MRSA (Mersa) Questions

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.

PuriCore Receives US Patent on Wound Therapy Method

Link: PuriCore Receives US Patent on Wound Therapy Method - Forbes.com.

PuriCore's patented wound therapy technology is being commercialized as the Vashe(TM) Wound Therapy System, a novel, noninvasive, easy-to-use wound management process that has been shown to be complementary to existing treatment methods. The Vashe System is an FDA-cleared medical device used for moistening, irrigating, cleaning, and debriding acute and chronic wounds including stage I through IV pressure ulcers, stasis ulcers, diabetic ulcers, post-surgical wounds, first and second degree burns, abrasions, and minor irritations of the skin. The Vashe Solution mimics the human body's own infection fighter, hypochlorous acid. Recent and ongoing clinical case studies show that the Vashe Solution eliminates pathogens that produce harmful toxins and odor and cause significant pain, without any damage to tissue. Research to date demonstrates that the Vashe Solution provides a safe and effective alternative to cytotoxic antimicrobial and antiseptic products currently used to treat infected wounds and surgical sites and is an important element in the overall clinical process of effective wound management.

Do pre - op antibiotics combat MRSA?

Link: HighWire Press -- Medline Abstract.

CONCLUSIONS: Preoperative AMP was useful to suppress postoperative superficial or deep incisional SSI, but was unlikely to suppress organ/space SSI or remote site infections. In addition, due to preoperative AMP, MRSA and Pseudomonas sp., which showed SSIs, were decreased in detection rates, whereas the detection rate of Enterococcus sp., which is resistant to cephems, was increased.

Surgical Mesh creates MRSA problem

Link: HighWire Press -- Medline Abstract.

Methicillin resistant Stephylococcus aureus (MRSA) infection has now become a major problem in hospitals. We present a case of postoperative infection MRSA where the primary source of the infection was found to be an abdominal mesh that was used to reinforce the abdominal wall. After one year of surgery, the patient developed wound dehiscence and discharge. MRSA was isolated from the wound, mesh, external nares, throat and axilla. Initially she was started on clindamycin and discharged from the hospital. After 5 months, patient came back to the hospital with infection at the same site. The patient was then treated with vancomycin and MRSA clearance. She responded to the treatment with complete healing of the wound and clearance of MRSA.

MRSA more common, no less dangerous

Link: nwi.com :: MRSA more common, no less dangerous.

MRSA cases have become standard fare in the emergency room. Once diagnosed, not only is MRSA frightening, it is expensive. Bayci cited a recent study that showed one case of health-care-associated MRSA cost more than $35,000 in 2006 while other types of health-care-associated infection cost less than $14,000. Yes, even if expensive, it can still be treated. "We have an array of medicines that are effective ... but are more difficult to use," Stemer said. Because different strains of MRSA have different sensitivity to different drugs, Stemer recommends swabbing the wound and culturing the invader to see what will work best against it. If ever there was a good example of prevention being the best medicine, this is it. The Washington Redskins spent $300,000 last year to have an anti-microbial substance sprayed on surfaces throughout its locker room and adjacent facilities. Stemer has advice for those with a more limited budget. "The best thing for the typical person to do is use bacitracin on every scratch or zit," he said. "Then, I wouldn't do any more than normal hygiene." Among athletes, good hygiene means NOT sharing items such as clothing, equipment, toiletries and towels. Following that advice costs nothing. Ignoring it could be priceless.

Surgery without the scars could stem MRSA

Link: TheStar.com - Health - Surgery without the scars.

Hospital administrators may also welcome natural orifice surgery since it will free up more beds, reducing costs and wait times. And the less invasive the surgery, the less risk of a patient getting a hospital-borne infection such as methicillin-resistant Staphylococcus aureus, or MRSA, says Hawes. Piercing the skin increases the chance the bacteria, which are resistant to a commonly used group of antibiotics, get into the body.

Drugs not the answer for MRSA?

Link: CapeGazette.com - Covering Delaware's Cape Region.

Eleven years ago, when Olewiler began his career at Beebe, he saw maybe two cases of MRSA a year. He said he now sees about three a week. While the germ has grown more common, he sees it as relatively easy to take care of and is little more than glorified acne. “I’ve never had a case that didn’t respond to treatments,” he said. “I think there are much more serious threats.” While he sees no immediate solution, Olewiler considers MRSA a threat to be managed, not solved with a quick fix. “The answer is not antibiotics,” he said. “I’ll say that 25 times: no antibiotics. People need to see their doctors and get topical treatments. If the treatment’s not working, get a different one.”

Gel from own blood heals and protects

Link: Daily Mail.

A gel made from patients' own blood cells dramatically speeds up the rate at which wounds heal after surgery. The DIY gel could slash the risk of life-threatening hospital infections by shortening the recovery process and lessening the infection risk. Doctors who tested it on a small group of patients found that, two weeks after surgery, the wounds treated with the gel had healed completely in almost 80 per cent of cases. But only 50 per cent of identical wounds treated with antibiotics had healed, researchers found.

Maggots cut MRSA cure time by 6 months

Link: BBC NEWS

Maggots are being used to help successfully treat MRSA patients in record time, according to a new study by the University of Manchester. Researchers used green bottle fly larvae to treat 13 diabetics whose foot ulcers were contaminated with MRSA. They found that all but one were cured within a mean period of three weeks, instead of the usual 28 weeks for conventional treatment. The university has now been awarded a �98,000 grant to carry out more tests.