MRSA Blog : Methicillin-Resistant Staphylococcus Aureus- MRSA Lawyer & Attorney : Marler Clark Law Firm

Universal screening may curb spread of MRSA

Once considered a hospital anomaly, community-acquired infections with drug-resistant strains of the bacterium Staphylococcus aureus now turn up regularly among children hospitalized in the intensive-care unit, according to research from the Johns Hopkins Children's Center.

The Johns Hopkins Children's team's findings, to be published in the April issue of the journal Emerging Infectious Diseases, underscore the benefit of screening all patients upon hospital admission and weekly screening thereafter regardless of symptoms because MRSA can be spread easily to other patients on the unit.

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a virulent subset of the bacterium and impervious to the most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in ill people or in those with weakened immune systems, it can lead to invasive, sometimes fatal, infections.

In 2007, The Johns Hopkins Hospital began screening all patients upon admission and weekly thereafter until discharge. Some states have made patient screening mandatory but the protocols vary widely from hospital to hospital and from state to state.

"MRSA has become so widespread in the community, that it's become nearly impossible to predict which patients harbor MRSA on their body," says lead investigator Aaron Milstone, M.D., M.H.S., a pediatric infectious disease specialist at Hopkins Children's.

"Point-of-admission screening in combination with other preventive steps, like isolating the patient and using contact precaution, can help curb the spread of dangerous bacterial infections to other vulnerable patients."

The new Johns Hopkins study found that 6 percent of the 1,674 children admitted to the pediatric intensive-care unit (PICU) at Hopkins Children's between 2007 and 2008 were colonized with MRSA, meaning they carried MRSA but did not have an active infection. Of the 72 children who tested positive for MRSA, 60 percent harbored the community-acquired strain and 75 percent of all MRSA carriers had no previous history or MRSA. MRSA was more common in younger children, 3 years old on average, and among African-American children. The reasons behind the age and racial disparities in MRSA colonization remain unclear, the investigators say. Patients with MRSA had longer hospital stays (eight days) than MRSA-free patients (five days) and longer PICU stays (three days) than non-colonized patients (two days).

Eight patients who were MRSA-free upon admission became colonized with MRSA while in the PICU. Of the eight, four developed clinical signs of infection, meaning that the other four would have never been identified as MRSA carriers if the hospital was not performing weekly screenings of all patients.

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J. A. J. W. Kluytmans

VU University Medical Centre, Amsterdam and Amphia Hospital, Breda, The Netherlands
Corresponding author and reprint requests: J. A. J. W. Kluytmans, Laboratory for Microbiology and Infection Control, Amphia Hospital, Location Molengracht, PO Box 90158, 4800 RK Breda, The Netherlands - E-mail: jankluytmans@gmail.com

ABSTRACT

The widespread use of antimicrobial agents, in combination with insufficient infection control measures, is the main driver of the current pandemic of antimicrobial resistance in human pathogens. The use of antimicrobials in food animal production also contributes, because resistant organisms and resistance genes can spread from animals to humans by direct contact or through the food chain. An important, traditionally human, pathogen, methicillin-resistant Staphylococcus aureus (MRSA), is currently endemic in many hospitals around the world and has also emerged in the community. Recently, a new reservoir of MRSA has been identified in food production animals and people in contact with these animals. This involves a specific clone, multilocus sequence type 398 (ST398), which has spread extensively among animals. ST398 has also been found in up to 11.9% of retail meat samples in several surveys from different parts of the world, posing a potential threat to human health.

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Seal Shield LLC today announced the new SEAL CELL(TM) Waterproof Cell Phone. The product is the world's first cell phone to be washable and antimicrobial. The Seal Shield(TM) SEAL CELL(TM) phone is easy to clean. Regular cleaning in the sink or dishwasher can help prevent the spread of germs, viruses and bacteria, which are known to harbor on frequently touched surfaces.

The SEAL CELL(TM) has been created to help reduce the risk of worldwide cross contaminations, including H1N1, Norovirus and the "superbug," MRSA. Dr. Charles Gerba, University of Arizona, tested numerous common surfaces and found cell phones are the highest carrier of bacteria with 25,000 germs per square inch, or 500 times more bacteria than the average toilet. Unlike any other cell phone, the Seal Shield(TM) SEAL CELL(TM) phone combines Seal Shield(TM) waterproof technology and SILVER SEAL(TM) technology for antimicrobial protection of the product, making it dishwasher safe and resistant to mold, mildew and odor causing bacteria.

The SEAL CELL(TM) is Dual SIM, Dual Holding Quad Band GSM compatible and features a 2.0 megapixel camera with video and torch light, GPRS, MMS, background noise elimination, walkie-talkie function, Bluetooth 2.0, GPS and a ruggedized touch screen. The SEAL CELL(TM) is waterproof to international IPx7 standards and is completely dishwasher safe. The phone also contains SILVER SEAL(TM) technology for antimicrobial protection.

SEAL SHIELD(TM) will be demonstrating the new SEAL CELL(TM) phone at the international Consumer Electronics Show (CES) in Las Vegas, January 7th-11th. The product is scheduled to begin shipping in early 2010. Pricing has not yet been released.

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According to the CDC, Scripps-Howard and the St. Petersburg Times Methicillin-resistant Staphylococcus aureus (MRSA) is found not only in hospitals and other health-care facilities, where it is deadliest, responsible for more than 70 percent of all hospital staph infections and killing some 20,000 Americans annually. MRSA started turning up outside hospitals in the late 1990s in schools, gyms and military barracks, evolving into community-associated MRSA, or CA-MRSA. Now a new study published this month says that strain is bouncing back into hospitals, increasing the infection risk to the most vulnerable people.

The U.S. Centers for Disease Control and Prevention estimates that 14 percent of people with MRSA have the community-associated strain. Many are young. A Minnesota study found that the average age of a CA-MRSA patient is 23, compared to 68 for other MRSA patients. Starting in the late 1990s, most cases of CA-MRSA were linked to places like gyms and schools where people are in close proximity and might share exercise equipment, bathroom and shower facilities, razors, towels, uniforms and other clothing. A study in the December issue of Emerging Infectious Diseases suggests that health-care workers, who often move between outpatient clinics and inpatient hospital rooms, may be dragging the bacteria with them and infecting hospitalized patients.

What is MRSA?

Methicillin-resistant Staphylococcus aureus is a bacteria that can cause terrible skin infections, pneumonia, blood poisoning, even death. It is resistant to common antibiotics, like penicillin, making it difficult to treat.

How to protect yourself:

-- Wash hands frequently.

-- Use alcohol-based hand sanitizer when you can't wash.

-- Bandage wounds and cuts until healed.

-- Avoid contact with bandages, infected skin of others.

-- Wipe down shared gym equipment before and after use.

-- Clean shared surfaces, then use disinfectant or bleach solution.

-- Wash and machine-dry laundry that contacts infected skin.

-- Don't share personal items such as towels and razors.

-- If you develop a painful sore that looks like a pimple or boil, seek medical attention.

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Jeff Brinker of the University of New Mexico and Sandia National Laboratories says the application of a simple protein can halt the switch of MRSA and other bacteria from a harmless to a virulent form. The control of such strains of MRSA has been a formidable problem in hospitals, Brinker says.

Brinker research team's nonantibiotic approach may make it easier to treat staphylococci strains like MRSA that have become drug resistant.

"The good news is that by inhibiting the single cell's signaling molecules with a small protein, we were able to suppress any genetic reprogramming into the bacterium's more virulent form," Brinker said in a statement. "Our work clearly showed the strategy worked."

The findings, published in Nature Chemical Biology, shows the Staphylococcus aureus bacteria isolated in individual, self-assembled nanoscale compartments. Isolation of an individual bacterium previously had been achieved only computationally, leaving open questions of how a physically and chemically isolated bacterium would actually behave.

The study also demonstrates that it was the release of signaling peptides from a single cell that acted as a trigger to reprogram that same cell so that it released toxins.

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MRSA Cases of community-acquired MRSA infection, the potentially deadly superbug that is resistant to most antibiotics, are increasing and spreading rapidly into hospitals as well, researchers reported today.

MRSA -- methicillin-resistant Staphylococcus aureus -- can attack wounds and trigger lethal bloodstream infections. Infections cause about 20,000 deaths each year in the United States. MRSA has traditionally spread in hospitals, which is called hospital-acquired MRSA. "But the findings from this study suggest that there is a significant reservoir in the community as well," the lead author of the study, Eili Klein, said in a news release. Community-acquired strains can be picked up in almost any public place, such as schools and gyms.

The study analyzed data from 300 microbiology labs serving hospitals around the country and found a sevenfold jump in the proportion of community-acquired MRSA in outpatient hospital units. This is significant because healthcare professionals frequently move between outpatient care settings and hospitals, perhaps facilitating the spread of the germs. Researchers found that MRSA infections increased more than 90% among outpatients with staph infections and now account for more than half of all staph infections.

Community-acquired MRSA is generally less dangerous than hospital-acquired MRSA, but it can still be deadly. Hospital officials, who have already adopted procedures to limit the spread of MRSA, will have to redouble their efforts to stop the community-associated infections. "This emerging epidemic of community-associated MRSA strains appears to add to the already-high MRSA burden in hospitals," said Ramanan Laxminarayan, a researcher with Extending the Cure, a project that examines solutions to antibiotic resistance at the Washington, D.C.-based organization Resources for the Future. Resources for the Future conducted the study with support from the Robert Wood Johnson Foundation. The study appears online in the journal Emerging Infectious Diseases.

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Antibiotics to prevent bacterial infection in organ transplants, hip replacements, cancer chemotherapy, intensive care and neonatal care for premature babies will become ineffective due to antibiotics overuse, according to Dominique Monnet at the European Centre for Disease Prevention and Control (ECDC).

Approximately 25,000 deaths are caused by antibiotics in Europe each year; six by the most common infections including MSRA. Superbug infections currently add 900 million euros each year to hospital costs.

"The latest data confirms that across the European Union the number of patients infected by resistant bacteria is increasing and that antibiotic resistance is a major threat to public health," says Monnet.

Responsible use of antibiotics is advocated by the ECDC as key to preventing the development of resistant bacteria. November 18 is this year's Antibiotic Awareness Day designed to raise awareness of how to use antibiotics responsibly.

In late November, the ECDE is due to publish a new survey of intensive care specialists across Europe which reveals 21% of specialists said they had seen – within the last six months – three or more patients suffering from infections that were totally or almost totally resistant to antibiotics. 8% of the specialists had seen more that 10 such patients over the same period.

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The Alliance for the Prudent Use of Antibiotics (APUA) and Cook County Hospital (currently John H. Stroger, Jr. Hospital of Cook County) announce the release of an eye-opening study on the economic impact of antibiotic overuse and antibiotic-resistant infections (ARIs) sponsored by an unrestricted educational grant from bioMerieux and the Centers for Disease Control and Prevention (CDC).

The authors conducted an exhaustive chart-by-chart review of 1,391 patients hospitalized in the year 2000, 188 of which had ARIs (13.5 percent). The medical costs attributed to these ARIs ranged from $18,588 to $29,069 per patient, while the duration of hospital stay was extended 6.4 - 12.7 days for affected patients. Additionally, the excess mortality attributed to ARIs alone was 6.5 percent -- a death rate two-fold higher than in patients without ARIs. The authors also estimated the societal costs incurred at this hospital as a result of the ARIs to be between $10.7 and $15 million, which is the cost that hits the families of those infected.

The study, "Hospital and Societal Costs of Antimicrobial Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship," analyzed the medical and human cost associated with ARIs. It was conducted at the Cook County (Stroger) Hospital of Chicago. Several studies have looked at the medical costs of these infections, but this is the first to look at the cost to families as well.

Antibiotic resistance is fueled by misuse and overuse of antibiotics. Bacteria become resistant to the very medicines developed to treat and cure the infection they cause. ARIs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and a growing number of additional pathogens that are developing resistance to many common antibiotics.

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I was reading an article on MRSE from Taiwan that hospital computers may harbor MRSA.  Apparently, researchers in Taiwan found computer keyboards and computer mice harbor pathogens -- including Methicillin resistant Staphylococcus aureus.  However, the researchers suggest few infections can be traced to the computers. The MRSA and other pathogens are not being spread around medical facilities because healthcare workers seem to be using good hand hygiene.

The research team, led by Yen-hsu Chen of Kaohsiung Medical University Hospital in Taiwan, looked at computer equipment in a 1,600-bed hospital with 282 computers. They found 17.4 percent contamination rate of S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1 percent and 4.3 percent, respectively. No P. aeruginosa was found.

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