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Old 06-22-2006, 07:00 AM
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Harrison Harrison is offline
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In February, we’ve talked about post-op infections and possible proactive treatments -- see an interesting discussion on the use of antibiotics here.

So when I read the recent issue of time which reports on a new type of staph, I wasn’t surprised with any of the news, just more alarmed than before. E.g., this quote sounds a bit concerning: "MRSA is where resistance and virulence converge."

Any way, you be the judge about the threat hyped in the article. Then go wash your hands!
__________________________________________________ _________________

Sunday, Jun 18, 2006
Surviving the New Killer Bug
A nasty, drug-resistant staph infection--the kind usually seen in hospitals--is racing across the U.S.
By CHRISTINE GORMAN

Jewaun Smith, a 9-year-old boy from Chicago, is lucky to be alive. A scrape on his left knee that he picked up riding his bike last October turned into a runaway infection that spread in a matter of days through the rest of his body, leaving his lungs riddled with holes. Jewaun managed to survive, but what worries doctors most about his near-death experience is that it's not an isolated case. The bacteria that infected his knee has become resistant to the most common antibiotics and is on the march across the U.S. It has spread rapidly through parts of California, Texas, Illinois and Alaska and is beginning to show up in Pennsylvania and New York.

"This bug has gone from 0 to 60, not in five seconds but in about five years," says Elizabeth Bancroft, a medical epidemiologist at the Los Angeles County Department of Health Services. "It spreads by contact, so if it gets into any community that's fairly close-knit, that's all it needs to be passed."

This is not bird flu or SARS or even the "flesh-eating bacteria" of tabloid fame. But it is every bit as dangerous, even if it goes by an uncommonly ungainly name: community-acquired methicillin-resistant Staphylococcus aureus (MRSA).

Never heard of it? Neither have most doctors. But major new health threats don't usually announce themselves with press releases. A quarter of a century ago, the world learned about the AIDS epidemic because a health bureaucrat noticed an uptick in prescriptions for treatment of a rare pneumonia. In 1912--more than a half-century before the Surgeon General's report--a New York physician chronicled "a decided increase" in lung cancer, which was considered rare at the time, and suggested that cigarettes might be the cause.

Which helps explain why infectious-disease specialists in the U.S. are so alarmed by the new killer bug. "We're out here waving our arms, trying to get everyone's attention," says Dr. Robert Daum, director of the University of Chicago's pediatric infectious-disease program, who was one of the first to call attention to the rapid spread of MRSA, back in 1998. "People talk about bird flu, but this is here now."

Hospital workers know all about drug-resistant bacteria. Several strains have been making the rounds of the biggest hospitals for the past 15 years or so, often posing a greater risk for patients than the condition they were admitted for. But until the late 1990s, epidemiologists assumed that the problem was restricted to large hospitals and nursing homes.

The MRSA strains turning up in the community at large are related to but different from the ones found in medical institutions. The hospital variety usually requires intervention with powerful intravenous antibiotics and is pretty hard to catch. By contrast, the new strains of MRSA respond to a broader range of antibiotics but spread much more easily among otherwise healthy folks. The bugs can be picked up on playgrounds, in gyms and in meeting rooms, carried on anything from a shared towel to a poorly laundered necktie.

One of the difficulties in tracking MRSA is that doctors rarely check for it. The standard test usually takes a couple of days, and hardly any doctors do it anymore because everyone assumes that most skin infections respond to the usual antibiotics. "HMO's aren't going to be paying for you to do a culture on what they consider to be a [common] skin lesion," Bancroft says.

The ubiquity of staph bacteria adds to the problem. The germs are part of the usual microscopic landscape of your outer and inner skin, including the mucus linings of the nose. Most of those bacteria don't cause illness, and in fact their presence is a good thing, since they can crowd out more dangerous pathogens. But every once in a while, the good guys take a beating, and one of the bad guys, like MRSA, takes hold, colonizing the skin.

Even when that happens, it doesn't necessarily signal an emergency. The skin, after all, is an effective barrier against many kinds of threats. But anytime you get a break in that barrier--even a tiny cut--there's a chance some bacteria will get inside and infect the wound. What makes MRSA germs particularly dangerous is that they excrete a potent toxin that attacks the skin, causing an abscess that's often mistaken for a spider bite. Normally, the body can wall that area off. But if the infection spreads, treatment with antibiotics may be called for.

And that's the problem. Doctors have grown used to prescribing antibiotics like oxacillin or cephalexin in that situation. It's not clear if that long-standing habit helped the bugs grow resistant in the first place. But what is abundantly clear is that those standard treatments are no longer effective.

There's another factor that makes the community-based MRSA so dangerous, one that has been revealed only recently by genetic analysis. In addition to their normal chromosomal DNA, staph and other bacteria like to mix and match genetic information by exchanging short strips of DNA called cassettes. Some of those cassettes carry genetic instructions to do two things at once: confer antibiotic resistance and make the host even more susceptible to infection. "MRSA is where resistance and virulence converge," says Daum.

What epidemiologists still can't explain, however, is how that particular bug manages to get around to so many cities and towns yet has left others relatively unscathed--at least so far. Cases of the new MRSA strain have only just started cropping up in New York City, for example. "We've been waiting for this to happen," says Dr. Betsy Herold of Mt. Sinai. "Now, we're in a unique position to watch it unfold and to find out why it's happening."

Meanwhile, there are things you can do to protect yourself (see box). To prevent more bugs from developing resistance, it's important to remember that not all skin infections need antibiotic treatment, even MRSA. "A garden-variety infection is still a garden-variety infection," says Dr. Philip Graham at New York-Presbyterian's Children's Hospital in New York City. "If your cuts and scrapes are acting like they always do, don't worry."

If, however, you or a loved one is running a high fever, has a lot of redness or shows signs that an abscess is forming, you need to get to a doctor right away. "It never hurts for a patient to say something like, Could this be an MRSA infection?" says Dr. Jack Edwards, chief of infectious disease at Harbor-UCLA Medical Center in Los Angeles. It could make all the difference in the world.

With reporting by Reported by Dan Cray/ Los Angeles, Wendy Cole/ Chicago

http://www.time.com/time/magazine/ar...205364,00.html
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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  #2  
Old 06-22-2006, 01:17 PM
JeffreyD JeffreyD is offline
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This topic reminds me of the difference in surgical care at the Alpha Klinik in Munich compared to standard practice in the U.S.
Meticulous protocols are observed in Germany; here, "lax" is the most polite way I can describe the sanitary procedures. It's alarming what is allowed in the operating theater and on the attending personnel in the U.S.
-Jeff
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15+ years back pain w/ advancing disc degeneration.
2002-2 level lumbar IDET w/ Nucleoplasty (very unsuccessful; huge setback)
Three level lumbar Charite (L3/4, L4/5, L5/S1) with Dr. Zeegers in Munich, Germany: 2/25/05 (successful)
Two level cervical Mobi-C (C5/6, C6/7) with Dr. Zeegers (successful)
Laser Facet Coagulation (left side: L3/4, L4/5, L5/S1 & sacral) with Prof. Dr. Reul (significant reduction in remnant lumbar & sacral pain)
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  #3  
Old 06-22-2006, 03:53 PM
Alastair Alastair is offline
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This is one reason I went to Munich- - - they have NEVER had a case of infection there EVER!!

Its got a lot to do with hygiene, the moment a patient leaves the Alphaklinik their room is washed down and steralised everywhere -- - walls ceilings etc.

I think no other nation is as cautious as the Europeans.

An antibiotic is being developed for MRSA but its going to be some years before it is available and done trials
Best
Alastair
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  #4  
Old 06-22-2006, 07:02 PM
luvmysibe luvmysibe is offline
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OK, I am going to stray just slightly off topic to post my staph infection story.

While teaching students with severe & multiple disabilities, I worked with one student in particular who displayed constant sinus drainage. One day, this student arrived with a serious infection and proceeded to sneeze and drool on me. A short while later, I developed horrible welts and sores all over my body. Subsequently, i was diagnosed with a staph infection. From that day on, I decided to keep an even safer distance and wash more frequently than before.
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  #5  
Old 06-23-2006, 10:43 AM
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Harrison Harrison is offline
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Jeffrey, Alastair – we talked a little about the U.S.-European hospital differences a while back. One thing left with me is the difference in actual missions between US and Euro operations; e.g. many U.S. medical facilities are treating a wider range of patients, thereby increasing infection risk. I doubt this accounts for ALL of the differences, but it must play a role…?

Crystal – that is a “yikesfest” on the infection! Between your stories and Paulette’s, it sounds like child care can be a particularly dangerous profession for ADR patients (seriously).

Any way, yet another story about MSRA…or should we say Mrs. A? Though this story talks about risks with tatoos, it offers a more succinct description than the lengthier article I posted; see here.
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
Founder & moderator of ADRSupport - 2004
Founder Arthroplasty Patient Foundation a 501(c)(3) - 2006
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  #6  
Old 06-23-2006, 12:42 PM
Alastair Alastair is offline
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Yes there is no doubt about it that the Alphaklinik is different to any hospital that you will see in any country.

It is totally devoted spines and knees and the occasional hip now I understand. The disciplines are so tight and well understood that I personally would advise anybody to go there with spine problems and have no worry about infection. It was one of the major things that influenced me to go there.

Of course there was the additional factor of Dr Zeegers being the world's most experienced ADR surgeon . He had done almost 1500 procedures and I was there in 2002 -- -- -- he must have done over 2000 surgeries now
Best,
Alastair
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ADR Munich 26th July 2002 L5/S1. Aged 82 now
Your best asset is your health
My story is here
http://www.adrsupport.org/alastair.html
Thank goodness for Dr Zeegers I am painfree
I am here to help,I live in the UK


I now run the UK spine site and can be contacted at

www.adrsupportuk.com/
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  #7  
Old 06-23-2006, 01:25 PM
JeffreyD JeffreyD is offline
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After I was summoned into the pre-surgery admittance area prior to my ADR surgery, my wife noticed a few moments later that a nurse opened the door to the area to announce something to another person in the waiting area. The nurse's foot crossed a painted line on the floor by an inch. That nurse could not return through the door she was standing in and had to exit the building and go back through the entire sterilization process before she could return to work...........which I found out takes a minimum of 30 minutes. Compare that with the typical scene in an American hospital where people who are actually working in the OR coming and going to the waiting room, etc.
-Jeff
__________________
15+ years back pain w/ advancing disc degeneration.
2002-2 level lumbar IDET w/ Nucleoplasty (very unsuccessful; huge setback)
Three level lumbar Charite (L3/4, L4/5, L5/S1) with Dr. Zeegers in Munich, Germany: 2/25/05 (successful)
Two level cervical Mobi-C (C5/6, C6/7) with Dr. Zeegers (successful)
Laser Facet Coagulation (left side: L3/4, L4/5, L5/S1 & sacral) with Prof. Dr. Reul (significant reduction in remnant lumbar & sacral pain)
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  #8  
Old 06-23-2006, 02:00 PM
Justin Justin is offline
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Quote:
Compare that with the typical scene in an American hospital where people who are actually working in the OR coming and going to the waiting room, etc.
Jeff,

I understand your point about the differences between the US and Munich. However, there is a sterile surgical field that cannot be broken (or should not be broken in an OR, as every action is taken to prevent this). People walking freely in and out of the OR is true to a certain extent, but precautions are taken to have only necessary medical staff present during an operation. If you are scrubbing in for surgery (the person(s) PERFORMING surgery) and you leave the room and come back in, you have to take the same steps necessary to be allowed back in the sterile field (hand washing, sterile drappings, booties and gloves, etc.)

I do agree that the operating theatres in Munich are held to much higher standards. Hospital infections, or nosocomial infections, are estimated to more than double the mortality and morbidity risks of any admitted patient, and they probably result in about 90,000 deaths a year in the United States (www.emedicine.com ):

Quote:
Frequency:

In the US: Nosocomial infections are estimated to occur in 5% of all acute care hospitalizations. The estimated incidence is more than 2 million cases per year, resulting in an added expenditure in excess of $4.5 billion. The National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention performed a survey from October 1986 to April 1998. They ranked hospital wards according to their association with central-line bloodstream infections. The highest rates of infection occurred in the burn ICU, neonatal ICU, and pediatric ICU.
Internationally: Health-care-associated infections (HAI) impact on the health care systems of developed countries is significant and proportionate to that of the United States.
This is a great discussion.

Justin
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  #9  
Old 06-23-2006, 02:42 PM
tmont tmont is offline
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The AP is also running an article on MRSA infections today--44 patients in 3 states between 2004 and 2005 who went to illegal tattoo parlors came down with it.

I wanted to copy it here, but there's a copyright on the article. AOL offers to IM or mail it which seems to be a violation of that?

As I don't know and don't want to risk being responsible for Harrison's midnight arrest, I'll just link it here:

http://articles.news.aol.com/news/ar...90027&cid=2194

(I can still do that, can't I?)
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  #10  
Old 06-26-2006, 07:35 AM
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Harrison Harrison is offline
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This article just shows that Alastair's "coodies" are bigger and stronger than our American coodies.

Kidding aside, more on hospital bugs. There are a few points that seem to contradict one of the previous article's points, about exchanging genes (referred to as cassettes). I'll defer to the members who dabble in microbioology on that one!
_________________________________________________

How hospital bug can evade attack
Scientists have decoded the genetic make-up of a bacterium responsible for many hospital-acquired infections - and shown why it is so difficult to tackle.

Clostridium difficile caused more than 44,000 infections in the UK in 2004 - mostly among the elderly.

Researchers found it can chop and change its genetic structure very easily - maximising its ability to neutralise attack by antibiotics.

The Sanger Institute study is published in Nature Genetics.

"....Its overall variation is remarkable."
-- Professor Brendan Wren

The researchers hope their work will aid the search for new treatments, vaccines, and diagnostic tests.

The emergence of bacteria resistant to many of the leading antibiotics is a major problem facing healthcare providers worldwide.

C. difficile is a particular problem, because it can only be treated with two antibiotics, metronidazole and vancomycin - and there is concern that these will also soon become ineffective.

Bigger threat than MRSA

The bug is now more prevalent, and causes more deaths than the notorious superbug MRSA.

It causes a range of diseases from antibiotic-associated diarrhoea to a life-threatening colon disease, called pseudomembranous colitis.

The Sanger team found that half of the genes in C. difficile are absent from four of its bacterial cousins, including species that cause botulism and tetanus.

The researchers also found great genetic variation even between different strains of the bug.

Most important, and unlike its nearest relatives, C. difficile can readily exchange genes and resistance elements.

Researcher Dr Mohammed Sebaihia said: "The genome of C. difficile is in a state of flux.

"More than 10% of the genome consists of mobile elements - sequences that can move from one organism to another - and this is how it has acquired genes that make it such an effective pathogen.

"It has gained an array of genes that make it resist antibiotics, help it to interact with, and thrive in, the human gut and help it to change its surface.

"This combination gives it a hugely impressive range of resources to help it prosper in humans."

Few shared genes

Professor Brendan Wren, from the London School of Hygiene and Tropical Medicine, also worked on the study.

He said only 40% of genes were shared between the eight different strains of C. difficile analysed.

"Its overall variation is remarkable. The genetic comparison of these strains will help us understand how C. difficile ticks and help to explain how the hypervirulent strains emerged and spread so rapidly."

The study also found that C. difficile produces a chemical called paracresol, which kills other competing bacteria, and protects it from bile acids in the gut.

C. difficile thrives in the absence of oxygen and can "hibernate" in adverse conditions by forming spores.

It is thought these spores are responsible for most human infections, and because they are highly resistant to most disinfection methods they are very difficult to eradicate, and can spread easily.

Since 2003, a new and more virulent strain (called NAP1/027) has emerged in hospitals in North America and is now present in most UK hospitals.

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/h...th/5109384.stm

Published: 2006/06/25 23:09:25 GMT
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Fell on my ***winter 2003, Canceled fusion April 6 2004
Reborn June 25th, 2004, L5-S1 ADR Charite in Boston
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