mrsa the super bug

[mrrk1562]

iv just went thru a mrsa thing with my kid ..she played a contact sport ..when the arm was showwed to me it was off to a hospital we went .spider bit at first but mrsa was on the menue ..its bad that kids playing pewe sports can get this they are not gay yet nor do they shoot drugs in their arms or any place els ..now why would a 12 year old get this ..now she had a flu shot she got it from some one thats a nurse and can buy this this shit from wal-mart ..the messed up yhing is now those peaple wont let my girl over to their house any more ..their son has been in and out of hospitals as he was beating very badly and now has probs with his kiddies ....this why i dont like vaccs ..i got realy sick from a mmr vac i needed it so i could go to collage i needed 2 got one and got realy sick ..so im not a good person to tell peaple to get the flu shot ..now those peaple hate my kids they gave then the shots ..if im making something out of nothing tell me now ..because i want to ack on those peaple as she was not sick be fore they gave her a flu shot ..

[DrBaboon]

OK -- I'll do what I can to try to make sense of the many things you've run together here.

iv just went thru a mrsa thing with my kid ..she played a contact sport ..when the arm was showwed to me it was off to a hospital we went .spider bit at first but mrsa was on the menue

It's not possible to try to diagnose someone by internet, nor is it desireable to try, so I am not trying to do that by saying what comes next:

I don't really see that you have said much of a description of what your daughter actually encountered, how it affected her, and how it has been treated. You also don't say anything about the success (or failure, or too soon to tell) of what has been done to treat her.

Can I assume she had a wound on her arm and that she had a skin infection of some variety? You are not talking about some other location for a MRSA infection, right?

Are you certain a spider bite is involved?

I mean, spider bites often result in significant damage to skin - it's not unusual to have an area of dead skin. If you mean to say that your daughter has lost a bunch of skin and is really sick, that sounds like something that happens with spider bites, whether or not a MRSA infection is also involved. If that's the case, maybe this thread should be about spider bites.


..its bad that kids playing pewe sports can get this they are not gay yet nor do they shoot drugs in their arms or any place els ..now why would a 12 year old get this

You are confusing the health of a person with BREEDING a species of bacteria to take on different characteristics.

This has nothing to do with sports, sexual orientation, drug use or age. It's really not about the person or their health. It's about changing characteristics of bacteria.

When I say BREEDING bacteria, I mean it occurs unintentionally. It's a consequence of the effects of antibiotics. If a population of bacteria is not eradicated by a course of antibiotics, the few surviving bacteria tend to be able to withstand that antibiotic. When they reproduce, they are the predominate bacteria of that type, and so the next generation of bacteria have a higher portion of being resistant to that antibiotic.

All that MRSA means is: Methicillin Resistant Staphylococcus Aureas.

IOW - a type of Staphylococcus aureas that has developed the ability to defeat methicillin (and along with methicillin, it defeats other penicillins and cephalosporin antibiotics).

That's why we treat it with other antibiotics. Vancomycin (given IV), clindamycin, tetracyclines, sulfas, linezolid are examples of antibiotics which are often appropriate for MRSA, depending on a person's allergies (if any), source of infection, other medical needs, etc.


Is MRSA a "super bug?"

Yes and no. It causes difficulties with antibiotic choices, and it's increasingly common, so in that sense "yes." Does antibiotic resistance always mean a bacterium is more agressive (more virulent)? Often, resistant bacteria are not as virulent, even if they are harder to treat. It's not a given that a resistant bacteria is less agressive, but it's the case somewhat often.

Now if a bacterial infection takes hold in a hard to treat area that has a high risk of complications, it can be life threatening even if it's "less agressive." An example would be having a heart valve infection.


..now she had a flu shot she got it from some one thats a nurse and can buy this this shit from wal-mart ..the messed up yhing is now those peaple wont let my girl over to their house any more ..their son has been in and out of hospitals as he was beating very badly and now has probs with his kiddies

I have no idea what you're talking about. It doesn't appear to be on-topic for MRSA.

FWIW - influenza vaccine has nothing to do with MRSA.


....this why i dont like vaccs ..i got realy sick from a mmr vac i needed it so i could go to collage i needed 2 got one and got realy sick ..so im not a good person to tell peaple to get the flu shot ..now those peaple hate my kids they gave then the shots ..if im making something out of nothing tell me now ..because i want to ack on those peaple as she was not sick be fore they gave her a flu shot ..

Again - MMR or influenza vaccine has NOTHING to do with MRSA.

Basically, the simplest way to see less MRSA is to do a few things:

1) Use antibiotics more judiciously. That means refraining from using antibiotics if we're not confronting a bacterial infection. It also means possibly treating acne differently across the country. It also means narrowing the spectrum of what an antibiotic targets whenever possible. It means pick and use antibiotics according to local antibiograms. I have discussed antibiograms in a different thread on this board.

http://www.survivalfiles.info/forums/showpost.php?p=727&postcount=21

2) If you do take antibiotics for a bacterial infection, take them until finished. Do not stop taking them once you feel better. Leaving surviving bacteria in the infection is a way to breed them into resistant bacteria. This is no different than breeding dogs or other animals.


From a planning standpoint, knowing what allergies you have (or other medical considerations) in your family/group/population, combined with watching trends on your local antibiogram, should be your primary guide.

I think it may be worthwhile discussing MRSA treatment further, so hopefully other people will post questions.

The "executive summary" is that it's possible to "breed" antibiotic resistant the other direction by changing our ways on a large scale.



Now, as much as the OP is opposed to vaccines...

One strategy that is being pursued in research for MRSA is a vaccine.

It may be available soon.

It's mainly being targetted to be given to people having heart valve surgery or orthopedic surgery where they end up with hardware installed, as a way of reducing infection rates with Staphylococcus -- both regular Staph and MRSA. It's also being looked at for vaccinating people who might have a high risk of needing orthopedic surgery -- such as frail elderly people, especially those who live in nursing homes. It isn't so much infections from nursing homes, as much as it is that if you're frail enough to be there, you're frail enough to have a higher chance of falling and breaking something (like your hip or other bones), and needing surgery to install hardware.

The healthcare network in South Dakota has done a really good job in reducing antibiotic resistance rates by changing antibiotic prescribing practices. A Dr. Sandvik out there is part of a team that has published a decent amount of research in the last few years showing how they did it. It's worthwhile understanding the gist of what they did.

Staph vaccination would result in less antibiotic use directed against Staph species, which would likely result in less MRSA over a period of months/years.

[DrBaboon]

http://www.netsymposium.com/index.php?select=product&data=14347

It's a link to purchasing an audio CD on what was done in South Dakota to reduce bacterial resistance.

The principles of doing this are fairly straight forward, and well worked out.

What is different here is that this health network covers a large area, with lots of places referring patients, so this involved a lot of people agreeing to follow a plan, and seeing if it worked out (it did so).

This is the kind of thing that has lots of implications for how antibiotics need to be optimized in a survival or austere situation (heck - it ought to be done this way in daily life under ordinary circumstances).

Historically, the tendancy is that people will use their supply of antibiotics, and will not restrain themselves to using it appropriately or optimally.

That's been true for physicians over the years. It's also been true for laypeople pulling the trigger on antibiotics.

You might say it's a human response to be uncomfortable *not* giving antibiotics, even if they are poorly chosen.

The former Yugoslav republics are not doing well with healthcare, supplies, etc.

My understanding from physicians who have been in those locations recently is that they saw docs giving patients whatever antibiotics they had, even if it was the last few doses of antibiotics available. Even if they knew that the infection was not matched to the antibiotic. Even if they did not have sufficient antibiotics to finish a course of therapy.

It might appear compassionate.

But it's not a winning strategy.

And it takes away from treating another patient later, who has an infection that could respond to the antibiotic you've got. It also keeps the breeding pressure on bacteria toward more and more resistance.

[HottAK47]

You got the good info, Doc. Now, about this chancre I got............

[Jonas Parker]

iv just went thru a mrsa thing with my kid ..she played a contact sport ..when the arm was showwed to me it was off to a hospital we went .spider bit at first but mrsa was on the menue ..its bad that kids playing pewe sports can get this they are not gay yet nor do they shoot drugs in their arms or any place els ..now why would a 12 year old get this ..now she had a flu shot she got it from some one thats a nurse and can buy this this shit from wal-mart ..the messed up yhing is now those peaple wont let my girl over to their house any more ..their son has been in and out of hospitals as he was beating very badly and now has probs with his kiddies ....this why i dont like vaccs ..i got realy sick from a mmr vac i needed it so i could go to collage i needed 2 got one and got realy sick ..so im not a good person to tell peaple to get the flu shot ..now those peaple hate my kids they gave then the shots ..if im making something out of nothing tell me now ..because i want to ack on those peaple as she was not sick be fore they gave her a flu shot ..


Huh??????? :confused:

[witchdoctor]

I AM A MRSA CARRIER!!! :D

Like most health professionals, I carry the MRSA in my nares. It is not active and I cannot just pass it along... MRSA is bad ju-ju and VRSA is even worse. So many antibiotics have been abused that we have created super-bugs!!! Good job America, pat yourselves on the back!! :p

[DrBaboon]

I AM A MRSA CARRIER!!! :D

It's a dynamic thing. People tend to reacquire Staph carrier status (ordinary Staphylococcus aureas or MRSA) if they clear it or have it eradicated. Likewise, it doesn't neccessarily persist forever.

Like most health professionals, I carry the MRSA in my nares.

Correct - one of the most common places where there is a resevoir of Staph in a carrier is the nose.

Extra Credit: What are the 2 other common Staph resevoir locations?

I don't know about "most" compared to "many" in healthcare. It seems to vary by where the study was done, when it was done, etc, and varies with changes in behavior (such has how antibiotics are prescribed).


It is not active and I cannot just pass it along...

Yes and no.

Even with ordinary Staph, a carrier can be the source of their own skin infections, and there's some small risk of people we care for converting to be carriers of MRSA even if they are not sick.

Yes, you're correct that it's not highly communicable.


Seeing a patient with recurring Staph infections will sometimes lead to looking to see if they are a carrier - for example, by getting a specimen from their nose.


Bactroban, a topical antibiotic, is not high on my list of austere medicines, as it's commonly used for impetigo, but not internal infections. There is a nasal form used for attempts at eradicating Staph carrier status.

http://www.gsk.com/products/prescription_medicines/us/bactroban_us.htm

VRSA is even worse.

Vancomycin Resistant Staphylococcus aureas

http://en.wikipedia.org/wiki/Vancomycin-resistant_Staphylococcus_aureus presents a reasonably straight forward overview.

So many antibiotics have been abused that we have created super-bugs!!! Good job America, pat yourselves on the back!! :p

It's a fairly global situation, more so where antibiotics are available and widely used. Agriculture/veterinary use of antibiotics also plays a role. See some of the links below.




Some MRSA links that may add to the discussion:

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_spotlight_2006.html

http://www.bt.cdc.gov/disasters/hurricanes/katrina/mrsainfoclinicians.asp

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_clinicians.html

http://www.cdc.gov/drugresistance/index.htm

http://www.cdc.gov/ncidod/dhqp/ar_mrsa.html

http://www.apic.org/Content/NavigationMenu/ResearchFoundation/NationalMRSAPrevalenceStudy/National_MRSA_Preval.htm

http://www.journals.uchicago.edu/cgi-bin/resolve?id=doi:10.1086/507967&erFrom=3235616009313008591Guest

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=PubMed&list_uids=14994935&dopt=medline

http://www.cdc.gov/ncidod/EID/vol12no12/06-0355.htm

http://www.hpa.org.uk/hpa/news/articles/press_releases/2005/050913_mrsa.htm

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10968688&dopt=Abstract

http://ndt.oxfordjournals.org/cgi/content/full/21/4/837

[DrBaboon]

Now, about this chancre I got............

LOL, right...

Bumper Sticker: "Clap if you've got the honk??"


FWIW -one of the infectious disease docs used to drive around with a bumper sticker that read:

"Sex, Bugs, Rock & Roll"

[DrBaboon]

BTW

Don't sweat all the fancy words in the MRSA links I posted.

I tried to pick links that would give an idea of:

1) how often MRSA is found in different populations in different parts of the world

2) what people are doing to control spread of MRSA during patient care

3) that there are in fact different types of MRSA (again - don't sweat the details of why and how). IOW - there are some biological differences in Community Acquired MRSA. This generally means that evolution/breeding continues. There may eventually end up being many different ways of Staphylococcus aureas strains becoming methicillin resistant. Biology seems to find a way to adjust and overcome.


My belief is you all can be RKIs and find the key couple sentences in the links, and we can discuss the rest if you want to do so.

Taken as a whole, the links also back up the notion that the key thing going on is antibiotic use.



My personal view of what constitutes a REAL "super bug," is closer to what may go on with multiple drug resistance. Particularly if that crosses the bacteria species barrier in a major or sustained way, and particularly if genetic material is passed on that encodes for resistance to more than one type of resistance.

The VRSA link talks about VRE interacting with Staph, which is an example of crossing a species barrier.



This also touches on why I am not encouraging people to make widespread use of quinolone antibiotics (such as cipro, levaquin, etc).

It's one thing to use those antibiotics for a very targetted reason.

It's another thing to use them as the drug of choice as a first-line agent for general use.

The emergence of resistance to quinolone in its own right is occurring in a variety of bacteria species faster than occurred in the past when other categories of antibiotics have been introduced AND there is a general bacterial phenomenon turning up where the bacteria "learns" to pump out the quinolone. "Learning" to do so, raises the question of whether that strain of bacteria will be able to pump out other antibiotics, too.

Quinolone "efflux pump" effects are turning up in more than one species. This is potentially ominous.

It's also the reason research is looking at giving a 2nd drug to block the ability of the bacteria to pump out the quinolone.

There are some things quinolones do very well, and that's probably where we ought to be using them - selectively.

We probably ought not to be treating ordinary urine infections and respiratory illnesses with them, particularly if the patient isn't allergic to other medications.

[delectric]

Having spent 6+ months grand total with friends and spouse at MD Anderson, I will tell your this MRSA and VRSA are EXTREMELY PREVAILENT in the Houston Med center.... the doc and staff there wear gloves not to protect themselves from MRSA but to keep MRSA from the patients. These two forms of septicimia(sp) are killing 40% of the patients at MDA. With most of the cancer patients having immuno suppressants and or immune systems destroyed, this place is a breeding ground for these pathogens.... a literal human petree dish.
Should a SHTF event occur these hospitals will be cesspools of infectious diseases.
I have seen what these two bugs do personally, I lost a FIL and a close friend to MRSA... simple infections and within 24 hours septicemia sets in killing within hours. One man lasted 16 hours, the other lasted 36 hours.
The mortuary people are scraid to death of these bugs, I know one that is considering another profession and when we loose these services, these diseases will multiple ten fold in a month.
It's only a matter of time before the next generation of antibiotics are overwhelmed before they even get used.

[DrBaboon]

MRSA and VRSA are EXTREMELY PREVAILENT in the Houston Med center

"Ordinary" MRSA has been prevalent to one extent of another for quite a few years. What is being discussed above in some of the material are other strains of MRSA that are not related to the "ordinary" strain that has been seen in hospitals for years (such as the strains of Community Acquired MRSA that have developed independantly from the "usual" MRSA strains). Community Acquired doesn't just mean developing the infection in the community. It's actually coming down to genetic lineage of which variety of MRSA, so that term means certain strains more than it means community now.

VRSA is NOT "extremely prevalent" at M D Anderson or any place else yet.

It's still a rare enough finding that it's reportable.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12567300&dopt=Abstract

It's still rare enough that the few cases of VRSA are discussed in continuing education or professional formats, and the physicians present often recall having seen the patient. IOW - it's still a unique enough event, that it's apparent which case is being discussed.

http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_data.html

http://www.cdc.gov/ncidod/dhqp/ar_visavrsa.html

http://www.cdc.gov/ncidod/dhqp/ar_visavrsa_FAQ.html

You are probably getting VRSA and VRE turned around with each other.

VRE (of one variety or another) is pretty common - and has also been so for some time.

VRE stands for Vancomycin Resistant Enterococci.

One VRSA concern is that Staphylococcus may obtain genetic material for vancoymycin resistance from VRE, and bring about more substantial ability to defeat antibiotics among Staph species.

FWIW - VRE is not a single entity.

Not only are there 2 Enterococcus species -- Enterococcus faecalis and Enterococcus fecium...

There are also entirely different manners and characteristics of vancomycin resistance among VRE isolates. As of a while ago, there were at least 4 types of vancoymcin resistance.

http://www.cdc.gov/search.do?action=search&queryText=vre&x=0&y=0

has lots of VRE links...


.... the doc and staff there wear gloves not to protect themselves from MRSA but to keep MRSA from the patients.

Universal precautions have widespread recognition.

These two forms of septicimia(sp) are killing 40% of the patients at MDA.

While VRE, VRSA or MRSA could be the organism involved in a person's septicemia, not all infections result in septicemia. People have lesser severities of infections a certain amount of the time.

http://en.wikipedia.org/wiki/Sepsis

OK - not that wikipedia is the "best" or most reliable source (in case anyone doesn't know, the articles there are written by whoever gets motivated to write it).

However, this is a reasonable overview on one page.

I think you're mixing metaphors here.

Is 40% mortality for really sick patients with sepsis about right? More or less. It could be higher.

That's going to be true regardless of the bacteria involved.

Are 40% of ALL of M D Anderson's patients dying during their hospital stay, much less dying from septicemia, or even VRSA or MRSA? No. Since they are a center of excellence for cancer treatment, they are going to attract a sicker population than average, and cancer patients die more often than people with simpler conditions. So in that sense, you'd expect the mortality of ALL patients at M D Anderson to be a little higher than your average hospital, but not 40%.

Could they have 40% of their sepsis patients die? Give or take however many percent, that's a typical figure for sepsis mortality (in more extreme cases, it's been known to hit 80% mortality). So if that's the actual fact behind what you're saying, it's pretty ordinary.

Or are you saying something else (which I would have no way to verify or dispute): That 40% of M D Anderson sepsis patients have MRSA or VRE as the organism that is part of their septicemia? That would be noteworthy if those 2 organisms accounted for 40% of septicemia cases.

And to repeat the VRSA business, VRSA isn't common enough anywhere in the US yet to account for 40% or 20% of anything. Key word: YET.

With most of the cancer patients having immuno suppressants and or immune systems destroyed, this place is a breeding ground for these pathogens.... a literal human petree dish.
Should a SHTF event occur these hospitals will be cesspools of infectious diseases.

You are making the wrong connection here.

Changes in the genetic capability of bacteria is not brought about by our immune system.

Sure, someone who is immunocompromised is more at risk for developing infections and from having difficulty fighting those infections.

But that doesn't change the bacteria's capability at the genetic level.

If anything, you could say that if we became easier "hosts/prey" for the bacteria, they would eventually breed in the direction of having less things in their arsenal.

This is primarily about bacteria living surrounded by antibiotics.

Immunocompromised patients end up on antibiotics - for actual infections, and in some cases for prophylaxis. Even when properly prescribed antibiotics change the surviving populations of bacteria, and antibiotic resistance results given enough generations of bacteria.

Regarding your view of SHTF and hospitals: I can't tell you that there isn't already significant difficulty with antibiotic resistant bacteria in hospitals. But it's also in the community, probably far more than you realize. It's also far more global than many people realize. SHTF probably won't immediately change how common that is.

However, I think it's reasonable to expect that if we are faced with a scarcity of antibiotics for a sufficiently prolonged time, the actual amount of antibiotic resistant bacteria will decrease.

I have seen what these two bugs do personally, I lost a FIL and a close friend to MRSA...

I am sorry for your losses.

simple infections and within 24 hours septicemia sets in killing within hours. One man lasted 16 hours, the other lasted 36 hours.

OK - on the one hand, these are not neccessarily "simple" infections.

On the other hand, you need to understand that septicemia is far more than the portion of itself that is attributed to infection.

Our own immune system does detrimental things to us in septicemia, and a variety of abnormal things result, ultimately leading to multi-system organ failure.

I can think of quite a few sepsis patients over the years where we had apparently successfully treated the infection, but the chain of events was not stoppable and the patient died anyhow. That's septicemia/sepsis/sepsis syndrome or whatever term you prefer.

The mortuary people are scraid to death of these bugs, I know one that is considering another profession

I don't doubt that it is true that you know some people who feel that way, at least some of the time. I have no reason to doubt your sincerity.

But is it REALISTIC and APPROPRIATE?

There are many reasons why physicians and nurses are considering leaving healthcare, but I've never heard any healthcare professional say that they were leaving for fear of personal illness due to occupational exposure.

Again - the reason I'm responding in as detailed a fashion here is that I feel the need to make clear the difference between acknowledging people's feelings and fear, and what's appropriate "respect" for infectious diseases.

FWIW - if this were a firearm discussion... People would have a good grasp of the facts. My goal is that members have appropriate material about healthcare. FAL Files members are quite skilled at recognizing superstitious reactions to firearms...

when we loose these services, these diseases will multiple ten fold in a month.

If you mean the loss of sanitation of all varieties, yes, we will see more infectious illnesses. It may not be the ones you are thinking about.

OTOH - if you mean that because morticians won't work on bodies we're going to see a rise in antibiotic resistant bacterial infections, I would be surprised if that were the case. See some of my reasons above (RE: antibiotic scarcity leading to less resistant bacteria given sufficient time).

Then again, I perceive more expedient burials as being a serious consideration for community health in the event of some unspecified calamity. People don't "need" to be worked on for the funeral.

If you're saying that bodies won't be buried by anyone due to fear of contagion, well, I can't argue with self-defeating bad behavior by a population.

I tend to think that leadership has a huge role to play - informally or the formal leadership. Remember, anyone can potentially lead, and most leadership is *not* down the chain of command. Most leadership is lateral, not up or down. It's peers.

Is it worth risking a physician on burial detail?

Sometimes, I guess you gotta lead from the front.

And in the process, teach appropriate handling precautions and hygeine, if they aren't already understood.

Fail to do that, and rampant superstition will rule.

It's only a matter of time before the next generation of antibiotics are overwhelmed before they even get used.

If you mean that figuratively, as in, it happens fast enough that it kind of seems that way, OK, I can agree with that.

However, if you literally mean that it's futile and that the new classes of antibiotics will truly be overcome by bacterial resistance prior to getting into widespread use, that's not what goes on.

The entry of a new category of antibiotic is what eventually would be expected to selectively breed bacteria resistant to it.

There are examples of how it's taking fewer years following introduction of a new category of antibiotic before resistance emerges. One case in point are the quinolones.

And in some manner, there's a tiny grain of reality in what you are saying - again, regarding quinolones. The EFFLUX PUMP as a means of antibiotic resistance certainly has the potential to reduce the effectiveness of any antibiotic on a bacteria strain where that's going on.

To me, it's a compelling argument to restrict our use of quinolone antibiotics, which is also the opinion of the infectious disease docs in my neighborhood. It's also part of what the group that Dr. Sandvik is part of accomplished in South Dakota.