hospital-acquired infections, including MRSA. Researchers from the Medical University of South Carolina at Charleston and Keck School of Medicine at the University of Southern California in Los Angeles compared newly available polymer, Ostene�, with bone wax, traditionally used to stop bone bleeding in surgically cut bone surfaces. The scientists looked at the two materials' effect on bone infection in the presence of Staphylococcus Aureus, similar to the organism that is responsible for MRSA. The results showed that, when exposed to bacteria, the bones treated with Ostene� were four times less likely to get infected than the bones treated with bone wax, 100% of which developed infection.

New Light Treatment Being Tested To Fight MRSA

Link: New Treatment Being Tested To Fight MRSA | Breaking News, Weather, Sports and Entertainment for Georgia and South Carolina | Health.

That's right, a flip of a switch could be the answer to battling these bacteria. Dermatologist Rox Anderson at the Wellman Center at Massachusetts General Hospital is one of the researchers investigating. "In a nutshell, it's harnessing the energy of light transforming it into chemical reactions that are toxic to bacteria but not to you," Anderson said. In animal studies, the MRSA bacteria was applied to a superficial wound, then a common dye was applied, followed by a light source. "We use deeply penetrating light because we want it to go as deep as we can and that tends to be red light," Anderson said. In about 15 minutes the treatment is over and the bacteria are dead. Rapid treatment is a benefit of light therapy because even if antibiotics worked, they would take at least a day or two to kick in. The future of using light therapy to treat infections is looking bright. "To be able to make the diagnosis of infection rapidly doing microscopy right on the patient, then be able to treat them at the time using light and I think we're getting close to that," Anderson said.

Combating infection after deep surgery

Link: Primary treatment of deep sternal wound infection after cardiac surgery: a survey of German heart surgery centers -- Schimmer et al. 6 (6): 708 -- Interactive CardioVascular and Thoracic Surgery.

There are various primary treatment modalities of managing deep sternal wound infection (DSWI) following cardiac surgery, namely surgical debridement with primary reclosure in conjunction with irrigation, Vacuum-assisted closure (V.A.C.�) therapy, and primary or delayed flap closure. The purpose of this study was to assess whether there is consensus of the primary management of DSWI using one method as a single line therapy or a combination of these procedures. Therefore, a questionnaire with regards to the primary treatment modalities of DSWI was distributed to all 79 German heart surgery centers. All replied to the questionnaire. V.A.C.� is used in 28/79 (35%) heart centers as the ‘first-line’ treatment, 22/79 (28%) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37%) clinics both treatment options were used according to intraoperative conditions. Mostly, as a primary management of DSWI two treatment modalities are mainly in use: primary reclosure coupled with a double-tube suction/irrigation system and V.A.C.� therapy. The current understanding is based purely on retrospective studies, not evidence-based medicine. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing these treatment modalities are pivotal to define evidence for patients presenting with DSWI.

Maggot excretions to kill MRSA?

Link: Maggot excretions/secretions are differentially effective against biofilms of Staphylococcus aureus and Pseudomonas aeruginosa -- van der Plas et al., 10.1093/jac/dkm407 -- Journal of Antimicrobial Chemotherapy.

Objectives: Lucilia sericata maggots are successfully used for treating chronic wounds. As the healing process in these wounds is complicated by bacteria, particularly when residing in biofilms that protect them from antibiotics and the immune system, we assessed the effects of maggot excretions/secretions (ES) on Staphylococcus aureus and Pseudomonas aeruginosa biofilms, the clinically most relevant species. Methods: We assessed the effects of ES on biofilms using microtitre plate assays, on bacterial viability using in vitro killing and radial diffusion assays, and on quorum sensing systems using specific reporter bacteria. Results: As little as 0.2 �g of ES prevented S. aureus biofilm formation and 2 �g of ES rapidly degraded biofilms. In contrast, ES initially promoted P. aeruginosa biofilm formation, but after 10 h the biofilms collapsed. Degradation of P. aeruginosa biofilms started after 10 h and required 10-fold more ES than S. aureus biofilms. Boiling of ES abrogated their effects on S. aureus, but not on P. aeruginosa, biofilms, indicating that different molecules within ES are responsible for the observed effects. Modulation of biofilms by ES did not involve bacterial killing or effects on quorum sensing systems. Conclusions: Maggot ES are differentially effective against biofilms of S. aureus and P. aeruginosa.