MRSA

[mugwump]

It's a complicated problem -- governments and the food/pharmaceutical industries need to jump to it, and right quick, but like most things in America right now powerful lobbies are pulling for the Dark Side. There are many other multiple-drug-resistant bugs cooking in the wings right now -- the enteric bugs (campylobacter, salmonella) will make the next big splash (pardon the imagery).

A major factor in induction of resistance is the use of massive quantities of antibiotics in the poultry, aquaculture, and beef/pork industries. Couple this irresponsible use of drugs with rampant over-prescribing and a rapid dropoff in antimicrobial R&D (drugs for chronic conditions are much more profitable than those which treat acute infections) and we are looking at a return to the pre-penicillin days.

Bad juju is right. Don't even get me started on TB.

[yasnevo]

all the recent news on TV and like about the super bug and MRSA... prompted todays interview I did on a local TV news station:

http://www.kgun9.com/NewsArticle/tab...5/Default.aspx

Here is some background...


How I managed to get a MRSA infection on my left forearm

On the Monday and Tuesday (January 15 & 16, 2007) mornings following the SHOT Show in Orlando I went to my local gym here in Tucson. I use a variety of machines, free weights and the aerobic apparatus’s there. I am sure it was on Tuesday, after I returned home I noticed on my left forearm what appeared to be a pimple. It was a small red area about ½ the size of a dime with a center that was raised and white. The white center was tender to the touch. Being the guy that I am I squeezed it.

By the mid afternoon it had swollen a bit and was really red and noticeable. Wednesday it was starting to emit puss. Same thing for Thursday and Friday and the wound site really began to grow. It was starting to freak me and my wife out. She is an RN and, God bless, always goes off the deep end on wanting to take care of us. Be, again being the typical guy, told her I would take care of this myself.

Almost immediately, I began flushing the site with hydrogen peroxide, washing with warm water and soap, then applying Neosporin antibiotic ointment and covering with a large band aide at this point, this was not helping and the wound was getting worse.

Sunday night I started to get a fever and the amount of puss coming from the wound increased. A USAF buddy of mine stopped by and when he saw the arm he immediately said that I need to go and see the Dr. I had already made an appointment but the earliest I could get in was Tuesday.

Monday night and I have a temperature of 101.5 and the amount of swelling and puss has increased dramatically. I don’t spook easily, but this was freaking me the hell out. Next morning I went to see the Dr. and my left hand has swollen during the night and I cannot close it.

I showed it to the Dr. and his eyes bulged. He gloved up, took a culture, and then said, “This may hurt a bit” and proceeded to squeeze around the wound draining it. He put me on 750 mg of Levaquin for 10 days and told me that he wanted to see me for a follow-up on Friday.

Immediately I took the first 750 mg Levaquin...and Wednesday I could see the color of the puss change from the brown tinge to more of a Bailey’s cream color. Wednesday my temperature broke and fell back down to normal.

Jump to Friday. I went in for the follow up and the Dr. was happy with the visual inspection of the wound. He pulled up the results of the culture he took from the following Tuesday and, tada! MRSA! Here is what it said:

2+ STAPH AUREUS
Note: Oxacillin resistance indicates methicillin resistance (MRSA). MRSA ORGANISMS ARE RESISTANT TO ALL BETA LACTAM AGENTS, INCLUDING CEPHALOSPORINS.
Then it listed stuff that this strain is resistant to:
Sulfa/Trimeth S (susceptible)
Tetracycline S
Clindamycin S
ERYTHROMYCIN R (Resistant)
Vancomycin S
Amoxicillin/Clavulinic Acid R
Oxacillin R
Moxifloxacin S
Rifampin S

The Dr. again gloved up, and began to squeeze out a shit load of puss. Then, he gave me a local anesthetic and then made a small incision on another part of the wound area and drained more. I was about to scream when he said, “ok, I think I got it all...” Whew.

I have six more days of Levaquin to take and I have another follow-up with the good Dr. on Wednesday.

Lessons Learned:
Gyms, common areas where large numbers of people live, meet, hang out are breeding grounds for a whole host of new and frankly dangerous new infections that start so benignly and then the end result is a MRSA 2+ Staph infection.

Future actions:
I was thinking that this could have started out as a piece of fiberglass working its way out and the site got infected, then I was thinking it was some kind of skin disorder... then it dawned on me that this similar thing happened one perhaps 2 other times but no where near the scale that this one turned into. With each case, I had either just returned from the gym or... I had just come back from training somewhere and was staying with a large group of people in one common area. So, I will definitely shower and clean up after each trip to the gym, and I will refrain from squeezing pimples.

Admin edit...Your holistic cure is not an antibiotic ointment as you advertise it to be. While it may show some premise, it has not been approved as a pharmacological treatment and will not be referred to as such here. Personal opinions on alternative medicine are fine. Advocations of such in treating potentially life threatening bacteria are another matter. This type of encouragement generally prevents people from seeking timely medical care from a qualified provider and tends to promote the belief that their local health food store substitutes for their pharmacy because "they read about it on a Special Forces Website" - Eagle

When I worked in the Jail Division I have never seen it so bad. Jeez, I didn't even know what "MRSA" was until I started doing the medical run. We had one inmate come in at the window who had advanced MRSA and we didn't take him because he was leaking so bad that it almost smelled like death. He eventually died within two days of getting to the hospital (which was that day). I personally took around 15-18 people to the hospital, one of which had to have his arm amputated.

The neat thing to watch however was the ER doctor's do a radial nerve block, incise, pull out the mucous plug, and in most cases debride the open would. Then it was the drugs they started them all on, Septra/Bactera and Augmentin (note sure it was this one as I cannot remember off hand. Mugwump, need some help here.).

Out of all the things you can pick-up working in a Jail or Prison, MRSA was the most feared. And would you believe there were still Deputies that would never wear gloves when patting a person down or searching through their belongings. I use to tell them that if you patted someone down that had it and you didn't know it and afterwards you had a bad itch on your neck from shaving and you scratched it to death, you would be in a very serious situation if it elected (MRSA) to start eating away on your neck

[LeapingGnome]

Crip is right, it's nasty stuff as witnessed at the old(er) school SOPC training location. I've read the recent news scares and listened to the talking heads spew panic but the one thing i haven't heard mentioned is the importance of properly taking your antibiotics. If you have a 5(7,9) day cycle...take the whole damn cycle. A lot of people will feel better on day 3 and stop taking their meds. Without going into the pharmacology, if you don't take the whole cycle you are helping create antibiotic resistant strains like MRSA. I heard a woman on the news last night saying that her doctor told her to stop taking her antibiotics so she wouldn't get MRSA. Wrong answer. The other issue is docs prescribing antibiotics for viral infections because mom wants the kid to have them. Also wrong answer. Antibiotics are for bacterial infections. Period. A QP I know was recently given antibiotics for an infection and the doc didn't culture the drainage. Once again, with out going into details, the doc needs to know what kind of infection it is in order to properly prescribe drugs. You can go ahead and make a guess and start treating, but if the culture comes back you can always change the drug regimen based on the culture. If antibiotics are properly prescribed and properly taken the risk is cut way down. Another fun MRSA fact is that it tends to live in the nose of the person who has it and can live there for months or years. As with anything, your mom was right. Don't pick your nose, keep yourself clean, always wash your hands, don't scratch scabs and wounds and if it looks bad go see a doctor...or your friendly neighborhood 18D. The whole MRSA thing is an evolving community health issue that is worth discussing and sharing information about. I would be interested in hearing other guys recent MRSA experiences.

[Odd Job]

Yasnevo

Many individuals are carriers of MRSA (usually on the skin) but it causes no problems unless it gets into a skin breach (on the carrier) or is transferred to the respiratory system of a person who is susceptible or otherwise vulnerable to that infection. In terms of infection control, the spread of the organism is by contact, but you still need a vulnerability for the infection to take hold. I advise that you check for some underlying skin breach or similar vulnerability because it is not usual for a person to develop those symptoms simply by coming into contact with another person who has the MRSA organisms on his/her skin. If that was the case, we would be inundated with non-iatrogenic infections and we would grind to a halt as a hospital.

At our hospital we have recently had to shut down an entire Intensive Therapy Unit because the MRSA and C. Diff. infection rates were unacceptably high. The unit was steamed and refitted and it was sealed over a period of 4 days and flooded with a toxic gas. There is a national campaign to nail the spread of MRSA here in the UK and there are various projects underway (some of which have been developed in partnership with US organisations):

1) The use of elemental silver in paints for new ward refits
2) The use of silver alloy threads for patients' ward clothing
3) The replacement of human IT interfaces with easier to clean alternatives. One example of this is flexible rubber keyboards for ITU.

(Silver is known to retard or prevent the spread of MRSA. The exact mechanism by which it does this is not clear.)

If you are in an organisation such as a hospital where you are experiencing recurrent MRSA infections in your patients or 'customers' then you need to look into the pathways of infection, ie your infection control policies. Staff and (to a lesser extent) asymptomatic visitors who are carrying the organism are the main cause of the spread of this infection. If it keeps happening, a blanket test of all critical staff who may have been in contact with that patient may be ordered. It has happened here: an entire department was forced to undergo nasal swabs for the detection of MRSA and if these were positive then the staff were reassigned while appropriate remedies were put in place.

The other thing they have done here is make infection control mandatory training for all hospital staff, not just those in direct day to day contact with high risk patients. It now joins manual handling, basic life support, fire training and child protection on the list of mandatories.

[Divemaster]

Just another bump to get this thread to the head of the line. When I started reading this, I was shocked to see this thread started 2 + years ago. Well, that was until I realized this was an SF medical thread. 18D's rock! (testimonial provided by a stunt team guy NOT on an STD closed course). Silver bullet? What silver bullet?

Seriously, admins how about giving the panic media a clue as to how our guys were all over this in 2005?

[yasnevo]

I am not in any way an expert in the field of MRSA...I did hower have it and dealt with it.

Here in Tucson, for the last week or two, on the evening news, there has been a MRSA altert.

Amazing.

Y-

[incarcerated]

A good friend at work got the pulmonary version. Watch your dust.
http://www.bloomberg.com/apps/news?p...d=aAkcxmCaOfKc

Infectious Bacteria Found on Northwest Beaches, Scientists Say

By David Olmos
Sept. 12 (Bloomberg) -- Drug-resistant bacteria that causes serious infections and is most commonly spread in hospitals was found on nine beaches in Washington state, scientists said.

Samples from water and sand collected from 11 public beaches near Puget Sound near Seattle and in California were tested for a germ known as methicillin-resistant Staphylococcus aureus, or MRSA, and a closely related drug-resistant organism, according to a study reported today at a meeting of infectious disease doctors in San Francisco.

MRSA is found in about 5 percent of hospital patients, and accounts for almost two-thirds of skin infections in emergency rooms, up from just 2 percent 35 years ago, according to the Rockville, Maryland-based U.S. Agency for Healthcare Research and Quality. Scientists are studying how the bacteria spread away from hospitals, nursing homes and kidney dialysis centers.

“We were interested in answering where in the community, outside the health care system, could the average American pick this up,” said Marilyn Roberts, the study’s lead author, in a telephone interview. “We found MRSA in a lot more places than we thought we would.”

Roberts, a researcher at the University of Washington’s School of Public Health in Seattle, presented the findings today at the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Francisco.

Strain of Staph Infections

Staphyloccus aureous is a strain of so-called staph infections that are typically carried on the skin or in the nose of healthy people. The first U.S. MRSA infection was reported in 1968, according to the National Institutes of Health. The bacteria are resistant to common first-line antibiotics, such as penicillin and amoxicillin, and can lead to a serious form of pneumonia and death. The most vulnerable patients are those with weakened immune systems and those undergoing surgery, Roberts said.

Scientists have known that staph can spread in water, such as in swimming pools, Roberts said. And previous studies have found MRSA present in warmer waters, such as South Florida.

The study by University of Washington researchers was the first to look at the presence of MRSA in the water and the sand at beaches, Roberts said. MRSA or the closely related germ, called Methicillin-resistant coagulase-negative Staphylococci, were found at all nine of the Washington sites. The bacteria weren’t discovered at the two California beaches. The germs may not have been found at the California sites because the samples were collected on a single day and the sample size was “skimpy,” Roberts said.

Question of Transmission

The study didn’t attempt to determine how MRSA was getting into the water or sand, Roberts said. Possible explanations include beachgoers shedding the bacteria from their bodies, transmission from birds and animals and run-off from hospital locations, although none of the sampling sites was near a hospital, she said.

“When we started the study, we didn’t necessarily think we’d find MRSA at all,” Roberts said. “The findings suggest that there’s probably a lot more out there than what we were able to detect” considering the relatively small samples taken, she said.

Further studies may analyze where people with MRSA infections were exposed to the bacteria, she said.

To contact the reporter on this story: David Olmos in San Francisco at dolmos@bloomberg.net.

Last Updated: September 12, 2009 12:45 EDT

[swatsurgeon]

Just be aware...despite being a "resistant" bacteria, there are medications available to use to treat it and kill it.

ss

[CivieAttorney]

A question for the docs and medicos on this forum:

While doing some pro bono stuff, I shook hands with a guy who then said "so I got MRSA from my job."

The thing is, I have open wounds on my hand from dry skin, and it was several hours before I could apply alcohol (though I washed my hands right after the interview).

I'm kind of worried, and web searches are giving me conflicting symptom info.

Then I found this thread. Is there an extended incubation period for this, or should I expect symptons within 24 hrs. / No worries if nothing in that time?

Thanks,

Benjamin

[Doczilla]

Everybody gets MRSA these days. The majority of cutaneous abscesses in urban centers are due to MRSA, and they rarely result in a life-threatening infection, particularly in immunocompetent active individuals.

The infection, if you got it (unlikely), would probably begin with localized redness of the skin around the open wound or point of entry. The redness may spread, or result in red streaks up the arm, or collect as an abscess at the point of infection. Fever would be a concerning sign. A systemic, life threatening infection would be very rare.

Because of the open wounds on your skin, this could be a portal of entry for the bacteria at any time. This exposure to your client really means nothing to you, as we are surrounded by MRSA constantly. Observe good hand hygiene, treat the dry skin, and observe for any signs of infection such as redness.


'zilla

Originally Posted by CivieAttorney

A question for the docs and medicos on this forum:

While doing some pro bono stuff, I shook hands with a guy who then said "so I got MRSA from my job."

The thing is, I have open wounds on my hand from dry skin, and it was several hours before I could apply alcohol (though I washed my hands right after the interview).

I'm kind of worried, and web searches are giving me conflicting symptom info.

Then I found this thread. Is there an extended incubation period for this, or should I expect symptons within 24 hrs. / No worries if nothing in that time?

Thanks,

Benjamin

[PedOncoDoc]

What Doczilla said. Also, we are all colonized with bacteria on our skin, in our guts (from cheek to cheek) and elsewhere. Staph aureus (the SA in MRSA) is one of the most common bacteria on our skin and rarely causes infection with appropriate hand/wound hygiene. MRSA is no different that regular Staph in this aspect; it just responds to fewer antibiotics when it does cause an infection.A large percent of us in this country are colonized with MRSA. It used to be that MRSA was almost exclusively encountered in hospital-acquired infections, but this is no more. Now most of the MRSA infections occur in the cummunity.

On a side note - the over-use of antibiotics has added to this problem, but the fault lies in the patients just as much as with the doctors. Patients often come in expecting/demanding antibiotics for illnesses/symptoms which do not require therapy. The culpable doctors, out of fear of losing patients or being sued when they miss the rare infection requiring antibiotics and don't see the patient in close follow-up, prescribe the antibiotics. Some also feel it's much easier to prescribe the drugs to avoid a lengthy discussion/argument about why the antibiotics aren't needed so they can see the 30-40 patients per day they need in order to support their family, pay their bills and astronomical malpractice insurance and pay off their medical school debt. They don't think about the downstream effect of adding to antibiotic resistance. (Rant off.)

I am a minimalist when I prescribe medications in general. More specifcaly related to antibiotics, I don't prescribe them to immunocompetent individuals without clear evidence of a bacterial infection that their immune system is not containing and clearing on its own. Yes, that often means a quick follow-up appointment in 1-3 days, but it saves them the cost of a drug copay, the risk of a reaction to antibiotics, and does not add to the growing problem of drug resistant bacteria.

It has been shown in some drug-resistant bacterial strains that the survival advantage of the resistant bugs is only in the setting of rampant antibiotic use, and that with appropriate prescribing practices and time the infection rates don't change but much fewer instances of multi-drug resistant bacterial infections are seen.

MOO for most, scientific literature references for the last paragraph.

[CivieAttorney]

Thanks for the info. It's more concise and to the point thabn I've found anywhere, even from the CDC. So far my hands are healing up without problem, so I'm going to start breathing again.

[AlifBaa]

I've treated/referred maybe two dozen Marines/Sailors with MRSA. Every damn one of them said it was a "spider bite." http://www.medscape.com/content/2004...82893.fig3.jpg This is what it looked like in the field. Pics available on Google seemed to be way further progressed then what it looks like at the casual "Hey Doc, have a look at this?" stage.

Is just a Marineism, or have y'all heard the same description of 'spider bite'?

[PedOncoDoc]

Originally Posted by AlifBaa

Is just a Marineism, or have y'all heard the same description of 'spider bite'?

It's a regional thing - people from most regions call these abscesses (pockets of pus) "spider bites" but in the deserts of the southwest - particularly on the reservations - abscesses, along with a variety of other maladies, are blamed on scorpions.

If you've never seen a brown recluse bite, they can appear similar early in the process. One way to tell the difference is that in later stages there will be necrosis in the pocket of the spider bite which leads to an indent in the skin. The abscesses over time will grow and can show pus at the surface. The recluse bites will not have pus in them unless they get infected.