[midnight-gamer]

MRSA: Somehow, I had missed reports of this nasty staph infection. I am hoping Small Pox Girl will weigh in here with her medical expertise. For your viewing pleasure.......
Video and Mrsa?

[Ivan_M]

not a new thing, but still pretty nasty. if you go to a hospital don't touch anything.

[smallpoxgirl]

Been around for a long time. It was relatively common back in 1995 when I was a pre-med. What's really new with MRSA is that a pretty virulent strain of it has spread out into the community. It was big in the Seattle area when I was in residency maybe 5 years ago, probably imported from Asia where antibiotics are available over the counter in most pharmacies. It's now spread out. I've seen it in Montana. It is unlike most staph aureus in that it really likes to cause skin abscesses in otherwise healthy young people. What's getting it noticed right now is not necessarily its antibiotic resistance, but its virulence in really going after otherwise healthy people. Most of the time young folks will eventually fight off the infection. You might have to lance the abscess, but it typically doesn't require antibiotics. If it does require antibiotics, there are a couple that have some effectiveness against some strains of MRSA. If you have a person who is seriously ill and needs guaranteed effective coverage of MRSA, there are a couple of options but they are all super expensive.

[californydreamin]

If Cowgirl would tell you more, she would say "When we saw MRSA infections they were put in isolation units and we had to gown and glove before we entered and exited the room, and certain people were not allowed to take care of certain patients.

Now, just 3 years later, More than half of ALL skin infections in seattle are MRSA. Saying "yo0uve seen it in montana" is a big coverup. it is the majority of cultured wound infections in any Emergency room in the USA. it can only be treated by *poor* antibiotics such as sulfa and tetracycilne which would not be our firstline drugs 15, 10, or 5 years ago vbecause they develop resistance so quickly.

it is multiplying at an astounding rate and will soon be a life threatening problem for all humans on the planet and as soon as it develops resistance to sulfa and tetracycline will start to multiply exponentially. today, when someone come to the Hospital, they are looked at and given sulfa, and SENT HOME. 5 years ago they were admitted to the hospital and put in isolation

how things change... same germ, and it is even MORE dangerous now but NO BODY gowns and gloves now. may I ask WHY? they gowned and gloved 10 years ago to the max under CDC recomendations. what happened?

well, it got away from us, so now it isnt that it is less dangerous in fact it is worse. now there is V-mrsa and VL mrsa and community mrsa. and the people that get lanced, go home oozing pus and they go to the store and go shopping and try on clothes. I have seen it in montana! LOL that is pretty disingenious... it is a plague that is soon going to kill you.

[californydreamin]

There is also a big hoaky movement to WASH YOUR HANDS and all infections are the FAULT OF MEDICAL STAFF. this is BS

We have a huge emergent MRSA and Leukocidin producing MRSA that is multiplying and the CDC dont want to SCARE you so they say EVERYONE WSHOULD WASH YOUR HANDS and they make patients report their doctors if they dont wash their hands

this is a red herring, the MRSA is admittedly COMMUNITY ACQUIRED and the PATIENTS bring it in to the hospital on THEMSELVES and on THEIR SHOES and on their pus sores, and they sit on the couches and waiting rooms and they sit in the exam rooms and they use the SAME BLOOD PRESSURE CUFFS on everyone and the same nurses stethoscopes on everyone and then they say

OOooo, our MRSA rate is increasing the DOCTORS are not washing THEIR HANDS. too funny. what a joke. Let me tell you how it is goin to be in just two years. everyone here will know someone who has DIED of MRSA. that is how fast it is going to increas eand hand washing is not going to touch it and they are going to blame the nurses and the doctors anyway... wait and see.

[californydreamin]

people seem to recur more and more frequently and many eventually die from it. also new, is MRSA pneumonia, mortality is way high. it hits the young more often, if you have a fever and a cough and feel sick and are around 20 and have pneumonia,
you could have mrsa pneumonia (HEALTHY YOUNG MALES ARE GETTING IT) when you get it, get your will in order.

by the time it cultures out you likely dead usually. this is so serious that no one is talking about it, when you refer one of these to the big center, the intensivist usually gos. oh, ****. skin infections, now, it is MALPRACTICE to not treat for MRSA before cultures even return. MENINGITIS it is malpractice now to treat without using MRSA drugs. dont believe it? gove some adult rocephin for meningitis and when you end up with a dead MRSA patient you will loose the lawsuit, my friend did this a few years ago, everything now revovles around MRSA

may cowgirl is in northern outpost of montana and really doesnt know what is going on, it is likely she will not see much MRSA there until some city slicker comes in and dies with MRSA pneumonia and they confiscate her cows.

[dissimulo]

$this->bbcode_second_pass_quote('californydreamin', 'i')t can only be treated by *poor* antibiotics such as sulfa and tetracycilne which would not be our firstline drugs 15, 10, or 5 years ago vbecause they develop resistance so quickly.

[Jack]

$this->bbcode_second_pass_quote('californydreamin', 'm')ay cowgirl is in northern outpost of montana and really doesnt know what is going on, it is likely she will not see much MRpneumonia and they confiscate her cows.

[Zardoz]

$this->bbcode_second_pass_quote('Jack', '.')..You are a new poster, californydreamin. I find it surprising that you would enter our online community and immediately begin berating a long-term and well respected poster...

[Jack]

$this->bbcode_second_pass_quote('Zardoz', 'I')s it my imagination or have we seen an unusual number of nasty newbies like this lately?

[midnight-gamer]

I won't tolerate insults in my thread.
-------------
OK, with that out of the way. I would like some evidence to back up californydreamin's claims.Please give personal experiences, studies, or other medical professional viewpoints.
$this->bbcode_second_pass_quote('', 'e')veryone here will know someone who has DIED of MRSA. that is how fast it is going to increas eand hand washing is not going to touch it and they are going to blame the nurses and the doctors anyway...

[pedalling_faster]

$this->bbcode_second_pass_quote('Zardoz', 'I')s it my imagination or have we seen an unusual number of nasty newbies like this lately?

[smallpoxgirl]

It's a big scary world. There's lots of things to be terrified of. MRSA is frankly not that high on my list. Most healthy people fight it off on their own. Most strains are sensitive to sufla and doxycycline. Some are sensitive to clindamycin. Partial resistance to Vancomycin has been reported, though I've never personally seen a case that wasn't sensitive to it. All strains are sensitive to Linezolid. The number of people killed by falling in their bathtub is still probably an order of magnitude higher than those killed by MRSA.

[Specop_007]

$this->bbcode_second_pass_quote('Zardoz', '')$this->bbcode_second_pass_quote('Jack', '.')..You are a new poster, californydreamin. I find it surprising that you would enter our online community and immediately begin berating a long-term and well respected poster...

[WatchfulEye]

That video is a bit of scaremongering.

The name 'superbug' is commonly used in the popular media, but it is rather misleading. MRSA isn't necessarily any more virulent, contagious or harmful than the classical susceptible Staph. MRSA just means a Staph aureus organism that is resistant to the use of the classic antibiotic 'methicillin' and its variants such as 'flucloxacillin'.

Staph aureus has been around probably for as long as humanity, and has been a common cause of all manner of diseases, most commonly skin boils, but also a variety of other illnesses. e.g. a severe case of influenza can predispose to catching pneumonia and S. aureus is the number 1 organism that infects influenza weakened lungs.

When Pencillin was first introduced for medical use in the 50s, all Staph aureus isolated from patients were killed by penicillin. However, within just 2 years of the introduction of pencillin, doctors started reporting cases of Staph aureus where the organism was resistant to the effects of penicillin. By the 70s, pencillin sensitive staph aureus was the exception; most S aureus was resistant. The antibiotic methicillin was developed from penicillin and was highly effective, even against the new penicillin resistant forms.

Now we are starting to see MRSA appearing in increasing numbers. It's misleading to say that it's not treatable, but treating it is more difficult. Flucloxacillin is an excellent antibiotic with few side-effects, can be taken in tablet form, and penetrates deep into the tissues of the body - e.g. damaged or inflamed tissue. There are plenty of antibiotics that are effective against MRSA; doxycycline, trimethoprim, rifampicin, vancomycin, teicoplanin, linezolid are some just off the top of my head. There are several other unusual ones. However, these all tend to have some disadvantages - either they're of limited potency, and need to be taken in a cocktail of 2 or 3 different antibiotics, or they have potentially dangerous side effects which require careful medical supervision.

There are numerous different strains of S aureus, with different levels of virulence (how much disease they call). Some are relatively mild, and healthy people will just fight off the infection with barely any symptoms - may a bit of a spot on the skin. More virulent ones can cause boils/abscesses. And some of the most virulent ones can cause septicaemia, and horrendous infections causing serious illness and organ damage, even in healthy people with strong immune systems.

There's a particularly nasty type of virulence in S aureus called PVL (Panton-Valentine leukocidin). PVL positive S aureus can cause devastating 'necrotizing' (flesh eating) illness even in healthy people. There have been outbreaks of PVL+ MRSA in a number of countries; in Europe, Asia and the USA. However, PVL is not new - it was recognised in the 30s - just that it tends to attract attention because it's nasty.

There are a lot of factors that determine the prevlence and the development of MRSA. Overuse of antibiotics is certianly one - but it's not just overuse of methicilllin/flucloxacillin that is necessarily to blame. One thing relatively recently recognised is that other antibiotics may predispose. E.g. ciprofloxacin. Ciprofloxacin isn't particularly useful for Staph infections, but it is excellent for things like urine infections and gut infections (which are caused by different bugs e.g. E. coli). However, it's now recognised that receiving ciprofloxacin is a major risk factor for contracting MRSA; it completely cleans out all the 'friendly' bacteria that normally inhabit the skin, and is partially effective against staph aureus. However, the same genes that cause SA to become MRSA tend to confer resistance to cipro. So, if you take cipro, you preferrentially select the MRSA. This is such a problem where I've worked, that the hospital has now essentially banned the use of cipro, except on the orders of an attending microbiologist.

It's also perhaps disingenous to dismiss the recent initiatives such as rigorous attention to detail in hand washing, etc. In some countries, e.g. the UK, MRSA infections are reportable, and a lab reporting a positive significant culture (e.g. septicaemia) must report the result to the health protection agency. In recent years, there has been a significant decline in number of significant MRSA infections recorded in this way. The peak was in 2004, and the rate has decreased year-on-year in each subsequent year. Of course, the data to identifiy which intervention this can be attributed to doesn't exist - but it's likely that it's the combination of measures.

[CarlinsDarlin]

Watchful Eye,
Thank you for your informative post. I appreciate the time and effort you took to type it all out.

Here's a question that may sound naive (and probably is) ... but it comes to mind. I have, as some of you may know, dairy goats. There is a vaccination for staph aureus that I give to my dairy goats yearly. Lysigin is the brand name. Obviously people have different systems from goats. But if there's a vaccination against staph aureus for goats, why isn't there one for people?
Kathy

[smallpoxgirl]

$this->bbcode_second_pass_quote('WatchfulEye', 'M')RSA isn't necessarily any more virulent, contagious or harmful than the classical susceptible Staph.

[AlterEgo]

Watchful Eye sounds well-informed and has it right. MRSA has been around since the 1960s. The hospital-acquired MRSA (HA-MRSA) strains are typcially much more virulent genotypes than the community-acquired MRSA. HA-MRSA is typically treated with the stronger newer abx such as Vancomycin. There is a high prevalence of CA-MRSA up here in AK, typically seen as boils and other skin infections, especially in the bush where hand hygiene is more difficult.

Hand hygiene in hospitals is extremely important to prevent transmission of all kinds of bugs, and should not be discounted. The US has not tackled MRSA eradication as some European countries have; the Netherlands have 100% culturing of both patients and employees and thus have much lower rates. Most US hospitals prefer to put their heads in the sand and not culture new admits or staff; what would they do when they found that half of the admissions or half or their employees were colonized with MRSA (either HA or CA types)?

SPG probably sees very little MRSA in Montana (so far). It is spreading, but it is probably not the civilization-ending plague that people are looking for. I would recommend that people who enter the hospital do police the hand hygiene adherence of their caregivers, though. A gentle, "Please wash your hands or use handrub before you care for me is enough." That goes for patients in medical offices, etc.

A study last year in a critical care unit calculated that if nurses washed their hands as many times as required by policy, then it would take up over 3 hours of the day.

(edit-colonization is not the same as active infection)