UK gives superbug alert outside of the hospital environment

November 28, 2007

The BBC reports that experts are warning that bugs such as MRSA have been spreading in the wider community environment. They want doctors to be alert to the most dangerous form of MRSA that can attack the lungs and may strike young people in particular.

 

Panton Valentine leukocidin (PVL) strains of community-acquired MRSA can cause a condition called necrotizing pneumonia, which destroys lung tissue.

This only affects a minority of those infected, but can be deadly.

“These new strains of bacteria appear to be able to stick to damaged skin and airways better than the hospital MRSA strains, and they can also multiply at a faster rate,” says Dr Marina Morgan, of the Royal Devon and Exeter Foundation NHS Trust.

So far these strains are mainly spreading in the US, where 12% of all MRSA cases are community-acquired, but the UK has seen an increasing number of cases.

It is unclear why children seem to be at particular risk, but the speculation is that older people in the community have fewer cuts and abrasions – a key transmission route – and have less contact with other people.

 

Nursing home threat

Meanwhile, Irish researchers are examining a new breed of bacteria which carry enzymes called extended spectrum beta lactamases (ESBLs), which are capable of destroying a many common antibiotics.

They include a strain of E. Coli, which is spreading into nursing homes and communities across Europe.

This was held responsible for a severe outbreak of cystitis, a bladder infection, in the UK between 2003 and 2004.

“Although cystitis is not life threatening, it is the most common form of urinary tract infection, and the economic consequences of failing to treat an outbreak quickly and properly are considerable,” said Dr Dearbhaile Morris, of the National University of Ireland.

“In severe infections, patients may suffer serious complications if the first antibiotic given to them does not work.”

Mark Enright, professor of molecular epidemiology at Imperial College, said he was “not surprised” by the findings.

“The emergence and spread of ESBL E. Coli does give physicians problems in providing proper initial care for some patients especially those with urinary tract infections.”

He added: “The control of infections in many nursing homes is inferior to hospitals despite the medication and specialist care required by some residents.”

 


A Responsible approach to MRSA

October 25, 2007

By JEFFERSON WEAVER
Staff Writer

Health
officials hope encouraging better hygiene and following strict
protocols can prevent the MRSA virus from becoming more of a problem in
Columbus County.

Columbus Regional already has close
enforcement of hand hygiene and patient isolation rules to avoid spread
of the drug-resistant bug. The infection has been blamed for several
deaths across the country in recent weeks, and is turning up in
previously unaffected portions of the population.

Methicillin-resistant
Staphylococcus aureus, better known as MRSA or simply staph, was
previously rare outside of hospitals and nursing homes, but in recent
years the virulent strain of MRSA has begun appearing in schools,
prisons, and the general population.

Miranda
Dufour, who is in charge of Infection Control and Employee Health at
Columbus Regional, said the hospital was already on a prevention
platform for the disease, which has no vaccination of cure.

“We’ve
been monitoring it closely,” Dufour said. “That’s been the case since
2005, when we became aware this could be a growing problem.”

Community-related
MRSA, according to the state Department of Health, can be treated with
medicines. Hospital-associated MRSA, the more virulent strain, is the
one doctors are worried about.

The disease became a
major concern to health officials in the 1990s, when people with no
connection to medical facilities began showing signs of HA-MRSA.

The
variation of the disease was noticed in 2005 in North Carolina. Day
care centers and schools have been the hardest hit by the disease,
which the Centers for Disease control estimates will kill more people
than the AIDS virus next year.

MRSA infections can appear as a spider or infected insect bite.

This
changes into a “red hot pimple,” Dufour said, and may be followed by
flu-like symptoms. The disease usually causes powerful infections to
the rest of the body.

MRSA is carried by many people who never exhibit symptoms or get sick.

“A lot of people can be colonized in their skin, nose or armpits,” Dufour said, “and never show an active infection.”
The disease is spread through skin-to-skin contact, or by extended
contact with articles that carry the germ, like towels, washcloths and
razors. MRSA can also be transmitted through the handles of shopping
carts, telephones and athletic equipment.

Dufour
said medical professionals are eyeing the bug because it is appearing
in greater numbers in the general population. The hospital has taken a
strong preventative stance on the disease, Dufour said.

“We
are concerned,” she said. “MRSA has always been there, especially in
hospitals and nursing homes, but when it started moving out into other
places it became even more serious.”

The hospital already checks nursing home or long-term care patients for MRSA, Dufour said.

If
a patient tests positive for the bug – either through an active case or
by being colonized, or carrying the disease – he or she is isolated
from other patients. Staff members also wear gowns and other protective
gear whenever they treat a colonized patient.

“We also
practice strict handwashing hygiene throughout the hospital,” Dufour
said, “and we encourage anyone visiting the hospital to do the same.”

Dispensers
with alcohol-based sanitizers are set up throughout the hospital, and
some members of the staff carry individual bottles.

It’s a habit Dufour said health officials encourage for the general population, too.

“You
can get the personal size bottles almost anywhere,” she said. “There
are small ones that fit perfectly in a child’s lunchbox or bookbag, and
everyone should have some available if they go to a store or other
public place where contact is likely.”

The germ commonly turns up in infants with skin abcesses, Dufour said, and children who spend time in close quarters.

The
state Department of Health has issued special advisories on MRSA for
schools and athletic organizations, since a 17-year-old Virginia youth
contracted the disease while playing high school sports.

Several members of a North Carolina high school team were also infected recently and are being treated.
Health clubs and gyms have also been put on notice, Dufour said,
because the germ can be spread through sweat from an infected person.

Others
at risk are people with poor general hygiene, anyone who lives in a
confined space, intravenous drug users, and people with chronic
illnesses such as renal failure or diabetes.

“If you’re in generally good health, “ Dufour said, “just keep an eye on anything suspicious.”

While there is no antibiotic that can treat the disease, Dufour said there is a simple way to prevent it.

“Good
handwashing hygiene is the best preventative,” she said. “Washing your
hands in warm soapy water for 15 to 20 seconds will eliminate much of
the danger.”

Dufour said there has been a rise in calls
to area doctors about the disease, especially from concerned parents
and people who notice insect bites.

“Not every bite or
pimple is MRSA,” Dufour said. Keep any suspicious wound clean, dry and
covered, Dufour said, and if there is no improvement in a few days,
“call your doctor.”

The wound will then be drained and
the infection tested to determine if the patient has staph, Dufour
said. Sometimes the problem can be treated with draining by a doctor.

The disease has historically struck older people, Dufour said, but the
new strain is increasingly taking aim at young people, especially
children.

To
avoid spreading the disease, the hospital has also asked that parents
not allow young children to crawl into hospital beds with patients.

“You
hate to have to say something like that,” Dufour said, “but if a person
is infected, and a little one crawls into bed with grandma – then you
have two infected people, not just one.”

Both the U.S. Centers for Disease Control and the state Department of Health have set up a special website on MRSA.

For more on diagnosing and preventing the spread of the disease, go to
the state site at www.epi.state.nc.us/epi/gcdc/ca_mrsa, or the federal
site at www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html.

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