The threat of CA-MRSA is no longer emerging; it's here

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The threat of CA-MRSA is no longer emerging; it's here

Postby patoco » Wed Sep 20, 2006 5:05 am

This is from the Infectious Disease News Journal, one of my online

I feel like saying lymphedema patients beware and take note.


The threat of CA-MRSA is no longer emerging; it's here

Doctors may need to consider adding MRSA coverage to patients with
skin and soft tissue infection who are candidates for empiric
antibiotic therapy.

by Theodore C. Eickhoff, MD
IDN Chief Medical Editor

September 2006

Two months ago, I discussed a presentation that I had given at the
May meeting of the Southeastern Society for Emerging Biological
Threats. In that presentation, I reviewed the threat posed by
hospital-acquired staphylococcal infection during the late 1950s and
early 1960s.

These epidemic penicillin-resistant staphylococci were mostly of
bacteriophage type 52/52A/80/81, and for the most part seemed to
disappear during the late 1960s and early 1970s. The reasons for the
virtual disappearance of this epidemic threat were never clarified,
whether it was due to infection control practices, the introduction
of methicillin and its congeners, or simply a long-term secular
trend. I also alluded to some limited evidence that the current CA-
MRSA of the USA 300 type was genetically related to the epidemic
52/52A/80/81 staphylococci of 50 years ago.

There were a number of other presentations at that meeting that were
devoted to the challenges posed by CA-MRSA. I will discuss only two
of these: a presentation by Scott Weese, MD, of the Ontario
Veterinary College, on CA-MRSA in animals, and one by Elizabeth
Bancroft, MD, from the Acute Communicable Disease Control section of
the Los Angeles County Department of Health Services.

Transmission of MRSA

In his presentation about CA-MRSA in animals, Dr. Weese outlined
several concerns: the transmission of MRSA from infected animals to
humans (and vice versa); whether colonized animals acted as
reservoirs of MRSA in the community and whether these reservoirs
were of human or animal origin; and the nature and extent of disease
that occurred in animals. Each major animal species presented
different issues: Among horses, the major issues were nasal or
facial contact, fecal contamination and international movements,
particularly among race horses; among household pets the significant
issues were the degree, duration and intensity of contact; among pet
birds the issues were fecal contact and aerosolization of fecal
matter. Finally, there are issues in processing animals raised for
human consumption as food.

In horses, MRSA appears to be endemic in certain horse populations
worldwide. The organism seems to transmit regularly between horses
and humans. The USA 500 strain appears to dominate globally.
Infection control measures, entirely similar to those we employ in a
human health care setting, can eradicate MRSA from horse farms.

Among household pets, there have been rapid increases in reported
cases of MRSA infection in recent years. However, colonization has
been generally uncommon in household pet populations. Where studied,
colonization rates have varied from zero to 2% in dogs, and there
was no colonization at all in cats. However, there have been
sporadic episodes in veterinary clinics in which colonization rates
have been as high as 9%. In general, pet isolates have been
indistinguishable from common human clones.

It is clear that there is both intra- and inter-species transmission
of MRSA in veterinary clinics. Does this occur in households as
well? Is there a household cycle that can be broken? How common are
such household "outbreaks"? Answers to these questions await further
study. It is clear, however, that colonization of veterinary
personnel with MRSA from infected animals does occur and appears to
be a risk factor for infection of veterinary personnel.

Finally, important questions arise in considering the threat, if
any, posed by therapy animals. For example, should therapy animals
and their contacts be screened in some way before visitation? Have
infection control protocols been established to deal with MRSA
colonization or infection of therapy dogs? There seems to be no end
of legitimate questions that could be asked about the implications
in this area.

Pediatric MRSA

Through the Los Angeles County Department of Health Services, Dr.
Bancroft carried out an MRSA surveillance study of pediatric MRSA
hospital admissions during a six-month period in 2003. There were
140 such admissions to Los Angeles hospitals during this period, 92%
of which were skin and soft tissue infections.

Frequency was highest in those younger than 2 years, but cases
occurred at all ages. Twenty-three percent of the cases were
initially misdiagnosed as spider bites. Most of the strains (96%)
were of the USA 300 type. Significant risk factors that emerged
were: exposure within the previous month to someone who had been
incarcerated; the presence of traditional risk factors for
nosocomial MRSA; and household contact with a skin/soft tissue
infection within the previous month. Participation in contact sports
also seemed to be a risk factor.

Specific recommendations for outbreak control in athletic teams,
correctional institutions, and day care or developmentally disabled
settings were developed and are available at the following Web site:

Skin and soft tissue infections

Viewed against this background, the findings of Moran, et al and the
EMERGEncy ID Net Study Group, (N Engl J Med; 2006;355;7) should not
be a huge surprise. This study was carried out in 11 university-
affiliated emergency departments throughout the United States during
the month of August 2004, and focused specifically on patients
presenting with skin and soft tissue infections.

There were 422 such patients, and S. aureus was recovered from 320
(76%) of them. Spider bites again was a significant early
misdiagnosis. Of the 320 isolates, MRSA accounted for 59% overall.
In individual EDs, the MRSA rate ranged from a high of 74% in Kansas
City to a low of 15% in New York City. However, in Philadelphia,
just a short distance from New York, the rate was 55%. Among the
MRSA isolates, 97% were USA 300 type, and most were of a single
strain, USA 300-0114. Similarly, 98% of the strains possessed the
Panton-Valentine leukocidin toxin gene.

Antimicrobial susceptibility patterns were also quite similar; 95%
were susceptible to clindamycin (not tested for inducible
clindamycin resistance), 6% were susceptible to erythromycin, 100%
to rifampin and sulfa-trimethoprim, and 92% to tetracycline. In 57%
of patients treated with antibiotics, with or without incision and
drainage, treatment was not concordant with the results of
susceptibility testing. Interestingly, among patients with adequate
follow-up information, there was no significant difference in
outcome whether the antibiotics given were active against MRSA or
not. This confirms the long-standing belief that incision and
drainage are not only necessary but also sufficient for treatment of
most skin and soft tissue infections. Antibiotic therapy should
probably be reserved only for these with underlying disease or those
with significant systemic signs.

The major message, however, is quite clear: it is high time for
emergency department physicians to re-examine their own treatment
protocols, and if they haven't done so already, consider whether to
add MRSA coverage to patients with skin and soft tissue infection
who are considered candidates for empiric antibiotic therapy.

Infectious Disease News


For more information on lymphedema:

Lymphedema People


Recent Related News Articles

MRSA - leading cause for skin infections

by Gunika Khurana - August 19, 2006
MRSA or Methicillin-resistant Staphylococcus aureus, a rare germ, that seldom affected people a decade back, is now the major cause for skin infections in most American cities.

On average, Methicillin-resistant Staphylococcus aureus (MRSA) accounts for 59 percent of skin infections in the ER, the study found.

MRSA is resistant to many standard antibiotics that have been used for years, but it can still be effectively treated with one of several antibiotics, experts said .

"MRSA is now the most common cause of skin infections in most of the big U.S. cities," said researcher Dr. Gregory Moran, a professor of medicine at the University of California, Los Angeles, David Geffen School of Medicine.

"When doctors are deciding if a patient needs antibiotics, they should be given antibiotics that cover MRSA. That's a change from things we've been doing for a decade. This has changed. A different type of bacteria is now the most common cause of infections," Dr. Moran noted.

Patients with MRSA skin infections, which can cause painful lesions or sores, often mistakenly blame the infection on a spider bite, the researchers found. They advise doctors to "consider the possibility of MRSA infection in patients who report spider bites."


MRSA and bedbugs are found in hospital

By Nigel Gould18 August 2006 - Belfast Telegraph An Ulster hospital is tackling an outbreak of MRSA - and an infestation of bedbugs.

Doctors and nurses had to be moved from the Enniskillen-based Erne Hospital's residential block because of the bedbugs.

The Trust said there was no risk to any patients or visitors to the hospital.

Meanwhile, 11 patients in an elderly ward are believed to have contracted feared superbug, MRSA.

In a statement, Dr Richard Smithson, consultant in communicable disease control, said: "MRSA control is a challenge for all hospitals across NI and has become an increasing problem in the community.

"Overall the Erne Hospital has no greater a problem with this bug than any other hospital in Northern Ireland.

"Fortunately none of the patients found to be carriers of this bug has indicated any infection or has become unwell as a result of it.

"The MRSA problem in general has arisen chiefly because of the overuse of antibiotics.

"With regard to the bedbugs in the residential block, the expert opinion is that it is no indication of housekeeping standards or lack of cleanliness.

"Bedbugs are transported into environments. Once introduced into environments specialist measures are required to eradicate them.

"It is not a matter of cleaning the area."

Last month, the Belfast Telegraph revealed that MRSA-related deaths in Northern Ireland had quadrupled in just four years.

Figures show the antibiotic-resistant superbug played a part in the deaths of 69 people throughout the province during 2005. That compares to just 17 in 2001.

Overall between 2001 and 2005 there were no fewer than 186 MRSA-connected deaths.

Places of death include hospitals, nursing homes or the patient's residence.

In each case, MRSA was mentioned on the patient's death certificate - although it is not clear whether the bug was the primary cause of death or where the infection was initially picked up.

Bedbugs are small nocturnal insects of the family Cimicidae that feed on the blood of humans and other warm-blooded hosts.

They live in bedclothes, mattresses, bedsprings and frames, soft furnishing, cracks and crevices and under wallpaper.

Females lay between 200-500 eggs in batches of 10-50, on rough surfaces such as wood or paper.

Eggs are white, sticky and about 1/3 inch long. They are laid in cracks or crevices, never on people.

A bedbug's entire life cycle can take between five weeks to four months, depending upon the temperature and availability of food.

Meanwhile, this time last year the Belfast Telegraph revealed that doctors were forced out of their flat inside the complex of Craigavon Hospital - by an army of ants.


Rise in community MRSA

[Posted: Fri 18/08/2006]

Antibiotic-resistant infections account for more than half of the skin infections treated in A&E units in US hospitals, it has been found.

A new study sponsored by the Centers for Disease Control and Prevention analysed all skin infections among adults who visited hospital emergency departments in 11 US cities in August 2004.

The researchers, reporting in the New England Journal of Medicine, found that 249 out of the 422 cases , or 59%, were caused by MRSA. In some of the hospitals, MRSA infections accounted for between 15 and 74% of the total skin infections encountered in hospital A&Es.

The study provides evidence of the continuing prevalence of drug resistant infections such as MRSA in the community as well as in hospitals.

A study earlier this year found that 17% of drug-resistant staphylococcal infections were acquired in communities rather than from hospitals.
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Postby silkie » Wed Sep 20, 2006 12:33 pm

Thanks Pat this is something we have had problems with a long time in the UK
Ang on thr chat forum has both lymph and MRSA she is having many problems

One being getting treatment They cant do the lymph treatment till the MRSA is clear and they weeping continues and the MRSA cannot clear

For anyone getting this dredful infection life is not pleasant
for lymphers well i Have great respect for Ang and her determination to deal with this ongoing problem

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