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

Medical scientists present the “strongest evidence” yet that antibiotic use in farm animals has driven the emergence of a new strain of methicillin-resistant Staphylococcus aureus (MRSA) in people. Writing this month in PLoS One they say the strain, known as ST398, is a potential threat to public health. “The observation that MRSA carriage in humans is associated with MRSA prevalence among their calves is remarkable,” write Haitske Graveland and colleagues. “This might indicate that the prevalence in humans in close contact with animals follows the prevalence of MRSA among animals over time.” ST398 MRSA first appeared in four pigs and a farmer in France in 2004, and since then it has been spotted in people living in several countries worldwide. Although scientists know that farmers are at highest risk of contracting the bug, the factors that put farmers at risk have not been evaluated until now.

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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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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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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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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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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."

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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.

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 A couple weeks back, in "Meticillin Resistant Staphylococcus Aureus (MRSA) --It's What's For Dinner!", we reported on a European study that those working closely with animals were most likely to contract MRSA.

Now, however, Stephanie Woodard, writing for Prevention Magazine on the MSNBC website, is claiming more of us are at risk because enough MRSA has found its way into retail cuts of pork, chicken and beef to make handling of meat dangerous.

Ms. Woodard writes that:

"You may not have the same close contact with meat that a processing plant worker has, but scientists warn there is reason for concern.  Most of us handle meat daily, as we bread chicken cutlets, trim fat from pork, or form chopped beef into burgers.  Cooking does kill the microbe, but MRSA thrives on skin, so you can contract it by touching infected raw meat when you have a cut on you hand, explains Stuart Levy, MD, a Tufts University professor of microbiology and medicine.  MRSA also flourishes in nasal passages, so touching your nose after touching meat gives the bug another way to enter your body, adds University of Iowa Professor Tara Smith."

It was Professor Smith who in 2008 found a new MRSA strain, called ST398, in 45 percent of the farmers and 49 percent of the pigs in two large midwestern hog operations.  The connection between animal and human health raised by the study still did not cause either state or federal government to inspect comprehensively for MRSA

Other studies have found MRSA in retail cuts of pork, chicken and beef sold in the U.S., Europe, and Asia.  For example, according to Prevention, a Louisiana State University study tested 120 cuts of meat purchased at local retail outlets.  MRSA was found in 4 percent of the pork cuts and 1 percent of the beef.

Check out the entire story at MSNBC.

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 A “World MRSA Day” is being pushed by a Chicago-based nonprofit known as the MRSA Survivors Network.

"As governments and world agencies continue to put their focus on swine flu and prepare to spend billions of dollars on it as they did with Avian flu; the true epidemic/pandemic, MRSA continues to be virtually ignored", says Jeanine Thomas, president of MRSA Survivors Network and the National Spokesperson for MRSA.

"It is unconscionable what has been allowed to happen and MRSA has been swept under the carpet in healthcare facilities for decades and the purpose of World MRSA Day is to raise awareness."

Her comments were included in a longer article that can be found in Medical News Today.

3M, Tec Labs, Cepheid, and Pfizer are among the U.S. health care companies that have signed on to the “World MRSA Day” campaign.  The Chicago group is focusing on the U.S. and U.K.  Some preliminary events are planned for October.

Meanwhile, the swine flu death earlier this month of 13-year old Matthew Davis of Buffalo, NY is coming in for attention because of the role methicillin-resistant staphylococcus aureus (MRSA) played in his death.   The boy was a healthy teenager before becoming “co-infected” with both swine flu and MRSA.

The Buffalo News has the story. 

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People who work closely with MRSA-infected animals are at risk of catching the bacteria, meaning farmers, veterinarians and their families are the most threatened.

And, MRSA is able to infect food but eating or handling produce carrying the superbug does NOT present an increased health hazard to humans.

Those are the among the findings of a study by the European Food Safety Authority (EFSA), the European Centre for Disease Control and Prevention (ECDC) and the European Medicines Agency (EMEA).

"While food may be contaminated by MRSA there is currently no evidence that eating or handling contaminated food can lead to an increased health risk for humans," an EFSA statement said.

The organizations conducting the study said the focus on control of the superbug should be at the farm level.   There's more in the Food Production Daily.

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People who work closely with MRSA-infected animals are at risk of catching the bacteria, meaning farmers, veterinarians and their families are the most threatened.

And, MRSA is able to infect food but eating or handling produce carrying the superbug does NOT present an increased health hazard to humans.

Those are the among the findings of a study by the European Food Safety Authority (EFSA), the European Centre for Disease Control and Prevention (ECDC) and the European Medicines Agency (EMEA).

"While food may be contaminated by MRSA there is currently no evidence that eating or handling contaminated food can lead to an increased health risk for humans," an EFSA statement said.

The organizations conducting the study said the focus on control of the superbug should be at the farm level.   There's more in the Food Production Daily. 

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Salon.com features an interesting article about Methicillin-resistant Staphylococcus aureus that focuses on the origins of MRSA and how it is spreading to humans.  Following is an excerpt from the article:

"Methicillin-resistant Staphylococcus aureus, also known as MRSA -- or, in the parlance of New York tabloids, "super staph" -- is an antibiotic-resistant version of one of the bacteria collectively known as staph. Staph, which can cause everything from skin infections to more life-threatening diseases, usually attacks older hospital patients who develop infections after surgery. The newer, often more virulent strains collectively known as CA-MRSA (community-acquired MRSA) have been all over the news in the past few weeks, as they affect people younger and healthier than the usual targets. A recent study suggested that MRSA infection was responsible for almost 19,000 deaths in the United States last year -- more than AIDS -- including the very public deaths of children and adolescents in Virginia, New York and elsewhere. Public health officials have tried to quiet fears, but the problem could get worse. MRSA remains treatable with a number of different antibiotics, but there are already signs that resistance to some of those drugs might be just around the corner.

Recently, something about MRSA -- and its epidemiology -- has been changing in ways that suggest that those changes could be taking place among livestock. Traditionally considered a disease picked up in hospitals, MRSA is now being seen more and more often in the community. And it doesn't appear that the hospital-acquired strains have just left the hospital and gone feral. The community-acquired strains of MRSA are genetically different. They're new. And though there is as of yet no definitive proof identifying livestock as the source of the major new MRSA strains, there is a growing body of evidence that suggests animals are, at minimum, reservoirs for other new strains now infecting humans.

Those studies done to date in Europe and Canada on MRSA give some credence to the involvement of livestock in MRSA's mutation. Hospitals in the Netherlands, for example, have had fantastic success at controlling MRSA. They employ a "search and destroy" policy, using aggressive screening, strict infection-control procedures, and severe restrictions on the quantity of antibiotics dispensed. They have managed to keep MRSA rates far below those in the rest of Europe. Dutch rates are so low, in fact, that Dutch hospitals list a previous visit to a foreign hospital as an MRSA risk factor.

Read the full article here.

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According to  All Headline News, a new study published in Veterinary Microbiology found MRSA (methicillin-resistant Staphylococcus aureus) is surprisingly common in Canadian pigs, farms and pig farmers, signaling that animal agriculture may be a source of the deadly bacteria. The Veterinary Microbiology study (Khanna et al. Veterinary Medicine 2007) is the first to show that North American pig farms and farmers commonly carry MRSA.

Researchers looked for MRSA on twenty Ontario farms, in 285 pigs.  They found MRSA at forty-five percent of farms (9/20) and in nearly one in four pigs (71/285). One in five pig farmers studied (5/25) also were found to carry MRSA, a much higher rate than in the general North American population. The strains of MRSA bacteria found in Ontario pigs and pig farmers included a strain common to human MRSA infections in Canada.

A study published in the October, 2007 issue of JAMA (the Journal of the American Medical Association) (Klevens et al: Invasive methicillin-resistant Staphylococcus aureus infections in the United States JAMA 2007; 298: 1753-1771) estimated almost 100,000 MRSA infections in 2005, and nearly 19,000 deaths in the United States. In comparison, HIV/AIDS killed 17.000 people that year.

Researchers generally believed MRSA was an opportunistic infection occurring mainly in hospitals. However more information is coming to light that finds even healthy people are developing MRSA infections and pig farms may be a possible culprit. Some experts in the in the agricultural, medical,  and environmental industries are calling for Congress to compel the US Food and Drug Administration (FDA) to study whether the use of human antibiotics in animal agriculture is contributing to the reported surge in MRSA infections and deaths in the United States.
 

"Identifying and controlling community sources of MRSA is a public health priority of the 1st order," said Richard Wood, Executive Director of Food Animal Concerns Trust and Steering Committee Chair of Keep Antibiotics Working. "Are livestock farmers and farms in the United States also sources? We don't know for sure, because the US government is not systematically testing US livestock for MRSA."

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