MRSA Review - Methicillin-resistant Staphylococcus aureus in food products: cause for concern or case for complacency?

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.

Seal Shield Announces World's First Dishwasher Safe Cell Phone

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.

Methicillin-resistant Staphylococcus aureus (MRSA) causing illness in and out of hospitals

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.

U.S. researchers say they are learning to stop methicillin-resistant Staphylococcus aureus before it starts.

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.

MRSA Spreading Rapidly

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.

Antibiotic Resistance on Rise in Europe

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.

Antibiotic-Resistant Infections (MRSA) Cost the U.S. Healthcare System in Excess of $20 Billion Annually

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.

I knew I hated computers - now it is MRSA

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.

Yet Another Way to Contract MRSA...The Beach?

According to a new article published in USA Today by Steve Sternberg, your local beach can be added to the ever-growing list of places where MRSA, or methicillin-resistant Staph aureus, can be found.  As many of you know, MRSA is a potentially life-threatening bacteria that is highly resistant to many types of antibiotics.

This new information comes from a recent study completed by researchers at the University of Washington who found MRSA in in marine water and beach sand from seven public beaches located around the Puget Sound. 

The researchers identified Staph bacteria on nine of 10 public beaches that they tested. Seven of 13 Staph aureus samples, found on five beaches, were multidrug resistant, says lead investigator Marilyn Roberts.

"Our results suggest that public beaches may be a reservoir for possible transmission of MRSA," she told the Interscience Conference on Antimicrobial Agents and Chemotherapy here, the leading international conference on new and resurgent diseases.

Antibiotic-resistant bacteria have been around for almost as long as there have been antibiotics. Until recently, researchers have been able to outwit them by developing new antibiotics. Now, however, the pipeline of new antibiotics has slowed, and germs are coming perilously close to winning the race.

The best available treatment for MRSA, vancomycin, is more expensive than other antibiotics and takes a long time to conquer the infection. "It's like trying to turn an ocean liner around," says Henry Chambers of the University of California, San Francisco.

Until a decade ago, most multidrug-resistant Staph aureus infections were found in hospitals among severely ill patients. That changed about seven years ago with the emergence of a strain hardy enough, and virulent enough to infect healthy people, usually in their skin and soft tissues.

Since about 30% of healthy people carry Staph aureus, most people are able to survive infection. But it is fatal in about 20% of people who develop MRSA bloodstream infections and 40% of those who develop MRSA pneumonia. It has emerged as a killer of people with severe influenza, including the new H1N1, or swine, flu.

Curiously, Roberts says, five of the samples found on the beach and in the sand more closely resembled hospital-acquired MRSA than the bacteria found in the community. Three of the samples, from three beaches 10 miles apart, were virtually identical, she says. "One would think they came from the same source," Roberts added.

The most likely scenario, she says, is that the source is environmental, not human, but "where all of these organisms are coming from and how they're getting seeded (on the beaches) is not clear." Tests of ocean water and sand taken from two beaches in Southern California turned up no Staph aureus at all.

Genetic analysis also suggested that the Puget Sound beaches, and maybe others, may represent an "ecosystem," where bacteria thrive, mingle and swap genes, particularly those confer antibiotic resistance.

Roberts says there may be much more MRSA than her team's "grab and go" sampling experiments indicated. "The fact that we found these organisms suggests that the amount is much higher than we previously thought," she says.

Lance Peterson, a University of Chicago infectious disease specialist who was not involved in the study, says, "Staph is a salt-loving organism. It's not surprising to see it in the ocean."

More States Require Hospitals To Test For MRSA

States are sometimes called the "laboratories of democracy" for trying new ideas long before they are commonly accepted.   At least five states --California, Illinois, Pennsylvania, New Jersey, and Tennessee  --are now requiring hospitals to test for methicillin-resistant Staphylococcus aureus (MRSA) and report infection rates.

Legislatures in New York, Nevada, Kentucky, South Carolina, Massachusetts Maine, and Washington State are considering it. At the federal level, Veterans Administration hospitals require MRSA testing.

MRSA infects 90,000 Americans each year and kills an estimated 19,000; more than AIDS.

One MRSA victim, Jeanine Thomas, who successfully lobbied for the new requirement on Illinois hospitals, believes that the testing and isolation of the infected will eventually wipe out the Superbug.

Many infectious disease experts, however, do not agree. All sorts of germs infect 1.7 million Americans in hospitals each year and killing 100,000, according to the Centers for Disease Control & Prevention (CDC).

CDC lists testing upon entry to a hospital as an option, but says there is no evidence it is better than the combination of methods used by most hospitals. These include wearing gloves, gowns, and other protective gear, hand washing, and proper use of antibiotics.