From the 5 October 2013 post at Time- Health & Family
Bacterial infections can imperil the fragile patients at hospitals‘ intensive care units. And a new study reveals an unlikely spreader: the health care workers who treat them. The standard sterile hospital garb typically thought to prevent infections isn’t helping.
Physical barriers are the most effective way to block invisible intruders like the bacteria responsible for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections, which are among the most common hospital-acquired pathogens. Such strains, which are resistant to most antibiotic treatments, contribute to more than $4 billion in health care costs for treating the skin lesions, respiratory symptoms and sepsis that the bacteria cause.
It’s hardly been clear that requiring all health care workers to put on gowns and gloves before visiting each patient, then discarding and re-robing before visiting the next patient, would help to reduce the spread of such infections in ICUs. The Centers for Disease Control currently recommends that workers suit up with gowns and gloves before caring for patients with known MRSA or VRE infections, but researchers led by Dr. Anthony Harris at the University of Maryland School of Medicine wanted to see how effective universal gowning and gloving would be in lowering the number of new cases of disease in ICUs.
Scientists at The University of Nottingham have opened the way for more accurate research into new ways to fight dangerous bacterial infections by proving a long-held theory about how bacteria communicate with each other.
Researchers in the University’s School of Molecular Medical Sciences have shown for the first time that the effectiveness of the bacteria’s communication method, a process called ‘quorum sensing’, directly depends on the density of the bacterial population. This work will help inform wider research into how to stop bacteria talking to each other with the aim of switching off their toxin production.
As some pathogenic organisms are increasingly resistant to traditional antibiotics, medical researchers around the world, including scientists at The University of Nottingham, are trying to find other ways of fighting infection. This new work involves using ‘quorum quenching’ compounds which interfere with bacterial signalling and disrupt their social lives.
Quorum sensing (QS) is the process by which bacteria communicate and co-operate using signal molecules which control, among other things, the production of toxins. QS is therefore an important factor in a number of bacterial species that cause serious infection in humans includingPseudomonas aeruginosa, a leading cause of death among cystic fibrosis sufferers, and MRSA which is a huge clinical problem in hospitals….
- Fighting bacteria’s strength in numbers (eurekalert.org)
- To beat toxic bacteria, break up their party (futurity.org)
he U.S. Department of Health and Human Services (HHS) estimates that about one in every 20 patients develops an infection each year related to their hospital care. The key to preventing an outbreak of potentially deadly healthcare-associated infections (HAIs) – such as methicillin-resistant Staphylococcus aureus (MRSA) or C. difficile – is identifying them before affected individuals can pose a transmission risk.
But, according to a survey released by the Association for Professionals in Infection Control and Epidemiology (APIC) and the American Society for Microbiology (ASM), the typical turnaround time for laboratory test results may not be meeting expectations. Greater collaboration between labs and infection preventionists may hold the key to addressing the gap – and to more effective management of some HAIs.
Most (51 percent) of the infection preventionists (IPs) surveyed indicated that they need results for MRSA screening tests within 12 hours to initiate the necessary precautions; however, MRSA cultures – a traditional method for screening – typically take 24 to 48 hours to complete.
The survey identified two factors that could be addressed to help resolve the discrepancy and reduce HAIs: the need for increased communication between IPs and lab professionals, and the lack of tools and resources for training and educating all healthcare personnel. …
- Collaboration needed to facilitate rapid response to health-care-associated infections, survey says (eurekalert.org)
- Infection control certification associated with lower MRSA infection rates (eurekalert.org)
- Study Finds MRSA Screening Saves Hospitals Money (prweb.com)
Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children
Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in ChildrenSource: Archives of Pediatrics & Adolescent Medicine
To investigate in children the association between antibacterial drugs and subsequent diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) in the community.
Population-based case-control study in children 1 to 19 years of age.
Primary care, General Practice Research Database, United Kingdom, 1994-2007.
Cases were children who had MRSA diagnosed as outpatients, and controls were individually matched on age and practice, with the matched case’s diagnosis date as the index date for both.
Antibacterial agents prescribed 180 to 30 days prior to the index date, excluding prescriptions 30 days before the index date to prevent protopathic bias.
Rate ratios (RRs) estimated from the odds ratios of exposure in cases compared with controls using conditional logistic regression, adjusted for comorbid conditions, other prescription drug use, and hospitalization.
The rate of MRSA was 4.5 per 100 000 per year. Of 297 cases and 9357 controls, 52.5% and 13.6%, respectively, received antibacterial drug prescriptions during the 150-day exposure window. The adjusted RR with any antibacterial drug was 3.5 (95% confidence interval [CI], 2.6-4.8). The RRs increased with the number of prescriptions (2.2 [95% CI, 1.5-3.2], 3.3 [95% CI, 1.9-5.6], 11.0 [95% CI, 5.6-21.6], and 18.2 [95% CI, 9.4-35.4] for 1, 2, 3, and 4 prescriptions, respectively). The RR was particularly elevated for quinolones at 14.8 (95% CI, 3.9-55.8), with wide variation among antibacterial classes.
While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs, such agents are associated with a dose-dependent increased risk, concordant with findings in adults.
***Image from http://commons.wikimedia.org/wiki/File:EARSS_MRSA_2008.sv, Institute for Public Health and the Environment (RIVM), Epidemiology and Surveillance, 3720 BA Bilthoven,The Netherlands
- MRSA (MedlinePlus) A general guide with links to overviews, diagnosis/symptoms, specific conditions, news items, and more
- MRSA Infection (eMedicine Health) A patient/consumer guide with links to diagnosis/symptoms, risk factors, images, and slideshows
- Methicillin-resistant Staphylococcus Aureus (MRSA) Infections (CDC) Comprehensive guide with links to definition, symptoms, prevention, people at risk, environmental cleaning, statistics, and educational resources
The inclusion of any article here does not necessarily mean agreement with this author’s beliefs
- MRSA In Children: Do You Know The Signs? (vintagevicki.com)
- Pimples (and Rosacea) Link to MRSA (tfollowers.com)
- MRSA found in Iowa meat (scienceblogs.com)
- Forget MRSA, Fear VRSA (alternativendhealth.wordpress.com)
- MRSA: From A Nosocomial Pathogen To An Omnipresent Source Of Infection (medicalnewstoday.com)
- More MRSA Found In U.S. Retail Meat (Turkey, Too) (wired.com)
HealthyRoads Media contains free patient and consumer health information in a variety of formats and languages.
It has recently added a set of patient safety materials adapted from guides created by SHEA (Society for Healthcare Epidemiology of America)
and partners and the development support was provided by Inova Fairfax Hospital.
The materials are in English (Spanish coming soon) and are available as handouts, web-videos and downloadable mobile videos.
- Catheter-Associated Bloodstream Infections
- Catheter-Associated Urinary Tract Infections
- Clostridium Difficile
- Surgical Site Infections
- Vancomycin Resistant Enterococcus
- Ventilator Associated Pneumonia
Careful cleaning of children’s skin wounds key to healing, regardless of antibiotic choice
Hopkins Children’s study suggests antibiotics may not always be best therapy
When it comes to curing skin infected with the antibiotic-resistant bacterium MRSA (methicillin-resistant Staphylococcus aureus), timely and proper wound cleaning and draining may be more important than the choice of antibiotic, according to a new Johns Hopkins Children’s Center study. The work is published in the March issue of Pediatrics.
Researchers originally set out to compare the efficacy of two antibiotics commonly used to treat staph skin infections, randomly giving 191 children either cephalexin, a classic anti-staph antibiotic known to work against the most common strains of the bacterium but not MRSA, or clindamycin, known to work better against the resistant strains. Much to the researchers’ surprise, they said, drug choice didn’t matter: 95 percent of the children in the study recovered completely within a week, regardless of which antibiotic they got.
The finding led the research team to conclude that proper wound care, not antibiotics, may have been the key to healing.
“The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week,” says study lead investigator Aaron Chen, M.D., an emergency physician at Hopkins Children’s. “The better news might be that good low-tech wound care, cleaning, draining and keeping the infected area clean, is what truly makes the difference between rapid healing and persistent infection.”
Chen says that proper wound care has always been the cornerstone of skin infection treatment but, the researchers say, in recent years more physicians have started prescribing antibiotics preemptively.
Although the Johns Hopkins investigators stop short of advocating against prescribing antibiotics for uncomplicated MRSA skin infections, they call for studies that directly measure the benefit — if any — of drug therapy versus proper wound care. The best study, they say, would compare patients receiving placebo with those on antibiotics, along with proper wound cleaning, draining and dressing.
Antibiotics can have serious side effects, fuel drug resistance and raise the cost of care significantly, the researchers say.
“Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case,” says senior investigator George Siberry, M.D., M.P.H., a Hopkins Children’s pediatrician and medical officer at the Eunice Kennedy Shriver Institute of Child Health & Human Development. “We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them.”
The 191 children in the study, ages 6 months to 18 years, were treated for skin infections at Hopkins Children’s from 2006 to 2009. Of these, 133 were infected with community-acquired MRSA, and the remainder had simple staph infections with non-resistant strains of the bacterium. Community-acquired (CA-MRSA) is a virulent subset of the bacterium that’s not susceptible to most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in those who are sick or have weakened immune systems, it can lead to invasive, sometimes fatal, infections.
At 48-hour to 72-hour follow-ups, children treated with both antibiotics showed similar rates of improvement — 94 percent in the cephalexin group improved and 97 percent in the clindamycin group improved. By one week, the infections were gone in 97 percent of patients receiving cephalexin and in 94 percent of those on clindamycin. Those younger than 1 year of age and those whose infections were accompanied by fever were more prone to complications and more likely to be hospitalized.
Co-authors on the study included Karen Carroll, M.D., Marie Diener-West, Ph.D., Tracy Ross, M.S., Joyce Ordun, M.S., C.R.N.P., Mitchell Goldstein, M.D., Gaurav Kulkarni, M.D., and J.B. Cantey, M.D., all of Hopkins.
The research was funded by a grant from the Thrasher Research Foundation and the General Clinical Research Center at Johns Hopkins.
Knowledge Gaps, Fears Common Among Parents of Children with Drug-Resistant Bacteria http://www.hopkinschildrens.org/Fears-Common-Among-Parents-of-Children-with-Drug-Resistant-Bacteria.aspx
Community-Acquired MRSA Becoming More Common in Pediatric ICU Patients http://www.hopkinschildrens.org/Community-Acquired-MRSA-Becoming-More-Common-in-Pediatric-ICU-Patients.aspx
Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units
Landmark Initiative to Reduce Healthcare-Associated Infections Cuts Deaths Among Medicare Patients in Michigan Intensive Care Units
Older Americans who were treated in Michigan intensive care units (ICUs) saw larger decreases in their likelihood of dying while hospitalized than similar ICU patients in other Midwestern hospitals, according to a new study evaluating an innovative quality improvement initiative funded by HHS’ Agency for Healthcare Research and Quality (AHRQ). The initiative, known as the Keystone Project, targeted ways to reduce the number of healthcare-associated infections (HAIs). Previous research has shown that targeted quality improvement programs can reduce HAI rates. This study, “Impact of a Statewide Intensive Care Unit Quality Improvement Initiative on Hospital Mortality and Length of Stay: Retrospective Comparative Analysis,” published in today’s British Medical Journal, is the first to link these programs to reduced death rates. “This study gives us assurance that investing in large-scale, evidence-based quality improvement programs can save lives—the most important outcome for patients and doctors,” said AHRQ Director Carolyn M. Clancy, M.D. “AHRQ and others have already initiated work to expand this project nationwide to other ICUs across the country.” Researchers led by Allison Lipitz-Snyderman, Ph.D., of The Johns Hopkins Bloomberg School of Public Health, analyzed Medicare data for ICU patients in Michigan hospitals and 364 hospitals in 11 other Midwestern states. They looked at data before the project was initiated, while it was being phased in, and up to 22 months after implementation. The researchers found that overall a person’s chance of dying decreased by about 24 percent in Michigan after the program was implemented compared to only 16 percent in surrounding Midwestern states where the program was not implemented. “We knew that when we applied safety science principles to the delivery of health care, we would dramatically reduce infections in intensive care units, and now we know we are also saving lives,” says Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at The Johns Hopkins University School of Medicine. Dr. Pronovost led development of the AHRQ-sponsored Keystone Intensive Care Unit Project and implemented it in Michigan hospitals with the help of the Michigan Health and Hospital Association. “These results are very exciting, and further research should be done to address other important issues impacting the safety and quality of patient care,” added Dr. Lipitz-Snyderman. The Keystone Project uses a comprehensive approach that includes promoting a culture of patient safety, improving communication among ICU staff teams, and implementing practices based on guidelines by the Centers for Disease Control and Prevention (CDC), such as checklists and hand washing, to reduce rates of catheter-related bloodstream infections and ventilator-associated pneumonia. AHRQ continues to support the Keystone Project through a contract with the Health Research & Educational Trust, an affiliate of the American Hospital Association, by reaching more hospitals and other settings in addition to ICUs and applying the approach to various HAIs. For AHRQ’s recently funded HAI projects, go to http://www.ahrq.gov/qual/haify10.htm. According to the CDC, HAIs are one of the most common complications of hospital care, accounting for an estimated 1.7 million infections, and 99,000 associated deaths in 2002. These infections are responsible for $28 billion to $34 billion in preventable health care expenses every year. Infectious agents, such as bacteria, found in health care settings can cause patients to develop HAIs when they have surgery or require central lines or urinary tract catheters. The Keystone Project is part of a Department-wide effort to address HAIs, as outlined in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ash/initiatives/hai/index.html). Partners across HHS, including AHRQ, CDC, the Centers for Medicare & Medicaid Services, and National Institutes of Health, are working together to achieve the goals of the Action Plan. For more information, please contact AHRQ Public Affairs: (301) 427-1864 or (301) 427-1855. Use Twitter to get AHRQ news updates:http://www.twitter.com/ahrqnews/
Additional articles about this news release
- Safety checklist use yields 10 percent drop in hospital deaths (Science Blog)
- Program reduces serious hospital infections – report (Reuters)
Articles about related studies
- Study finds MRSA screening saves hospitals money
- Private room intensive care unites associated with lower infection rates
- More doctors must join nurses, administrators in leading efforts to improve patient safety, outcomes
Presentations also track antibiotic prescriptions, new drugs
FRIDAY, Oct. 22 (HealthDay News) — An increasingly stubborn strain of methicillin-resistant Staphylococcus aureus, or MRSA, a common bacterial infection acquired in hospitals, has been identified in Ohio, according to research presented at the  annual meeting of the Infectious Diseases Society of America.
The strain, ST239 MRSA, killed 22 percent of the people it infected within 30 days, the study found. It’s the first time that the strain, originally identified in Brazil, has been seen in the United States since the 1990s.
“It does have epidemic potential for outbreak,” the study’s co-author, Dr. Shu-Hua Wang, said. “It has increased capacity to cause invasive, serious infection.”
Wang’s group reported that 6.8 percent — or 77 — of 1,126 MRSA samples collected through the Ohio State University Health Network and seven rural hospitals in a three-year period from January 2007 to January 2010 were ST239.
Wang, who is an assistant professor of medicine at Ohio State, called for more genotyping of MRSA isolates.
A second study presented at the conference found that antibiotic prescriptions in the United States were much higher in the South than in the West, a finding that held for all types of antibiotics……
Among other research being presented at the conference, which concludes Sunday in Vancouver, Canada: three new drugs appear to show promise in fighting MRSA and other bacteria when current antibiotics fail.
- Fusidic acid, which could fight S. aureus. “This is pretty exciting because it has no cross-resistance with any class of antibiotics so it could be used widely,” said Dr. Ronald N. Jones, chief executive of JMI Laboratories in North Liberty, Iowa, which makes the drug and funded the study being presented.
- JNJ-Q2. This potential agent belongs to a class of drugs known as fluoroquinolones and may be effective against S. aureus, including the methicillin-resistant form. “JNJ-Q2 was 16 times more potent than the existing marketed fluoroquinolones,” Jones said. The drug is moving into phase 2 and phase 3 trials, he said.
- A version of cephalosporin. It “may enable us to treat a broader spectrum of drug-resistant bacteria, although it probably won’t be on the market till 2013 or 2014,” Jones said.
Also being presented at the conference is a study involving a computer model that found that “universal contact precautions” — requiring anyone visiting a MRSA patient in the hospital to wear gloves and a gown — were more effective at preventing MRSA infection among patients in intensive-care units than were other strategies.
But the approach was expensive. The study’s lead author, Dr. Courtney A. Gidengil, an instructor in pediatrics at Children’s Hospital of Boston and Harvard Medical School, said that other strategies might be less effective but they are also less costly.
Another study presented at the conference found that carbapenem-resistant Enterobacteriaceae, or CRE, which carries a high mortality rate, is becoming more prevalent in the Chicago area.
Editor Flahiff’s note: If you need assistance tracking down studies in this news item, contact a reference librarian at your local public, academic, or medical library. Alternatively, you may contact me at firstname.lastname@example.org. I will reply within 48 hours. At the very least, I will provide contact information for a study’s author(s). Many study author’s are happy to share at least citations to their works, if not full text of their studies.
AHRQ Researchers Study How Community-Acquired Methicillin-Resistant Staphylococcus aureus Is Managed in Health Care Settings
Findings from three new AHRQ-funded reports on community-acquired methicillin-resistant Staphylococcus aureus (MRSA) are now available. The reports result from two-year projects conducted by AHRQ’s Practice-Based Research Networks in Colorado, Iowa, and North Carolina. Select below to access each report.
- Management by Primary Care Clinicians of Patients Suspected of Having Community-Acquired Methicillin-Resistant Staphylococcus AureusInfections—State Network of Colorado Ambulatory Practices and Partners. Researchers tested interventions for two health networks to optimize treatment for skin and soft tissue infections consistent with the community-acquired MRSA guidelines developed by the Centers for Disease Control and Prevention. They found the intervention resulted in an increase in antibiotic use and the proportion of prescribed antibiotics that covered MRSA.
- Community-Acquired Skin Infections in the Age of Methicillin-Resistant Organisms—Iowa Research Network Practices, University of Iowa. Researchers assessed how family physicians in rural areas managed patients with skin and soft tissue infections after introducing Centers for Disease Control and Prevention guidelines. They used chart review and/or follow-up to compare infection management and antibiotic therapy in patients before and after the CDC guidelines were introduced. They found that providers were more likely to prescribe antibiotics that covered MRSA at the initial patient visit after the guidelines were implemented.
- Cellulitis and Abscess Management in the Era of Resistance to Antibiotics (CAMERA)—Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill & Duke Clinical Research Institute. Researchers worked with nine primary care practices to improve the quality of care for individuals with skin or soft tissue infections. As a result, they developed recommendations and strategies for diagnosing and managing community-acquired MRSA in these settings. For example, researchers recommend that practices develop documentation and coding presentations; integrate templates into electronic medical records for describing skin and soft tissue infections; and hold workshops in the management of skin and soft tissue infections.