Tuesday, January 16, 2007
Methicillin-Resistant Staphylococcus Aureus (MRSA) - Evolved Bacteria not a Pandemic
Tuesday January 16, 2007
A recent outbreak of Methicillin-Resistant Staphylococcus Aureus (MRSA) in professional athletes' locker rooms in the US has been spotted in Canada.
However, Dr. Mohammad Kahn, the Medical Health Officer with the Kelsey Trail Health Region said it is not the beginning of a pandemic outbreak."It has nothing to do with the pandemic," Kahn said."It is a common bacteria, that has, with the passage of time and with some factors in place, developed a resistance to a group of antibiotics."
He said the bacteria commonly referred to as staph or staphA is common on the skin and around the nostrils and can become infective in some people, but not everybody."
It is in every human being, but is not infective. It becomes infective in certain conditions. If a person has low immunity or if a person has some conditions then the bug becomes infective."Originally thought to exist only in hospitals or care homes it is being spotted more frequently in different communities.
Although it hasn't been found in Melfort Kahn said there have been reports of it in the northern parts of the health region.
Even though MSRA is resistant to some antibiotics it can be treated using different medications."
It is not that dangerous, it could be treated with antibiotics, but the thing is it should be diagnosed early and then use the proper antibiotics to be effective against this bug."
Symptoms of the staph infection include skin lesions, which should be tested quickly. To slow down or even stop the spread of the infection doctors urge people to wash their hands with soap or use an alcohol based gel and to cover sneezes or coughs to prevent spreading it through the air.
Treatment to rid colonized patients of MRSA
Updated Tue. Jan. 16 2007 8:23 AM ET
TORONTO -- Canadian researchers have shown for the first time that a treatment to rid hospital patients who are carrying but not yet infected with a potent superbug can work, potentially offering hospitals a way to both reduce the risk of illness for individual patients and lower levels of dangerous bacteria in their facilities.
A seven-day course of treatment with the new combination therapy was effective over the long term (three months) in eradicating methicillin-resistant Staphylococcus aureus - better known as MRSA - from between 60 and 70 per cent of treated patients, said the study, reported Monday in the journal Clinical Infectious Diseases.
Even at eight months 54 per cent of treated patients remained free of the bacterium, which is a major cause of hospital-acquired infections and is becoming a significant source of serious illness among non-hospitalized people as well.
Lead author Dr. Andrew Simor said this is the first study to show therapy to "decolonize" MRSA carriers can be effective over an extended period of time.
"Lots of treatment has been shown to work for a shorter period of time. But what's the point? If you clear it for a month or two but then you're positive again, you haven't gained anything," said Simor, head of microbiology at Toronto's Sunnybrook Health Sciences Centre.
The treatment is a combination of antibiotic ointment applied to skin sites where the bacteria is normally found, baths with antiseptic soap and oral antibiotics.
MRSA is one of a number of types of bacteria that are said to "colonize" people.
The bacteria can lurk in the nostrils, groin or around the anus of people who've been exposed to it without making them sick. But the bacteria can go on to trigger illness, especially when carriers go into hospital for medical care.
Between 20 and 30 per cent of carriers go on to develop an MRSA-induced illness, ranging from skin or wound infections to abscesses to pneumonia.
And MRSA carriers aren't simply a risk to themselves. They can infect other patients - which is why hospitals isolate people known to be MRSA carriers. Placing patients in isolation eats up scarce resources, says Dr. John Embil, head of infection control for the Winnipeg Regional Health Authority and director of the infection control unit of the Canadian Healthcare Association.
"The reality is in every single facility it is a colossal problem because we're decreasing the readily available number of rooms if we have to isolate people," Embil said from Winnipeg.
It's been estimated that an MRSA infection picked up in hospital adds between four and 21 days to the length of a hospital stay and costs, on average, $15,000 to treat per patient.
Simor said the most recent estimate of MRSA's cost to the Canadian health-care system is at least $250 million a year.
The treatment he and his co-authors - from several Toronto and Vancouver hospitals and from McMaster University - devised costs about $20 to $30 per treatment course.
Previous efforts to clear colonized hospital patients of MRSA have been mixed. And when they have worked the effect has been short lived.
For this study, patients found to be colonized with MRSA were randomized to receive either no decolonization treatment or were given the combination treatment.
Embil found the results impressive, but said one study doesn't generally lead to a complete switch in treatment protocols.
"You always have to be careful. You can't jump and change your entire practice based on one report. However it's certainly a very important and valuable report that may help us rethink what we do and how we do it," he said, suggested his team will likely try to decolonize carefully selected patients using this "more aggressive approach."
A commentary in the journal by Dr. Suzanne Bradley of the University of Michigan Medical School in Ann Arbor said it would be important to ensure that the treatment didn't have unintended consequences, clearing carriers of more benign strains of MRSA only to open them up to recolonization with more dangerous strains causing an upswing in so-called community-acquired cases.
"We must be vigilant that our attempts to eradicate old strains do not facilitate the acquisition of strains that contain virulence determinants," Bradley wrote.
And Simor himself raised another possible concern, saying infection control specialists would need to watch to ensure the treatment didn't accelerate antibiotic resistance in MRSA strains.
"That remains a potential concern and a potential drawback," he said.