MRSA Strategy in ICU Cuts All Infections

By Ed Susman, Contributing Writer, MedPage Today

Published: October 18, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

SAN DIEGO – Bathing all patients in the ICU with antibacterial agents rather than simply screening for methicillin-resistant Staphylococcus aureus (MRSA) reduced all bloodstream infections by more than 40%, researchers said here.

In a study conducted at 43 hospitals, universal treatment – without screening – cut MRSA colonization by 37% and resulted in a 44% reduction in all bloodstream infections, said Susan Huang, MD, MPH, associate professor of infectious diseases at the University of California, Irvine School of Medicine.

That compared with essentially no difference in reduction of infections when patients were given the standard-of-care treatment of screening and isolation, Huang said at a press briefing during IDWeek 2012.

Huang also said that universal treatment without screening proved more effective than screening, followed by washing patients with chlorhexidine and using mupirocin to decolonize MRSA in the nose. That strategy was 22% better than the standard of care , but universal treatment was better than screening first then treating ), she said.

"I am pleased to say that on the basis of this study, Hospital Corporation of America has adopted the universal strategy for treating patients in ICU at their 160 facilities," Huang told MedPage Today.

"This study is compelling enough to change standard practice of screening and isolation," briefing moderator Daniel Diekema, MD, professor of medicine and director of infectious diseases at the University of Iowa, Iowa City, told MedPage Today. He was not involved in the study.

Huang noted, "This trial provides strong evidence that removing bacteria from the skin and nose is highly effective at preventing serious infection in high-risk ICU patients. 

Article Concluded: Med Page Today

Superbug Hideout: Finding MRSA in U.S.Wastewater Treatment Plants

Superbug Hideout: Finding MRSA in U.S.Wastewater Treatment Plants

Nov 2012

For many years, the “superbug” methicillin-resistant Staphylococcus aureus (MRSA) was confined to hospital patients, but since the 1990s it has been infecting otherwise healthy people in settings such as schools and locker rooms. Researchers now report the discovery of MRSA in U.S. wastewater treatment plants (WWTPs), identifying another possible environmental reservoir for the bacteria [EHP 120(11):1551–1558; Rosenberg Goldstein et al.]. People shed MRSA from their nostrils and skin and in their feces, which makes wastewater a likely vector for the bacteria. Previous research had identified MRSA in Swedish WWTPs, but no studies had been conducted on U.S. facilities.

The researchers collected wastewater samples throughout the treatment process at two mid-Atlantic and two Midwestern WWTPs. MRSA, as well as pathogenic methicillin-susceptible Staphylococcus aureus (MSSA), were present at all four WWTPs, with MRSA detected in 50% of all samples and MSSA detected in 55%. Genetic testing of the MRSA isolates revealed traits common among exceptionally virulent community-acquired strains circulating in the United States. Most MRSA isolates and 29% of MSSA isolates showed resistance to two or more classes of antibiotics, including several that the U.S. Food and Drug Administration has specifically approved for treating MRSA infections.

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