Case Reports
Case 1. In July 1997, a 7-year-old black girl from urban Minnesota was admitted to a tertiary-care hospital with a temperature of 103 F (39.5 C) and right groin pain. An infected right hip joint was diagnosed; she underwent surgical drainage and was treated with cefazolin. On the third day of her hospital stay, antimicrobial therapy was changed to vancomycin when cultures of blood and joint fluid grew MRSA. The same day, the patient had another hip drainage procedure, but had respiratory failure and was placed on mechanical ventilation. Her course was complicated by acute respiratory distress syndrome, pneumonia, and an empyema that required chest tube drainage. She died from a pulmonary hemorrhage after 5 weeks of hospitalization.
MRSA isolated from her blood, hip joint, and sputum was susceptible to multiple antibiotic classes . An autopsy revealed bilateral bronchopneumonia with abscesses. The patient was previously healthy with no recent hospitalizations. No family members resided in LTCFs or worked in health-care settings.
Case 2. In January 1998, a 16-month-old American Indian girl from rural North Dakota was taken to a local hospital in shock and with a temperature of 105.2 F (40.6 C), seizures, a diffuse petechial rash, and irritability. She was treated with ceftriaxone but developed respiratory failure and cardiac arrest and died within 2 hours of arriving at the hospital. Blood and cerebrospinal fluid cultures drawn immediately postmortem grew MRSA that was susceptible to multiple antibiotic classes . An autopsy revealed multiple small abscesses of the brain, heart, liver, and kidneys; autopsy cultures of meninges, blood, and lung tissue grew MRSA. One month earlier, the patient had been treated with amoxicillin for otitis media. Neither the patient nor family members had been hospitalized during the previous year; no family members resided in LTCFs or worked in health-care settings.
Case 3. In January 1999, a 13-year-old white girl from rural Minnesota was brought to a local hospital with fever, hemoptysis, and respiratory distress. The day before admission she had a productive cough and a 2-cm papule on her lower lip. A chest radiograph revealed a left lower lobe infiltrate and a pleural effusion. She was treated with ceftriaxone and nafcillin. Within 5 hours of arriving at the hospital, she became hypotensive and was transferred to a pediatric hospital, intubated, and treated with vancomycin and cefotaxime. Despite pulmonary and hemodynamic support, the patient's respiratory status deteriorated, and she died on the seventh hospital day from progressive cerebral edema and multiorgan failure.
The patient's blood, sputum, and pleural fluid grew MRSA that was multidrug susceptible . An autopsy revealed consolidated hemorrhagic necrosis of the left lung. The patient had no chronic medical conditions and no recent hospitalizations; no family members were health-care workers or employees of an LTCF or had a history of IDU.
Case 4. In February 1999, a 12-month-old white boy from rural North Dakota was admitted to a tertiary-care hospital with bronchiolitis, vomiting, and dehydration. He had a temperature of 105.2 F (40.6 C) and a petechial rash. Chest radiograph revealed an infiltrate in the right lung consistent with pneumonitis. On the second hospital day, the patient was diagnosed with a large right pleural effusion. He was transferred to the intensive-care unit, a chest tube was inserted, and treatment with vancomycin and cefuroxime was initiated. The patient developed severe respiratory distress and hypotension the following day and died.
The patient's admission blood culture was negative, but his pleural fluid and a postmortem blood culture grew multidrug-susceptible MRSA . An autopsy revealed acute necrotizing pneumonia with extensive hemorrhage and numerous gram-positive cocci in the right lung. The patient had not been hospitalized since birth and had no known medical problems; no family members were health-care workers or employees of an LTCF or known to be IDUs. His 2-year-old sister had been treated for a culture-confirmed MRSA buttock infection 3 weeks earlier. MRSA isolates from the sister and the patient had identical antibiotic susceptibility profiles.
Wednesday, October 24, 2007
Protect Yourself and children from MRSA
Preventing 'staph' and MRSA infections?
As with most things, prevention is important to avoid these infections.
Understanding that 'staph' and MRSA is usually spread from having close contact with infected people can help you avoid these infections. In addition to direct physical contact, it may also be spread by 'indirect contact by touching objects (i.e., towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or staph bacteria.'
To avoid 'staph' and MRSA, the CDC recommends that you and your kids practice good hygiene, including:
Keeping your hands clean by washing thoroughly with soap and water. Athletes should be encouraged to shower and wash with soap after all practices and competitions.
Keeping cuts and abrasions clean and covered with a proper dressing (e.g., bandage) until healed.
Avoiding contact with other people’s wounds or material contaminated from wounds, including towels, clothing and sports equipment.
If a family member is diagnosed with MRSA, it might be helpful to prevent its spread by treating all family members with Bactroban nasal ointment (to prevent colonization) and an antimicrobial wash, like Hibiclens. This 'decolonization' is controversial though and not all experts recommend it because of the concern that it might lead to even more resistance.
Most importantly, to prevent the continued spread of MRSA and other resistant bacteria, don't ask for antibiotics when your child has an infection that doesn't need it, like a cold or the flu. Although in the past, resistance simply meant that you might have to take 2 or 3 antiobitics to clear your child's ear or sinus infection, the consequences are becoming much more serious, as children are dying from these MRSA infections.
As with most things, prevention is important to avoid these infections.
Understanding that 'staph' and MRSA is usually spread from having close contact with infected people can help you avoid these infections. In addition to direct physical contact, it may also be spread by 'indirect contact by touching objects (i.e., towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or staph bacteria.'
To avoid 'staph' and MRSA, the CDC recommends that you and your kids practice good hygiene, including:
Keeping your hands clean by washing thoroughly with soap and water. Athletes should be encouraged to shower and wash with soap after all practices and competitions.
Keeping cuts and abrasions clean and covered with a proper dressing (e.g., bandage) until healed.
Avoiding contact with other people’s wounds or material contaminated from wounds, including towels, clothing and sports equipment.
If a family member is diagnosed with MRSA, it might be helpful to prevent its spread by treating all family members with Bactroban nasal ointment (to prevent colonization) and an antimicrobial wash, like Hibiclens. This 'decolonization' is controversial though and not all experts recommend it because of the concern that it might lead to even more resistance.
Most importantly, to prevent the continued spread of MRSA and other resistant bacteria, don't ask for antibiotics when your child has an infection that doesn't need it, like a cold or the flu. Although in the past, resistance simply meant that you might have to take 2 or 3 antiobitics to clear your child's ear or sinus infection, the consequences are becoming much more serious, as children are dying from these MRSA infections.
Facts about MRSA
Most people have heard of the Staphylococcus aureus bacteria. Also called S. aureus or simply 'staph', this bacteria is one of the most common causes of skin infections. Although 'staph' can cause serious infections, like blood and bone infections, pneumonia and surgical wound infections, most infections are minor, such as impetigo, cellulitis and small abscesses or boils.
And unfortunately, more and more people are becoming aware of MRSA, or methicillin-resistant Staphylococcus aureus.
While regular 'staph' infections are usually easily treated with cephalosporin antibiotics that are related to penicillin, like Keflex, Duricef, and Ancef, the MRSA bacteria has developed a resistance to these antibiotics, so that they don't work anymore.
How common are staph and MRSA infections?
It is estimated that 25% to 30% of people have the staph bacteria either on their skin or in their nose, althought it doesn't necessarily cause an infection unless there is a break in the skin, like from an insect bite or scratch. Unless they have an infection, these people are simply 'colonized' with 'staph' and don't necessarily need treatment.
Although usually thought of as a 'nosocomial' infection or one that is spread among people in the hospital or a nursing home, etc., MRSA infections are becoming increasingly more common in healthy people who have not been in the hospital (community acquired infections).
There have also been reports of outbreaks 'among participants in competitive sports,' including fencers, football players and wrestlers. These outbreaks may be because athletes have many risk factors for infection, including 'physical contact, skin damage, and sharing of equipment or clothing.'
How did 'staph' become resistant to antibiotics?
Probably because of the general overuse of antibiotics these days. When you take an antibiotic, like Omnicef, Vantin or Ceftin, for an ear or sinus infection, in addition to targeting the bacteria causing those infections, if you are colonized with 'staph', the 'staph' bacteria is also exposed to those antibiotics and so have time to 'learn' how to fight them or become resistant.
Even if your child isn't on antibiotics a lot, if he is in daycare or around a lot of other children who are often on antibiotics, then he might be exposed and can catch resistant bacteria.
Can you treat 'staph' and MRSA infections?
Fortunately, yes. Although MRSA is resistant to methicillin and related penicillin type antibiotics, there are usually other oral antibiotics that still work, like Bactrim (trimethoprim-sulfamethoxazole) and Clindamycin. Vancomycin is usually the drug of choice for hospitalized patients.
Linezolid (Zyvox) is a newer antibiotic recently approved for use in adults, can treat MRSA and VRSA (Vancomycin Resistant Stapylococcus aureus), and which has been found to be 'effective and well-tolerated in children.'1
Also, when possible, these infections often clear up quickly if the wound can be drained.
And unfortunately, more and more people are becoming aware of MRSA, or methicillin-resistant Staphylococcus aureus.
While regular 'staph' infections are usually easily treated with cephalosporin antibiotics that are related to penicillin, like Keflex, Duricef, and Ancef, the MRSA bacteria has developed a resistance to these antibiotics, so that they don't work anymore.
How common are staph and MRSA infections?
It is estimated that 25% to 30% of people have the staph bacteria either on their skin or in their nose, althought it doesn't necessarily cause an infection unless there is a break in the skin, like from an insect bite or scratch. Unless they have an infection, these people are simply 'colonized' with 'staph' and don't necessarily need treatment.
Although usually thought of as a 'nosocomial' infection or one that is spread among people in the hospital or a nursing home, etc., MRSA infections are becoming increasingly more common in healthy people who have not been in the hospital (community acquired infections).
There have also been reports of outbreaks 'among participants in competitive sports,' including fencers, football players and wrestlers. These outbreaks may be because athletes have many risk factors for infection, including 'physical contact, skin damage, and sharing of equipment or clothing.'
How did 'staph' become resistant to antibiotics?
Probably because of the general overuse of antibiotics these days. When you take an antibiotic, like Omnicef, Vantin or Ceftin, for an ear or sinus infection, in addition to targeting the bacteria causing those infections, if you are colonized with 'staph', the 'staph' bacteria is also exposed to those antibiotics and so have time to 'learn' how to fight them or become resistant.
Even if your child isn't on antibiotics a lot, if he is in daycare or around a lot of other children who are often on antibiotics, then he might be exposed and can catch resistant bacteria.
Can you treat 'staph' and MRSA infections?
Fortunately, yes. Although MRSA is resistant to methicillin and related penicillin type antibiotics, there are usually other oral antibiotics that still work, like Bactrim (trimethoprim-sulfamethoxazole) and Clindamycin. Vancomycin is usually the drug of choice for hospitalized patients.
Linezolid (Zyvox) is a newer antibiotic recently approved for use in adults, can treat MRSA and VRSA (Vancomycin Resistant Stapylococcus aureus), and which has been found to be 'effective and well-tolerated in children.'1
Also, when possible, these infections often clear up quickly if the wound can be drained.
Do I have MRSA?????
MRSA infection near eye ...?
“ I don't get the test results back til next week. I have 2 on my face, could just be a staph infection. they are "boil" like pimples. The one on my temple is the most serious because it's causing my eyelid to swell and this morning, now my under-eye is swollen too and the eyelid is beginning to turn red..Anyone know why my eyelid is doing all these tricks. Just because they are boils douesn't really mean MRSA does it? I started clindamycin.A regular staph infection could cause this too. I'm just a little freaked out and not looking forward to the unpleasant side effects of this antibiotic. I think my eye is starting to develop cellulitus ...I don't know what else would cause the redness and swelling coming from a boil on my temple. I get the results next week. Keeping my fingers crossed. Damn superbug stay awy from me... ”
You should have yourself tested for a staph infection. Its possible you have MRSA
“ I don't get the test results back til next week. I have 2 on my face, could just be a staph infection. they are "boil" like pimples. The one on my temple is the most serious because it's causing my eyelid to swell and this morning, now my under-eye is swollen too and the eyelid is beginning to turn red..Anyone know why my eyelid is doing all these tricks. Just because they are boils douesn't really mean MRSA does it? I started clindamycin.A regular staph infection could cause this too. I'm just a little freaked out and not looking forward to the unpleasant side effects of this antibiotic. I think my eye is starting to develop cellulitus ...I don't know what else would cause the redness and swelling coming from a boil on my temple. I get the results next week. Keeping my fingers crossed. Damn superbug stay awy from me... ”
You should have yourself tested for a staph infection. Its possible you have MRSA
Sunday, September 30, 2007
What Is V I S A ?
What is VISA?
Staphylococcus aureus, often referred to simply as "staph," is a bacteria commonly found on the skin and in the nose of healthy people. Occasionally, staphylococci can get into the body and cause an infection. This infection can be minor (such as pimples, boils, and other skin conditions) or serious and sometimes fatal (such as blood infections or pneumonia).
MRSA are staphylococci that are resistant to methicillin and other commonly used antibiotics and they have a unique gene that produces resistance. Therefore, alternate antibiotics must be used to treat MRSA. Vancomycin has been the most effective and reliable drug in these cases.
VISA are not susceptible to vancomycin. Therefore, vancomycin treatment is not reliable for treating these infections. However, to date, all VISA isolates have been susceptible to other Food and Drug Administration (FDA) approved antimicrobial drugs.
VRSA (vancomycin-resistant S. aureus) are resistant to vancomycin. These organisms have not yet been found in nature but might emerge from VISA. Vancomycin would not be effective at all for treating these infections.
How can the spread of VISA be prevented?
Use of infection control practices (such as wearing gloves before and after contact with infectious body tissues and proper handwashing) can reduce the spread of VISA.
Appropriate use of antibiotics (i.e., use only when needed to treat bacterial infections [and avoid overuse]) will reduce the emergence of resistance strains.
What is being done to prevent and control the spread of VISA?
Programs have been established to promote appropriate use of antimicrobials, especially vancomycin, in all healthcare settings, based on CDC’s, "Recommendations for Preventing the Spread of Vancomycin Resistance."
CDC and state and local health agencies have implemented a special project to detect and evaluate strains of MRSA that might be VISA. When such a strain is detected, special infection control precautions are implemented to isolate the patient and prevent spread to others.
Staphylococcus aureus, often referred to simply as "staph," is a bacteria commonly found on the skin and in the nose of healthy people. Occasionally, staphylococci can get into the body and cause an infection. This infection can be minor (such as pimples, boils, and other skin conditions) or serious and sometimes fatal (such as blood infections or pneumonia).
MRSA are staphylococci that are resistant to methicillin and other commonly used antibiotics and they have a unique gene that produces resistance. Therefore, alternate antibiotics must be used to treat MRSA. Vancomycin has been the most effective and reliable drug in these cases.
VISA are not susceptible to vancomycin. Therefore, vancomycin treatment is not reliable for treating these infections. However, to date, all VISA isolates have been susceptible to other Food and Drug Administration (FDA) approved antimicrobial drugs.
VRSA (vancomycin-resistant S. aureus) are resistant to vancomycin. These organisms have not yet been found in nature but might emerge from VISA. Vancomycin would not be effective at all for treating these infections.
How can the spread of VISA be prevented?
Use of infection control practices (such as wearing gloves before and after contact with infectious body tissues and proper handwashing) can reduce the spread of VISA.
Appropriate use of antibiotics (i.e., use only when needed to treat bacterial infections [and avoid overuse]) will reduce the emergence of resistance strains.
What is being done to prevent and control the spread of VISA?
Programs have been established to promote appropriate use of antimicrobials, especially vancomycin, in all healthcare settings, based on CDC’s, "Recommendations for Preventing the Spread of Vancomycin Resistance."
CDC and state and local health agencies have implemented a special project to detect and evaluate strains of MRSA that might be VISA. When such a strain is detected, special infection control precautions are implemented to isolate the patient and prevent spread to others.
How to Prevent MRSA and VRE
Prevention
MRSA infections are spread by close skin to skin contact with a person with MRSA infection or colonization or by coming into direct contact with a surface or item contaminated with MRSA (such as wound dressings, towels or linens).
Standard Precautions should be used to help prevent the spread of MRSA in the healthcare setting.
Clean hands with an antimicrobial soap or alcohol-based hand rub before and after each patient, even if gloves have been worn.
Wear gloves when examining infected areas and appropriately dispose of gloves after use.
Properly dispose of all dressings contaminated with drainage from the infected site.
Clean surfaces and equipment in the exam or hospital room that may have been contaminated by the patient with a commercial disinfectant or with a 1:100 bleach and water solution.
Launder all linens that come into contact with drainage or secretions from the infected site in hot water and dry with a high dryer setting as the heat will help to kill any bacteria still present after the wash.
Stay away from Hospitals as much as possible. Dont take your young babies into the hospital setting to visit ill relatives. Exposing them to the germs in a hospital can be deadly.
MRSA infections are spread by close skin to skin contact with a person with MRSA infection or colonization or by coming into direct contact with a surface or item contaminated with MRSA (such as wound dressings, towels or linens).
Standard Precautions should be used to help prevent the spread of MRSA in the healthcare setting.
Clean hands with an antimicrobial soap or alcohol-based hand rub before and after each patient, even if gloves have been worn.
Wear gloves when examining infected areas and appropriately dispose of gloves after use.
Properly dispose of all dressings contaminated with drainage from the infected site.
Clean surfaces and equipment in the exam or hospital room that may have been contaminated by the patient with a commercial disinfectant or with a 1:100 bleach and water solution.
Launder all linens that come into contact with drainage or secretions from the infected site in hot water and dry with a high dryer setting as the heat will help to kill any bacteria still present after the wash.
Stay away from Hospitals as much as possible. Dont take your young babies into the hospital setting to visit ill relatives. Exposing them to the germs in a hospital can be deadly.
Saturday, September 29, 2007
Flesh Eating Bacteria strain of MRSA spreading
The MRSA superbug is invading homes, schools and gyms, scientists have warned.
The strain found in the community is a particular threat to young, healthy people.
It spreads more easily than the one in hospitals and, unlike normal MRSA, it produces a flesh-eating poison.
This week's New Scientist magazine warns: "We hear a lot about antibiotic-resistant bacteria in hospitals, but the truth is that a frightening range of superbugs are lurking just about everywhere.
"They skulk around our homes, schools and at the local gym."
Robert Daum, a pediatrician at the University of Chicago's Children's Hospital and one of the first to warn of the dangers of community-acquired MRSA, said: "Everywhere it has come it has stayed and it comes to more and more places every day."
The bug is passed on through close contact and can be caught from dirty sheets, sharing towels in gyms and sharing sports kits. Symptoms range from painful boils to fatal blood poisoning.
Patients can die within 24 hours of the bug spreading to their lungs due to a form of pneumonia in which the flesh is rapidly eaten away by a poison produced by the bacteria.
While antibiotic treatment exists, the drugs need to be given early for maximum effect.
The bug has recently made its way into British hospitals, killing two patients at the University Hospital of North Staffordshire in Stoke-on-Trent last year.
Some hospitals already screen patients due to undergo operations for MRSA, but some doctors now want all patients, and even people visiting the Emergency Room, to be screened for the infection.
Professor Richard James, of the Centre for Healthcare Associated Infections at Nottingham University, said this would save hospitals money in the long-term.
The potential loss of earnings should community MRSA spread would "dwarf" the extra costs of screening to the NHS.
In Scandinavia, the battle against MRSA has already been taken into the community, with nurses sent to people's homes to treat carriers and teach them about hygiene.
Educating people about handwashing and not sharing towels has led to a drop in infections.
Danish MRSA expert Dr Robert Skov said: "If you don't fight MRSA in the community you will have a silent pool who are continuously spreading it to other people.
"Just by instructing people you can get quite far."
In Britain, the Health Protection Agency says the risk of infection with community-acquired MRSA is small, but people should make sure all cuts and grazes are properly cleaned and covered, avoid sharing towels and toothbrushes and ensure any gym they use is cleaned thoroughly.
The strain found in the community is a particular threat to young, healthy people.
It spreads more easily than the one in hospitals and, unlike normal MRSA, it produces a flesh-eating poison.
This week's New Scientist magazine warns: "We hear a lot about antibiotic-resistant bacteria in hospitals, but the truth is that a frightening range of superbugs are lurking just about everywhere.
"They skulk around our homes, schools and at the local gym."
Robert Daum, a pediatrician at the University of Chicago's Children's Hospital and one of the first to warn of the dangers of community-acquired MRSA, said: "Everywhere it has come it has stayed and it comes to more and more places every day."
The bug is passed on through close contact and can be caught from dirty sheets, sharing towels in gyms and sharing sports kits. Symptoms range from painful boils to fatal blood poisoning.
Patients can die within 24 hours of the bug spreading to their lungs due to a form of pneumonia in which the flesh is rapidly eaten away by a poison produced by the bacteria.
While antibiotic treatment exists, the drugs need to be given early for maximum effect.
The bug has recently made its way into British hospitals, killing two patients at the University Hospital of North Staffordshire in Stoke-on-Trent last year.
Some hospitals already screen patients due to undergo operations for MRSA, but some doctors now want all patients, and even people visiting the Emergency Room, to be screened for the infection.
Professor Richard James, of the Centre for Healthcare Associated Infections at Nottingham University, said this would save hospitals money in the long-term.
The potential loss of earnings should community MRSA spread would "dwarf" the extra costs of screening to the NHS.
In Scandinavia, the battle against MRSA has already been taken into the community, with nurses sent to people's homes to treat carriers and teach them about hygiene.
Educating people about handwashing and not sharing towels has led to a drop in infections.
Danish MRSA expert Dr Robert Skov said: "If you don't fight MRSA in the community you will have a silent pool who are continuously spreading it to other people.
"Just by instructing people you can get quite far."
In Britain, the Health Protection Agency says the risk of infection with community-acquired MRSA is small, but people should make sure all cuts and grazes are properly cleaned and covered, avoid sharing towels and toothbrushes and ensure any gym they use is cleaned thoroughly.
Subscribe to:
Posts (Atom)