MRSA or not MRSA that is the question?

Re: MRSA or not MRSA that is the question?

Evelyn Barbour-Hill — Thu, 15 May 2014 00:50:24 GMT

[quote user="bob lehner"]

What I find very scarey indeed is the extreme virulence of some of these bugs, as well as potential a/b resistance.

I saw a cat spay with post-op MRSA a good while back - the skin and muscle all round the wound were literally melting away day-by-day - ended up with a huge defect after repeated debridement - but did OK eventually (a while back the papers were full of 'flesh-eating viruses' (sic) - quite apt description despite the micro-biological misnomer.

[/quote]

This exemplifies what I'm on about. Sorry, but there's nothing about a Staphylococcus aureus being resistant to many antibiotics that also makes it terribly invasive or productive of endotoxins or exotoxins, is there? Before sulphonamides, there were no antibacterial drugs at all, but every Staph. aureus infection did not end up with hideous flesh-eating lesions, did it? Or did it?

The dreaded "flesh-eating superbug virus" is actually Streptococcus somethingor other probably carnoneccrotitans isn't it?

And, outside the body, these things are as susceptible as any to being scrubbed away and sluiced down t' plug-oil, aren't they? Or to being massacred with bleach?

Re: MRSA or not MRSA that is the question?

Martin Atkinson — Wed, 14 May 2014 19:04:51 GMT

[quote user="bob lehner"]I think we have had half a century of relative dominance over pathogenic bacteria - but I've got a sneaky feeling they'll come out on top in the longer run.[/quote] Well a bit of population reduction will be a good thing, worked well in the past! I might just save us from global warming.

Re: MRSA or not MRSA that is the question?

bob lehner — Wed, 14 May 2014 18:56:59 GMT

[quote user="Evelyn Barbour-Hill"] Why indeed is everyone so terrified of "superbug MRSA"? It may be resistant to methicillin and even some other antibacterial drugs, but it's still a Staphylococus aureus. It's no more invasive than any other Staph. aureus, is it?[/quote]

What I find very scarey indeed is the extreme virulence of some of these bugs, as well as potential a/b resistance.

Also heard recently of a work colleague's brother who had a vasectomy. Three days post-op he's in intensive-care/barrier nursing and close to death with some sort of streptococcal toxaemia. Seven GAs for debridement etc. and then skin grafts....

I think we have had half a century of relative dominance over pathogenic bacteria - but I've got a sneaky feeing they'll come out on top in the longer run.

Re: MRSA or not MRSA that is the question?

Martin Atkinson — Wed, 14 May 2014 13:58:00 GMT

[quote user="Anthony Todd"]Why not compare gloves with just washing your bleedin' 'ands![/quote] Indeed I never wear gloves for surgery and post-op wound infections are negligible. The exception is if I have cuts on my hands I feel I can't scrub adequately. This is something we've discussed before but IMO the major factors in post-op wound complications (assuming you have washed your hands!) are surgical skill and time.

Handling dirty wounds and other contaminated body parts is another matter, mostly for self preservation (I don't want smelly hands) as much as fear of cross contamination.

Re: MRSA or not MRSA that is the question?

Anthony Todd — Wed, 14 May 2014 10:03:07 GMT

[quote user="Evelyn Barbour-Hill"]It would be interesting to find out whether gloves do actually reduce any risks,[/quote]

Why not compare gloves with just washing your bleedin' 'ands!

From the evening Standard yesterday:

"The Care Quality Commission ordered changes at Lewisham hospital ensuring doctors wash their hands between patients......"

High tech stuff indeed

Re: MRSA or not MRSA that is the question?

Evelyn Barbour-Hill — Tue, 13 May 2014 17:56:23 GMT

[quote user="Tim Charlesworth"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Tim Charlesworth"] Never hurts to remind people to wear gloves when examining wounds etc[/quote]

It would be interesting to find out whether gloves do actually reduce any risks, how many billion individual bacteria are sprayed onto the nearest surface when you professionally snap the gloves off, how many people avoid touching anything that might just possibly have been touched by a possibly contaminated glove........

[/quote]

Yes they do!

http://pediatrics.aappublications.org/content/131/5/e1515.short

[/quote]

Interesting............ that was universal gloving though.

Re: MRSA or not MRSA that is the question?

Tim Charlesworth — Tue, 13 May 2014 14:38:40 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Tim Charlesworth"] Never hurts to remind people to wear gloves when examining wounds etc[/quote]

[/quote]

Yes they do!

http://pediatrics.aappublications.org/content/131/5/e1515.short

Re: MRSA or not MRSA that is the question?

Evelyn Barbour-Hill — Mon, 12 May 2014 18:57:23 GMT

[quote user="Tim Charlesworth"] Never hurts to remind people to wear gloves when examining wounds etc[/quote]

Re: MRSA or not MRSA that is the question?

Tim Charlesworth — Mon, 12 May 2014 18:32:34 GMT

[quote user="Martin Atkinson"]

[quote user="Tim Charlesworth"]If it is MRSA then it's worth flagging at M&M meetings and emphasising to staff to wear gloves/disinfect between patients etc etc. If there is a common factor/person involved with all the cases then they can get screened and treated if they are carrying.[/quote] It was stated in the OP that these two were independent cases that arrived with infected wounds so no connection to practice protocol and no reason to believe there is a practice problem. I'll admit that present nursing staff have not been screened but I have and the previous batch of nurses had after a previous cluster, all -ve.

[/quote]

sorry, didn't mean to insinuate that there was a problem but if you have MRSA cases in the practice (even if they're "just visiting") then it's worth making everyone aware to make sure you don't suddenly get a problem ie increasing post-op wound infection rates. Never hurts to remind people to wear gloves when examining wounds etc but I certainly wouldn't bother swabbing staff etc at this stage as it can all to easily become a bit of a witch-hunt..

Re: MRSA or not MRSA that is the question?

Martin Atkinson — Mon, 12 May 2014 17:07:11 GMT

[quote user="Hannah Wynne Richards"]Chicken and egg situaution who infected who.[/quote]Sounds like the cat ringworm case I saw that was brought in for PTS because the GP told them to as the child had it. I asked the simple question as which got it first? Turns out the child was infected first at school then gave it to cat but the GP didn't even ask. Mind you it says something about the intelligence of the owner if they couldn't work that out either.

Re: MRSA or not MRSA that is the question?

Hannah Wynne Richards — Mon, 12 May 2014 16:50:06 GMT

I once cultured MRSA from a hot spot that had developed 2y to otitis. The owner was an elderly lady, who was to and fro from hospital. She was being treated for a non-healing leg ulcer. After I found MRSA she asked the nurses at the ulcer clinic to swab her. Surprise surprise she was pos. Chicken and egg situaution who infected who.

Wynne

Re: MRSA or not MRSA that is the question?

Martin Atkinson — Mon, 12 May 2014 15:58:11 GMT

Re: MRSA or not MRSA that is the question?

Evelyn Barbour-Hill — Mon, 12 May 2014 13:03:58 GMT

[quote user="Linda Filshie"]

According to a lecture I went to on wound care at NAVC this year, bacteria can become resistant to antiseptics/disinfectants by the same mechanisms they use to acquire antibiotic resistance, and can actually become cross-resistant to antibiotics by exposure to biocides. Implications for chronic wound care and also perhaps for our own native skin flora.

The research has been out there for a while (e.g. see Cookson BD, Farrelly H, Stapleton P, et al. Transferable resistance to triclosan in MRSA. Lancet 1991;337:1548-9) but it was the first I'd heard of the phenomenon.

Expect to hear shortly in the Daily Fail about irresonsible use of chlorhexidine/iodine

[/quote]

Yes of course, but it's easy to change disinfectant, and I look forward to the day when resistance to bleach is reported.

[quote user="Tim Charlesworth"]

Tim

We had one last year with a classical sensitivity spectrum:

Amoxycillin                Resistant
Amoxyclav                  Resistant
Cephalexin                 Resistant
Sulpha/Trim                SENSITIVE
Marbofloxacin              Resistant
Erythromycin               SENSITIVE
Fusidic acid               SENSITIVE
Clindamycin                SENSITIVE
                           Oxacillin    Resistant

[/quote]

Which rather seems to reinforce Martin's original point. Even in that short list you've got four different antibacterial drugs that kill the blighter.

Re: MRSA or not MRSA that is the question?

Tim Charlesworth — Mon, 12 May 2014 12:05:49 GMT

If your isolate is only resistant to Methicillin then it is probably a Staph aureus that "happens" to be resistant to Methicillin aot the classical MRSA strains. True MRSA is usually resistant to all the B-lactams and they usually use Oxacillin to test if it is MRSA not Methicillin (so should be ORSA I guess). Worth having a chat with your lab to check results if you haven't already. I once saw a report which was diagnosed as MRSA despite it being a coag-ve Staph (ie not Staph aureus) so mistakes do happen.

If it is MRSA then it's worth flagging at M&M meetings and emphasising to staff to wear gloves/disinfect between patients etc etc. If there is a common factor/person involved with all the cases then they can get screened and treated if they are carrying. My NHS friends tell me that surgeons with MRSA still work but are kept out of ICU (if they were taken off-duty then the hospitals wouldn't have enough staff) so important to not hit the panic button but it is worth taking seriously as there are implications in terms of transferring infection from patient to patient and for any staff who have open wounds/booked in for surgery etc,

Tim

We had one last year with a classical sensitivity spectrum:

Amoxycillin                Resistant
Amoxyclav                  Resistant
Cephalexin                 Resistant
Sulpha/Trim                SENSITIVE
Marbofloxacin              Resistant
Erythromycin               SENSITIVE
Fusidic acid               SENSITIVE
Clindamycin                SENSITIVE
                           Oxacillin    Resistant

Re: MRSA or not MRSA that is the question?

Linda Filshie — Mon, 12 May 2014 09:18:04 GMT

[quote user="Evelyn Barbour-Hill"]It's just as vulnerable to disinfectants. No? Have i got it all wrong?

[/quote]

Expect to hear shortly in the Daily Fail about irresonsible use of chlorhexidine/iodine

Re: MRSA or not MRSA that is the question?

Evelyn Barbour-Hill — Mon, 12 May 2014 01:45:28 GMT

Nobody responded, so i'll bump this one up with some thoughts of my own. Why indeed is everyone so terrified of "superbug MRSA"? It may be resistant to methicillin and even some other antibacterial drugs, but it's still a Staphylococus aureus. It's no more invasive than any other Staph. aureus, is it? It produces no more toxins. It's just as vulnerable to disinfectants. No? Have i got it all wrong?