MRSA

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Study finds super bugs increasingly prevalent in community
08 November 2007 2120 hrs (SST) 1320 hrs (GMT)

SINGAPORE: A study by the Communicable Disease Centre (CDC) suggested that drug-resistant bacteria may already be present in the community at large.

Experts had thought that the super bugs are only found in hospitals, but the latest study proved this may no longer hold true.

Based on skin swabs of 1,000 patients at the Accident and Emergency Department at Tan Tock Seng Hospital, more than one in four were found to carry the ESBL and MRSA super bugs even before they were hospitalised.

Doctors said one reason of the finding could be the misuse of antibiotics among Singaporeans.

Starting next year, the CDC will work with grassroots organisations to collect more samples to determine the prevalence of these super bugs in the population.

"In situations where we need to use antibiotics, we need to use them. But in situations like common cough and cold, where we know that it's likely caused by virus, the antibiotics is not going to be useful, then we should strongly discourage the use of the antibiotics in such situations," said CDCs clinical director Associate Professor Leo Yee Sin. - CNA/ac

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Super-staph fight spreading
4 more hospitals to screen patients to detect MRSA
Chicago Tribune (IL)
October 30, 2007
Edition: Chicagoland; Section: Metro; Page: 3
Author: Judith Graham, Tribune staff reporter

In Europe, the intervention is known as "search and destroy." Search for every source of drug-resistant bacteria coming into a hospital and destroy opportunities for the superbugs to spread.

It's how countries from the Netherlands to England have battled the growing threat posed by methicillin-resistant Staphylococcus aureus (MRSA) and brought soaring infection rates under control.

Now, Loyola University Health System and three local Veterans Affairs facilities are embracing the tactic. Come November, Loyola will start testing all hospital patients for MRSA and taking aggressive steps to prevent its transmission. Hines VA Hospital near Maywood and the North Chicago and Jesse Brown VA Medical Centers implemented what's known as "universal screening" for MRSA at the end of September.

"It's a safety decision: We want to do what's in the best interest of our patients," said Dr. Paul Whelton, Loyola's chief executive, who announced the new policy Monday.

The four health facilities are implementing similar strategies. Every patient admitted to Loyola or the VA facilities will get a nasal swab from a nurse. The swabs will be sent to a laboratory for a DNA test to determine if MRSA is present.

The goal is to find patients who carry the bug without knowing it and who are at high risk of becoming infected when they undergo surgery or other invasive procedures. These "MRSA-colonized" patients can easily transmit the bacteria to others.

Patients testing positive for MRSA will be placed in a private room, and medical staff will be required to wear disposable gowns and gloves and follow strict hand-washing regimens.

Only one other institution in the Chicago area has a similar policy: Evanston Northwestern Healthcare has been checking all patients at its three hospitals for MRSA and taking vigorous steps to combat the bacteria since 2005.

Dr. John Jernigan, a MRSA expert at the Centers for Disease Control and Prevention, said that universal screening was "uncommon" in the U.S. and that evidence supporting it was limited.

But concern over MRSA is mounting, fueled by new data from the CDC showing that invasive infections caused by the bacteria strike nearly 94,000 people every year and kill about 19,000.

How best to combat the bacteria remains a much-debated question. The CDC advises hospitals to institute strict hygiene standards and focus on disinfecting potentially contaminated areas. If that doesn't work, the agency recommends that hospitals test patients and take measures to reduce transmission.

"No randomized peer-reviewed studies have been published which show the benefit of screening all patients for MRSA," said Dr. Gordon Trenholme, director of infectious disease at Rush University Medical Center, in an e-mail.
But numerous reports from the field suggest screening does lower MRSA infection rates.

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A Nasty Bug Breaks Out
Drug-resistant staph bacteria now stalk even students
U.S. News & World Report
Volume 143, Issue 15
October 29, 2007
Section: Health, Money & Education; Page: 58
Author: Lindsay Lyon

The trouble started in May, with a mild fever and what felt like a leg cramp. Within days, 12-year-old Hunter Spence had a temperature of 107 degrees and was fighting for her life in a hospital nearly 85 miles from her Victoria, Texas, home. There, doctors told her parents she had contracted methicillin-resistant Staphylococcus aureus and wasn't expected to live. Immune to common antibiotics, the MRSA infection had invaded her bloodstream, bones, and lungs. The seventh grader eventually got out of danger, but only after seven operations and five weeks in intensive care.

Hunter's terrifying experience is not an isolated event. Once confined primarily to hospitals and healthcare institutions, antibiotic-resistant staph is now increasingly attacking healthy people in communities across the country. Schools nationwide have been reporting outbreaks: Last Monday, the MRSA-related death of a 17-year-old Virginia student one of three such fatalities in recent weeks spurred officials to close 21 area schools for cleaning; schools in other states have been evacuated for disinfection. Jaime Fergie, the pediatric infections specialist who treated Hunter at Driscoll Children's Hospital, has observed exponential growth in such MRSA cases at the hospital in recent years, including three deaths since 2005.

"Young, healthy people who haven't been to a hospital since birth [are] getting sick," says Elizabeth Bancroft of the Los Angeles County Department of Public Health. Across all age groups, MRSA was the culprit behind more than 94,000 life-threatening infections and almost 19,000 deaths in the United States in 2005, researchers from the Centers for Disease Control and Prevention estimated last week in the Journal of the American Medical Association.

When detected early, even resistant staph is very treatable, says Neil Fishman, a physician and spokesman for the Infectious Diseases Society of America. The first sign of infection can be boils, which sometimes resemble spider bites and tend to become red, hot, and tender, or larger skin abscesses. While severe cases like Hunter's are rare, suspicious wounds should get medical attention. It's during treatment that MRSA can reveal its most frightening side: Unlike common staph, it's impervious to all but a few antibiotics. Specialized drugs can still kill it, however.

Staph microbes reside, usually harmlessly, in about 30 or 40 percent of the population. Infections typically occur when the bug comes in contact with a wound, and they can be transmitted by direct contact or via shared, contaminated items such as towels and bars of soap. Athletes who have cuts and scrapes may acquire it in locker rooms or during contact sports. Virginia's education department is recommending daily disinfection of objects that see heavy use desks, countertops, drinking fountains, weightlifting machines, and basketballs.

While the growing threat of community-acquired infections is alarming, it still pales in comparison with MRSA cases linked to healthcare facilities. In last week's JAMA report, CDC researchers found that rates of the infection were highest among people 65 years and older, many of whom were in or had recently been in a hospital or nursing home. Says Bancroft: "It's Grandma I'm a lot more worried about than kids."

Copyright (c) 2007 U.S. News & World Report, Inc. All rights reserved

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HARDER-TO-KILL GERM ISN'T AS RARE AS PEOPLE THINK
BUT SIMPLE STEPS CAN STOP INFECTION
Detroit Free Press (MI)
October 28, 2007
Edition: METRO FINAL; Section: NWS; NEWS; Page: 10A
PATRICIA ANSTETT; FREE PRESS MEDICAL WRITER

Here are some answers to frequently asked questions about MRSA.

QUESTION: How common is MRSA?
ANSWER: Very common. But not everyone gets sick from it. About 20% to 30% of us contract the germ, much the way we contract viruses for herpes and other germs, but many people never develop a full-blown medical problem.

Q: So if it's that common, why is it in the news so much?
A: The death of a Virginia high school student Oct. 15 triggered the recent concerns.
Public health authorities say there is no epidemic, nor even an unusual cluster of cases. But they welcome a chance to teach the public about prevention, which can carry over to protection against many infections. The sharing of drinks, towels and other objects, and the infrequent washing of hands increases the chances of picking up germs and passing them on.

Q: What are the warning signs of a MRSA infection?
A: It starts with a skin mark, much like a spider bite or pimple that can become swollen and red. That can happen quickly or over days. MRSA also can cause pneumonia, meningitis, skin abscesses and bloodstream infections.

Q: What should a person do if they have those signs?
A: Seek medical attention immediately.

Q: How can MRSA's transmission be prevented?
A: Thorough hand washing is the best advice. Shower immediately after contact sports. Don't share towels, soap, washcloths or razors, even among family members.
Wash towels in the hottest water available and dry them at the highest temperature. Do not line dry.
Clean doorknobs, telephones and shared sports equipment with disinfectants or diluted bleach.
The Environmental Protection Agency has a 25-page list of registered products effective in the prevention of MRSA, at www.epa.gov/oppad001/list_g_mrsa_vre.pdf

Q: Are there tests to detect MRSA?
A: Yes, but a blood test or skin swab is suggested only for those showing symptoms.

Q: Who is most likely to get sick from it?
A: People who are hospitalized or in nursing homes, who are frail or have in-dwelling catheters for chemotherapy, who are undergoing dialysis or who are IV drug users. Others at risk have skin cuts or live in crowded conditions, such as prisons and dorms.

Q: How it is treated?
A: Sometimes just opening and draining the wound helps, along with keeping it covered to prevent spreading it. A person with MRSA doesn't necessarily have to be isolated. Treatment may not initially require antibiotics. Most infections respond, even if the first antibiotic used doesn't work.

Q: Can it be serious?
A: Yes. It caused death in about 5% of 368,600 patients treated for it at U.S. hospitals in 2005. Most were elderly or had low incomes.