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I saw a patient today in my office.I had drained 2 abcesses in July and they healed up uneventfully.Out of curiousity,I looked at the C&S results......Heavy amounts of coag negative staph.....RESISTANT TO METHICILLIN!This is an office pt.He is doing well,however MRSA in an office setting strikes me as rare.How prevalent is this?Does anyone have any anecdotes about this?Are there studies on it?Any information is greatly appreciated.
I take it by Office you mean your practice clinic.
MRSA pts are not the exclusive domain of Hospitals and NHS clinics.
Anybody who sees members of the public for what ever reason will be exposed to people who are MRSA positive.
The reasons are many.
They have MRSA as a commensal on their body. usually nose mouth giblets.
They have a family member who is MRSA positive and so has cross infected the wound just by sharing the same environment at home.
Many people who have leg ulcers will be MRSA positive so if any pts with leg ulcers visit your premises they will bring MRSA into your working environment.
As an NHS podiatrist with responsibility for Diabetes and wound care in my trust, MRSA and now VRSA is a routine occurrence.
So one does the best one can to limit cross infection to others by Good Basic Infection Controls and patient management.
Dont forget the other nasties such as Pseudomonas.
Basically the human body is a walking talking Bug Factory so any visitor to your clinic should be considered as such.
Oh yeah dont forget everyones favourite!
A nice fresh pile of Doggy Doo on a pts shoes as they walk in from outside onto your loverly clean reception area , waiting area and then into your loverly shiny clinic
Speaking of microbes, here are a few facts to entertain you as you go about your daily business:
There are more microbial cells in our bodies than there are human cells! In fact 95% of all the cells in the body are bacteria, mainly living in the digestive tract.
There are more bacteria in the colon than the total number of people who have ever lived.
Everyone has about 1 kg in weight of bacteria in their gut. Each gram of faeces contains 100,000,000,000 microbes.
Human adults excrete their own weight in faecal bacteria every year.
And we wonder where infections come from? Remember, we can live with these microbial friends if we are healthy, drop the immune system's function, or change the micro-environment just a tad, and the pathogens are out in force. Our patients' overall health is such an important factor in infection control, yet I believe one we tend to overlook.
A highly stable strain of Staphylococcus aureus with a pulsed-field gel electrophoresis type of USA300 and multilocus sequence type 8 has been isolated from patients residing in diverse geographic regions of the United States. This strain, designated USA300-0114, is a major cause of skin and soft tissue infections among persons in community settings, including day care centers and correctional facilities, and among sports teams, Native Americans, men who have sex with men, and military recruits. The organism is typically resistant to penicillin, oxacillin, and erythromycin (the latter mediated by msrA) and carries SCCmec type IVa. This strain is variably resistant to tetracycline [mediated by tet(K)]; several recent isolates have decreased susceptibility to fluoroquinolones. S. aureus USA300-0114 harbors the genes encoding the Panton-Valentine leucocidin toxin. DNA sequence analysis of the direct repeat units within the mec determinant of 30 USA300-0114 isolates revealed differences in only a single isolate. Plasmid analysis identified a common 30-kb plasmid that hybridized with blaZ and msrA probes and a 3.1-kb cryptic plasmid. A 4.3-kb plasmid encoding tet(K) and a 2.6-kb plasmid encoding ermC were observed in a few isolates. DNA microarray analysis was used to determine the genetic loci for a series of virulence factors and genes associated with antimicrobial resistance. Comparative genomics between USA300-0114 and three other S. aureus lineages (USA100, USA400, and USA500) defined a set of USA300-0114-specific genes, which may facilitate the strain's pathogenesis within diverse environments.
Free full text from the Canadian Medical Journal: Community-acquired MRSA: a practitioner's guide
Quote:
Methicillin-resistant Staphylococcus aureus (MRSA) is usually considered a hospital-acquired (HA) organism. As highlighted elsewhere in this issue of CMAJ, infections with community-acquired (CA) strains of MRSA are being noted more frequently. The molecular and antimicrobial resistance profiles of these CA-MRSA strains are distinct from HA-MRSA strains. Practitioners must be prepared to diagnose, treat and help prevent these infections. This brief review addresses issues relevant to the identification, prevention and management of CA-MRSA infections for Canadian practitioners.
MRSA comprises the S. aureus strains that are resistant to all ß-lactam antimicrobials, including penicillins, cephalosporins and monobactams. A part of the normal flora of humans, S. aureus colonizes the anterior nares. It is also an important human pathogen that causes a broad spectrum of infections, from trivial to life-threatening. ...
I read an article today.We as pods should be up on what strains of infection are present in the communities we practice in.Is there any way to find out if there is an outbreak of a particular "bug" in a particular community?
hI JOHN
JUST A POINT IF IT WAS COAG - THEN THEY WHERE NICELY LETTING YOU KNOW THAT THIS WAS STAPH EPI. THIS IS A USUAL FLORA ON THE SKIN. THE REPORT READ HEAVY GROWTH CLEANING THE SKIN AND A LITTLE TOPICAL LIKE GOOD OLD SSD AND YOUR OKAY IF IT COMES FROM THE BONE AND IS A HEAVY GROWTH GET ID TO HELP. IF YOU DO A C&S ALWAYS LOOK AT IT ON A TIMLEY BASIS
The BBC are reporting: MRSA strain kills two in hospital
Quote:
A strain of MRSA that has never previously caused deaths in hospitals has killed two people, according to the Health Protection Agency (HPA).
After a healthcare worker died in September, it emerged that a form of Panton-Valentine Leukocidin (PVL) MRSA had also claimed a patient's life.
The strain attacks white blood cells and sufferers cannot fight infection.
Nine others also contracted the strain in the outbreak at University Hospital of North Staffordshire, Stoke-on-Trent.
Of these, only one was a patient.
In a statement the hospital said: "With the exception of one infection it is not clear at this stage whether transmission has occurred within the hospital or, as is more common, in the community which it serves.
"The hospital is continuing to take advice from the Health Protection Agency on management of the outbreak."
Hospital-associated strains of MRSA normally affect more elderly hospitalised patients.
But the PVL strain is unusual because it can affect young and otherwise healthy people.
Other strains
In the outbreak in Staffordshire, the first person - Case A - who died was a healthcare worker who developed MRSA, and was being treated as a patient at the hospital.
The second fatality was a patient being who was being treated on the ward where Case A had worked.
The HPA said there have been other cases of this particular strain of PVL MRSA in England and Wales - but these have been in the community, not hospitals.
Thirteen cases were recorded in the community in 2005. All were skin and soft-tissue infections.
There have also been five deaths linked to PVL MRSA in the UK over the last two years - but these were other strains of the bug.
Marine Richard Campbell-Smith, 18, cut a leg in training and died after becoming infected with a form of PVL in 2004.
A 28-year-old woman also died from a form of the infection after picking up the bug in her local gym.
'First time'
In a statement, the HPA said: "PVL-producing strains of MRSA have been seen in the UK before - however, the small numbers of cases reported have usually been in the community rather than a hospital setting.
"This outbreak is the first time transmission and deaths due to this strain are known to have occurred in a healthcare setting in England and Wales."
The agency identified those affected as being "among individuals in a hospital and their close household contacts in the West Midlands".
The agency only covers England and Wales.
Dr Angela Kearns, an MRSA expert with the HPA, said: "When people contract PVL-producing strains of MRSA, they usually experience a skin infection such as a boil or abscess.
"Most infections can be treated successfully with everyday antibiotics but occasionally a more severe infection may occur.
"The HPA is advising the hospital on outbreak control measures, and will continue to monitor MRSA infection nationally."
The PVL toxin is carried by less than 2% of the bacteria responsible for MRSA.
Although, it normally causes pus-producing skin infections, such as abscesses or boils, it can trigger more severe invasive infections such as septic arthritis, blood poisoning or a form of pneumonia.
Shadow health secretary, Andrew Lansley, said: "Over the last nine years there have been far too many cases where the government has allowed MRSA to become endemic.
"The inevitable result has been an evolving process leading to increased resistance to antibiotics.
"It is time for us to take on the threat of new and more dangerous bacteria."
Vancomycin- and methicillin-resistant gram-positive cocci have emerged as an increasingly problematic cause of hospital-acquired infections. We conducted a literature review of newer antibiotics with activity against vancomycin-resistant and methicillin-resistant gram-positive cocci. Quinupristin/dalfopristin, linezolid, daptomycin, and tigecycline have in vitro activity for methicillin-resistant staphylococci and are superior to vancomycin for vancomycin-resistant isolates. Dalbavancin, telavancin, and oritavancin are new glycopeptides that have superior pharmacodynamic properties compared to vancomycin. We review the antibacterial spectrum, clinical indications and contraindications, pharmacologic properties, and adverse events associated with each of these agents. Daptomycin has rapid bactericidal activity for Staphylococcus aureus and is approved for use in bacteremia and right-sided endocarditis. Linezolid is comparable to vancomycin in patients with methicillin-resistant S. aureus (MRSA) pneumonia and has pharmacoeconomic advantages given its oral formulation. Quinupristin/dalfopristin is the drug of choice for vancomycin-resistant Enterococcus faecium infections but has no activity against Enterococcus faecalis. Tigecycline has activity against both enterococcus species and MRSA; it is also active against Enterobacteriaceae and anaerobes which allows for use in intra-abdominal and diabetic foot infections. A review of numerous in vitro and animal model studies shows that interaction between these newer agents and other antistaphylococcal agents for S. aureus are usually indifferent (additive).
ScienceDaily are reporting: Overcrowding And Understaffing In Hospitals Increases Levels Of MRSA Infections
Quote:
A review article authored by a University of Queensland academic has found overcrowding and understaffing in hospitals are two key factors in the transmission of MRSA (Meticillin -- Resistant Staphylococcus Aureus) infections worldwide.
Dr Archie Clements, from the School of Population Health, reported overcrowding and understaffing increased levels of MRSA infections, which lead to increased inpatient hospital stay, bed blocking, overcrowding and more MRSA infections.
The review included information from 140 papers and Dr Clements was part of a team of seven authors.
The article titled: Overcrowding and understaffing in modern health-care systems: key determinants in Meticillin-Resistant Staphylococcus Aureus (MRSA) transmission, was published today in the July edition of The Lancet Infectious Diseases.
Dr Clements said MRSA was an antibiotic-resistant type of Staphylococcus Aureus, a common bacteria present on the skin and in the nostrils of many healthy people.....
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