Wednesday, February 29, 2012

MRSA Could Lead to Bigger Problems

MRSA Could Lead to Bigger Problems

Feb 29, 2012

The presence of a boil on the body should not be taken lightly, according to Dr. Bertha Ayi.

Leaving it untreated, she said, could result in serious health consequences, even death.

"If you have a boil, don't just lance it at home and forget about it," said Ayi, medical director of Mercy Infectious Disease & Epidemiology Center -- Sioux City. "See a physician and take a culture to see if it's (Methicillin-resistant Staphylococcus aureus), because it can progress."

According to Ayi, studies have show that 50 percent of patients suffering from boils who visit emergency rooms nationwide have Methicillin-resistant Staphylococcus aureus (MRSA).

In October 2007, the Centers for Disease Control and Prevention (CDC) released a study outlining the full extent of MRSA infection in the U.S. population. That study noted that in one year, MRSA infections killed more people than Human Immunodeficiency Virus (HIV).

Soon after the CDC report, MRSA made national headlines when several U.S. schools closed their doors when students died or became seriously ill from MRSA infection.

Four years after the study was released, Ayi said MRSA is present in Sioux City and around the country.

"Am I seeing more cases?" she said. "I've seen more cases in the past than now. I may not be seeing as much because other physicians are getting more comfortable treating it."


Staphylococcus aureus, the cause of common boils, has been around a long time, according to Ayi.

But over the years, she said the bacteria has become resistant to Methicillin, an antibiotic commonly used to treat ordinary staph infections. Hence Methicillin-resistant Staphylococcus aureus or MRSA.

Ayi said MRSA used to be found only in hospitals, but from 1995 to 1998 doctors began seeing healthy, young children, who had had no contact with the health care system, developing severe pneumonia and brain infections.

"They died within three to four days. It was due to the Methicillin-resistant Staphylococcus aureus," she said. "The thought was that over time (MRSA) acquire certain characteristics that allow them to get into the environment and cause infections in previously healthy young people."

Today MRSA is common in places where there is overcrowding, such as prisons. Ayi said MRSA is also prevalent among the homeless, who may leave wounds untreated.

Athletes participating in football and wrestling are at a higher risk of contracting MRSA, according to Ayi, because of the nearly constant skin-to-skin contact required in the sport.

"Among athletes, if somebody carries it on their skin they can pass it on without necessarily having an open wound," she said.


Cuts, scrapes and scratches allow bacteria to enter the skin, according to Ayi, leading to infection

It's important to clean and disinfect cuts and scrapes and cover them with bandages or sterile dressings.

If the wound becomes infected and a boil develops, Ayi said the patient should seek treatment from a medical professional immediately.

Ayi explained that a boil has blood flowing around it, meaning that the infection could spread into the blood stream leading to sepsis a potentially fatal illness where the blood is stream is overwhelmed by bacteria.

Those suffering from MRSA, Ayi said, could also develop infections of the brain and spinal chord, as well as necrotizing pneumonia - where the pieces of the lung are literally eaten away by the bacteria.

One of her patients, Ayi said, had a small MRSA infection on his thigh that spread into his femur bone.

"It can get into any tissue -- feet, ankle joints," she said. "Some times people will have joint replacement. It's a pretty bad infection to acquire."

Washing hands well and covering all wounds are key to preventing the spread of MRSA, according to Ayi.

"If somebody has MRSA we go in there with gloves, gowns and we dispose of their bodily fluids very well," she said. "We don't go in there with our bare fingers and try to examine the wounds. We make sure we're protected."

An athletic team in the midst of a MRSA outbreak, Ayi said, can attempt to "decolonize" the bacteria by putting cream in their nostrils, by avoiding sharing towels and clothing, and by washing with an antiseptic solution.

She said athletes with active lesions should refrain from participating in the sport.


How to treat MRSA, depends on the severity of the infection, according to Ayi.

She said a current patient has a MRSA infection in her elbow. The woman was taking antibiotics in pill form, but it didn't cure her infection. Now, Ayi said she is receiving antibiotics intravenously.

"Intravenous antibiotics -- usually people are a lot sicker," she said. "Maybe it involves their lungs or spinal chord or you can tell based on clinical judgment that it could aggressively progress to a more severe disease."

Ayi advises those who have previously suffered from MRSA tell their physicians whenever they go to a clinic or hospital for medical care.

"The care providers can think about it and put it in their differential diagnosis," she said.

Read more:

Wednesday, February 22, 2012

Increased prevalence of methicillin-resistant Staphylococcus aureus nasal colonization in household contacts of children with community acquired disea

Increased prevalence of methicillin-resistant Staphylococcus aureus nasal colonization in household contacts of children with community acquired disease.

Feb 2012



To measure Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization prevalence in household contacts of children with current community associated (CA)-MRSA infections (study group) in comparison with a group of household contacts of children without suspected Staphylococcus aureus infection (a control group).


This is a cross sectional study. Cultures of the anterior nares were taken. Relatedness of isolated strains was tested using pulse field gel electrophoresis (PFGE).


The prevalence of MRSA colonization in the study group was significantly higher than in the control group (18/77 (23%) vs 3/77 (3.9%); p [less than or equal to] 0.001). The prevalence of SA colonization was 28/77 (36%) in the study group and 16/77 (21%) in the control group (p = 0.032). The prevalence of SA nasal colonization among patients was 6/24 (25%); one with methicillin-susceptible S. aureus (MSSA) and 5 with MRSA. In the study (patient) group, 14/24 (58%) families had at least one household member who was colonized with MRSA compared to 2/29 (6.9%) in the control group (p = 0.001). Of 69 total isolates tested by PFGE, 40 (58%) were related to USA300. Panton-Valetine leukocidin (PVL) genes were detected in 30/52 (58%) tested isolates. Among the families with [greater than or equal to]1 contact colonized withMRSA, similar PFGE profiles were found between the index patient and a contact in 10/14 families.


Prevalence of asymptomatic nasal carriage of MRSA is higher among household contacts of patients with CA-MRSA disease than control group. Decolonizing such carriers may help prevent recurrent CA-MRSA infections.


Tuesday, February 14, 2012

MRSA Dx Tool in Osteomyelitis Called Faulty

MRSA Dx Tool in Osteomyelitis Called Faulty

Feb 2012

By John Gever, Senior Editor, MedPage Today

Published: February 09, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

SAN FRANCISCO -- A common clinical method for gauging risk that theStaphylococcus aureus causing a child's osteomyelitis will be methicillin-resistant is unreliable, a researcher said here.

The so-called Boston algorithm may have been accurate when and where it originated, but it was no help at all in assessing MRSA risk more recently in a major pediatric hospital in Arizona, according to a poster presented at the American Academy of Orthopaedic Surgeons annual meeting.

M. Wade Shrader, MD, of Phoenix Children's Hospital, said that children with osteomyelitis showing all four of the algorithm's criteria had the same risk of confirmed MRSA infection -- 50% -- as those with just one of the factors.

He and his colleagues concluded that genetic markers in clinical samples "may be the best early test to identify MRSA infections."

The algorithm in question was published in 2001 by Mininder Kocher, MD, MPH, of Children's Hospital in Boston, and colleagues, based on a series of pediatric patients evaluated there.

It identified four factors as highly predictive of MRSA versus methicillin-sensitive staph infections in pediatric osteomyelitis:

  • Temperature above 38° C
  • Hematocrit below 34%
  • White blood count greater than 12,000 per microliter
  • C-reactive protein above 13 mg/L

Kocher and colleagues found that 91% of pediatric osteomyelitis patients with all four factors were infected with MRSA as opposed to methicillin-sensitive S. aureus, whereas only 1% of those with a single factor had MRSA infections.

But the MRSA label covers multiple S. aureus strains, the distribution of which varies widely from one region to another. Moreover, individual manifestations of infection may vary from one person to another even when the same strain is involved.

Consequently, Shrader and colleagues examined records of 58 children seen recently in their hospital to determine whether the algorithm would apply in the population it serves. Only patients with culture-based confirmation of methicillin resistance status were included in the analysis.

They found that the Boston algorithm was essentially useless in the patients seen in Phoenix.

Half the children meeting all four criteria had confirmed MRSA, as did half of those with only one factor.

Among those meeting three of the Boston criteria, MRSA was confirmed in 42%; it was confirmed in 21% of those meeting two criteria.

Chad T. Price, MD, a pediatric orthopedic surgeon in Orlando, Fla., who was not involved in the study, commented that the desire for a predictive algorithm is understandable.

"It is nice to begin to predict MRSA because you might add vancomycin or some other medication at the beginning," he said.

Unfortunately, he said, the Phoenix study confirms the geographic and temporal variation in MRSA manifestations.

"Basically, what [the study] says is you can't predict," Price said.

In his clinic, he said, skin lesions are often a clue to MRSA in children with septic joints -- at least, to community-acquired MRSA strains that frequently carry the Panton-Valentin leukocidin toxin. He added that he had heard of vancomycin being administered as a matter of course in all children with osteomyelitis.

The study had no external funding.

Shrader and Price indicated they had no relevant financial interests.

Primary source: American Academy of Orthopaedi

MedPage Today

Methicillin-resistant Staphylococcus aureus infection is associated with increased mortality.

Methicillin-resistant Staphylococcus aureus infection is associated with increased mortality.


Pathogen Molecular Genetics Section, Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy & Infectious Diseases, NIH, Bethesda, MD, USA.


Evaluation of: Hanberger H, Walther S, Leone M et al. Increased mortality associated with meticillin-resistantStaphylococcus aureus (MRSA) infection in the intensive care unit: results from the EPIC II study. Int. J. Antimicrob. Agents 38(4), 331-335 (2011). Methicillin resistance is a widespread and major source of treatment complication in Staphylococcusaureus infections. Whether infections with methicillin-resistant S. aureus are associated with a worse clinical outcome, such as higher mortality, has remained controversial. Analyzing data from a large, global multicenter study, Hanberger et al. demonstrate that methicillin-resistant S. aureus infections are associated with approximately 50% higher mortality in the intensive care unit and significantly more frequent among critically ill patients than infections with methicillin-susceptible S.aureus. These findings call for the implementation or continuation of active methicillin-resistant S. aureus surveillance measures.


Genotypes, exotoxin gene content and antimicrobial resistance in Staphylococcus aureus recovered from foods and food-handlers.

Genotypes, exotoxin gene content and antimicrobial resistance in Staphylococcus aureus recovered from foods and food-handlers.

Feb 2012


Department of Functional Biology, Microbiology Area, University of Oviedo. Julian Clavería 6, 33006 Oviedo, Spain.


Staphylococcal food poisoning, one of the most common food-borne diseases, results from ingestion of one or more staphylococcal enterotoxins (SEs) performed by Staphylococcus aureus in foods. In the present study, 64 S. aureusisolates recovered from foods and food handlers, associated or not with food-poisoning outbreaks in Spain, were investigated. They were assigned to 31 strains by spa typing, MLST, exotoxin gene content, and antimicrobial resistance. The strains belonged to ten clonal complexes (CCs): CC5 (29.0%), CC30 (25.8%), CC45 (16.1%), CC8, CC15 (two strains each), CC1, CC22, CC25, CC59, and CC121 (one each). They contained haemolysin genes (90.3%); lukED (77.4%); exfoliatin genes: eta, etd (6.5% each) and etb (3.2%); tst (25.8%); and enterotoxin or enterotoxin-like genes or clusters: sea (38.7%), seb (12.9%), sec (16.1%), sed-selj±ser (22.9%), selk-selq (6.5%), seh, sell, selp (9.7% each), egc1 (32.3%), and egc2 (48.4%). The number of se/sel genes ranged from 0 to 12. All isolates carrying tst, and most isolates with genes encoding classical enterotoxins (SEA, SEB, SEC and SED), expressed the corresponding toxin(s). Two CC5 isolates from hamburgers (t002/ST5, t2173/ST5) were methicillin resistant and harboured SCCmec IVd. Six (19.4%) were mupirocin resistant and one (t120/ST15) from a food handler carried mupA (MIC 1250 μg/ml). Resistances to ampicillin (blaZ; 61.3%), erythromycin (ermA-ermC/ermC; 25.8%), clindamycin (msrA-msrB/msrB; 16.1%), tetracycline (tetK; 3.2%), and amikacin-gentamicin-kanamycin-tobramycin (aacA+aphD-aphA; 6.5%) were also observed.

The presence of S. aureus with an important repertoire of virulence and resistance determinants in the food chain represents a potential health hazard for consumers and deserves further observation.