The fight against MRSA

I spotted this article yesterday in the Irish Times and felt compelled to share it. It’s a new step in the fight against MRSA…

New research has found that as the superbug MRSA resists antibiotics, it becomes less virulent. 

CLAIRE O’CONNELL

LIFE IS full of trade-offs, and it seems the hospital-acquired “superbug” MRSA is no exception. A new study led by Irish scientists has discovered that when the bacterium acquires resistance to antibiotics, it becomes less virulent, at least in a lab model.

The finding could help shed light on why patients who have compromised immune systems are particularly vulnerable to healthcare-associated MRSA infections.

MRSA develops when a bacterium called Staphylococcus aureus (SA) acquires resistance to a number of antibiotics and becomes methicillin-resistant Staphylococcus aureus (MRSA).

The new study, just published in the open-access journal PLoS Pathogens, looked at SA and MRSA infections associated with medical devices that are surgically implanted in a laboratory model, explains lead author Dr Jim O’Gara from UCD’s Conway Institute.

“Bacteria are naturally present on the skin, where they often don’t cause any problem. But if they stick onto medical devices that are put into the body they can get access through the skin’s barrier and then they can potentially establish an infection,” he says.

“They will form biofilms, which are communities of bacteria attached to the medical device, and those biofilms are almost indestructible. In that case you have to take the device out and put in a new one, which is not always a trivial thing for the patient.”

O’Gara and a colleague at Beaumont Hospital noticed several years ago that SA and MRSA biofilms looked different.

“Our early research in this area revealed a hugely surprising result – that MRSA and SA use different ways of forming biofilms,” says O’Gara.

Their discovery was that SA bacterial cells use sugars to stick to each other and to surfaces as biofilms, while MRSA instead use proteins to form biofilms.

With funding from the Health Research Board, his group brought the project further and looked at the effects of turning SA into MRSA in the lab. They used a preclinical model that introduced infection by allowing the bacteria to form biofilms on implanted medical devices.

Again, the results far exceeded their expectations: when SA became resistant to the antibiotic methicillin (and so became MRSA), its ability to cause illness was toned down.

“What the data show is that if you take SA and you make it resistant to methicillin, you change the way it forms biofilms, but you also make it less virulent in a preclinical model,” says Dr O’Gara, whose group at UCD worked on the project with colleagues at the University of Bath, Harvard Medical School and the University of Nebraska.

“It’s like the bacteria are making a decision to divert their energy towards becoming resistant to the drugs, and they are not going to expend energy producing as many toxins or enzymes.”

In essence, the findings suggest that hospital-acquired MRSA may have have adapted to the hospital environment by sacrificing virulence for antibiotic resistance, according to O’Gara.

“This trade-off works for the pathogen because patients in hospital, particularly in an intensive care setting, can be very immuno-compromised and the pathogen does not need to be very virulent,” he says. “On the other hand, the bacterium does need to be very antibiotic resistant, due to the necessarily high levels of antibiotic usage in intensive care units.”

O’Gara is now looking into how the discovery could be used to help make MRSA less nasty for patients who get infected. “It may open up new ways to find anti-virulence drugs,” he says.

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This article makes great sense to me as it goes some way to explain why my sinuses are chronically infected with MRSA yet I’m otherwise well. It also explains why I’ve had problems over the years with medical implants which have had to be removed having become contaminated with MRSA.

The question is… how the hell do you get rid of MRSA once and for all?

Source: Irish Times HEALTHplus magazine

Blowing Bubbles

Just home from Nottingham following another trip to see the surgeon. The outcome wasn’t quite what I’d expected but if it results in the avoidance of further surgery, I welcome it with open arms…

Those of you who follow this blog will remember that I underwent a graft procedure last year having developed post-operative complications following previous surgery on my head. The graft healed well but the donor site for the graft (upper part of nasal septum) has failed to heal and despite regular medical supervision over the past year, using conventional treatment options, I’m still in trouble. Hence I was referred back to the specialist unit in Nottingham for further assessment.

The surgeon had a good look around the inside of my head yesterday using a flexible endoscope and local anaesthetic. Once nasal debridement had been achieved on the affected side, pictures were taken for comparison with previous records. I was then shown the recording with a step-by-step commentary from the surgeon, outlining the nature of the problem.

While my underlying connective tissue disorder (EDS) is a contributory factor, the surgeon suspects that resistant bacteria are the main cause of my failure to heal. Apparently, with a long history of chronic sinus infection, surgery, MRSA, osteomyelitis and long-term antibiotic use, I’m a prime candidate for bacterial biofilm formation… huh?

In other words… the mucosal lining of my head is banjaxed and I can’t shift thickened mucus (snot!) without some extra help. The solution to this problem… wait for it… is to use baby shampoo to rinse out my head!

I thought the surgeon was having me on but no, he was absolutely serious. Baby shampoo when used in nasal irrigations, has been shown to serve as an antimicrobial agent and works to affect mucus properties and promote secretion clearance. I bet you never thought you’d hear that about a baby product!

I’ve been prescribed a 6-week course of twice daily sinus rinse-outs using a well-known baby shampoo at 1% dilution in a commercial saline solution, as an adjuvant therapy to a combination of other conventional medications.

And so… if you see me frothing at the mouth, with bubbles emanating from my nose and ears… you know why!

Reasons to be cheerful

I don’t need to be admitted to hospital…Having consulted my GP about the latest infection in my head, he advised that I should be admitted to hospital for IV treatment. With my extensive resistance to antibiotics, treatment is limited to antibiotics which can only be given under hospital supervision. With a heavy heart, I presented myself for admission through A&E yesterday morning. After a long day of tests and assessment, the doctors concluded that I did not need to be admitted to hospital.

The infection is not systemic… While the recent swab analysis showed resistance to the antibiotic which saved my bacon last year, as well as resistance to methicillin (MRSA), yesterday’s tests confirmed that I am not systemically unwell with the present infection and therefore there is no need for intensive antibiotic treatment.

I was assessed by a new doctor… My own consultant was unavailable and so my care was overseen by his senior registrar whom I’d not met before. This worked to my benefit as it meant that my head was fully assessed from a new standpoint. Following a thorough endoscopic examination (the surgically altered internal anatomy of my head earned some interesting comments as he’d not seen anything like it before), I was sent for a CT scan.

The scan ruled out any serious complications… Reassured by the scan result, the doctors decided to opt for conservative treatment. I’ve been commenced on a rigorous regime of daily sinus wash-outs with a hypertonic saline solution. It’s not pleasant but if it manages to flush out the infection without recourse to systemic antibiotics, I’m happy.

It was heaven to come home to my own bed last night… When you are admitted to hospital with a positive MRSA status (colonization or infection), you have to be nursed in isolation to prevent cross-infection. In the hospital which I attend, all MRSA cases are put into a large isolation unit as they do not have en-suite single rooms. I had been dreading going back into this particular isolation unit.

I awoke this morning secure in the knowledge that the right decision has been reached… Conservative treatment is the right decision for now. It makes no sense to bombard my system with potent antibiotics just because I’ve tested positive for MRSA. While pus is discharging down the back of my throat, I’m not having severe headaches and I feel reasonably well. I’ve been instructed to return to the hospital if my symptoms worsen but otherwise I will be reviewed in a few weeks time. I told you I was in good hands!

I’m enormously grateful for the messages of support received over the last few days. It’s a real pleasure to bring you this good news.

Moving the goalposts

As we await the mother-of-all budgets to be announced in early December, I had hoped to be able to bring you a good news story this week but sadly, that’s not to be. Having enjoyed a summer free of infection in my head, it seems that the holiday is now well and truly over. I’m back on the treadmill of chronic infection once again.

Within 2 days of finishing the antibiotic after the recent acute infection, the congestion in my nasopharynx began to recur and a foul discharge seeped into the back of my throat. I requested an urgent appointment with my surgeon and was seen in his hospital clinic last week. Following a nasal endoscopic examination, the surgeon was able to identify the cause of my symptoms. While my forehead remains completely free of infection, pus could be seen dripping from my sphenoid sinuses. A swab was taken for analysis (culture and sensitivity) and an air of despondency descended on the room.

My surgeon confirmed what I already knew which is that the donor site (one side of nasal septum) used for the graft procedure last February, has still not fully healed. This failure to heal is more of a nuisance than a cause for concern. The infection in my sphenoid sinuses is a new development and is definitely a cause for concern as these sinuses are near the middle of the skull and are the most inaccessible of all the paranasal sinuses. They are also bordered by more vital structures than any other sinus.

While recovering from the surgery in Nottingham earlier this year, I developed severe headaches which were different to anything I’d experienced before. The pain was deep behind my right eye and radiated into the top of my skull and to behind my right ear. I was sent for a precautionary MRI brain scan which came back as normal so a ‘wait and see’ approach was adopted. The headaches gradually petered out over the summer months only to return with a vengeance when I developed the recent acute infection. In hindsight, I now realise that those headaches were classic symptoms of sphenoid sinusitis which subsequently developed into an acute bacterial infection.

The surgeon is now of the opinion that the radically altered internal anatomy of my head, has left my sphenoid sinuses more prone to infection. As the normal drainage channels in my head have been surgically removed, the ostium (opening) of the sphenoid sinuses is now exposed to a greater risk of bacterial infection. I could hardly believe what I was hearing.

I left the consultation armed with a prescription for further antibiotics for when needed. My normal ‘glass half-full’ self seems to have deserted me while I try to digest this bombshell news. All I can tell you is that if feels like the goalposts have just been moved again.

You win some, you…

The good news is… I’m on the mend.  The bad news is… I missed a weekend away with good friends. You can’t win ’em all, I suppose?

I was a bit “under the weather” last week. The back of my throat felt congested and my chest was a bit wheezy but as I’d no cough or cold, I concluded that the symptoms were probably viral in origin and not a cause for concern. I was wrong.

On Thursday evening, the congestion in my upper throat gradually turned sore… very sore… and I began to feel distinctly unwell. I tossed and turned all night in discomfort and while my throat had eased by the following morning, I’d developed severe pain in my head. I now had all the signs and symptoms of a bacterial infection which had homed in overnight on the vulnerable area of my head and I knew treatment was urgently required.

My GP took one look at me and sat down to write a letter to the admitting doctor at the hospital where I’ve been treated on many occasions for the severe infections in my head. However, luck was on my side on this occasion.

Being a Bank Holiday Friday, my GP agreed to let me go home to my own bed armed with oral antibiotics and a concoction of opioid pain relievers, with the promise that I would report to A&E if my condition worsened.

To be honest, the rest of the weekend is a bit of a blur… thanks to whatever was in that prescription. All I can tell you is that the pain in my head has now eased and the worst is over. While I missed out on the holiday with friends, I’m very happy to have avoided being admitted to hospital. Not only is the battle won, I feel like I’ve won my own lottery.

MRSA Awareness

Everyone has heard of the hospital superbug MRSA and many have a view on how to stop it. I recently came across the results of a survey carried out in Ireland*, to assess the knowledge and perception of methicillin-resistant Staphylococcus aureus (MRSA) among the general public.

The study concluded…

“The public are generally knowledgeable about MRSA but most agreed that they would feel angry and afraid by its diagnosis. Future public education campaigns on MRSA should be aware of this response.”

MRSA infection can be very serious or even fatal so it’s easy to understand why people would be afraid of a diagnosis. I was pretty scared when first diagnosed with MRSA but I can honestly say that I did not feel angry about it. The only time I felt any anger was when I was exposed to the stigma attached to MRSA, by hospital staff who had not been properly trained in infection control. Why is it then that most people in the above survey, agreed that they would feel angry if diagnosed with MRSA?

I can’t help but feel that the media coverage of MRSA has a lot to do with the opinion of the general public. The newspaper coverage tends to be alarmist in nature and is centered around individual’s stories. MRSA is a problem and should be reported but the media should reflect the whole story about MRSA.

Hospital cleaning is part of the answer but so is the reduction of antibiotic use, which is regarded as one of the most effective ways of reducing MRSA. More microbiologists are needed as well as more infection control nurses. Increasing the number of isolation units so those with MRSA can be treated without the fear of infecting others, is also part of the answer as well as reducing bed occupancy rates in hospitals.

And always remember… the most important thing you can do to reduce the spread of MRSA, is to wash your hands thoroughly and often. If soap or water isn’t available, use alcohol-based hand sanitizers.

How do you think you would feel if you, or someone close to you, was diagnosed with an MRSA infection? Would you feel angry?

* This survey was published in the British Journal of Infection Prevention.

What a week!

It all started last Sunday. We had some visitors staying and I wrongly assumed that my constantly recurring headache was as a result of the extra workload. I’m well-accustomed to popping pain relievers in order to function normally and I make no apology for it. As anyone who suffers from a chronic condition will know, it’s the only way to get things done. The secret however, is knowing when to shout for help.

When I dragged myself out of bed last Monday morning I knew I was in trouble. I’d barely slept a wink overnight as my headache was no longer responding to pain killers. As luck would have it, I’d a hospital appointment already booked with the surgeon for the following morning so expert help was at hand.

By the time the surgeon got to examine my head on Tuesday morning, I was in so much pain I could barely talk. A few hours later, I was lying inside an MRI scanner having a brain scan to rule out a possible brain abscess. Thankfully, nothing of this nature was diagnosed although a nasty infection was visible at the site of my recent surgery.

The same evening, my daughter arrived home from her work placement in a hospital, looking like death. She was suffering a flu-like reaction to travel vaccinations received the day before. Despite running a very high temperature overnight and still looking very pale the next morning, she insisted on going back to work. By lunchtime, she was in A&E of the hospital having developed a severe nose bleed while on the wards. Her nose had to be cauterised to stem the flow of blood and she limped home to bed for the second evening in a row.

The next day, I woke with horrible nausea and the return of colitis as a result of the antibiotics prescribed to treat my head. I had no choice but to lie very low that day.

On Friday morning, my husband was admitted to hospital for a cataract operation. Having collected him from the hospital at lunchtime and brought him home to recover, I was looking forward to a quiet afternoon but no such luck. One of our cats appeared with his tail bent double and I knew immediately that an urgent trip to the vet was in store. Last year, this same cat became very unwell having developed an abscess in his tail (most likely from a bite from another cat) and the tell-tale sign was a drooping tail. So, Friday afternoon was spent getting the cat sorted with an antibiotic.

As if the week hadn’t been testing enough, Saturday morning started with an early morning trip to bring the eye patient back to the hospital for a routine check. Having delivered the patient safely home again, I then attended a funeral before spending the afternoon at the nursing home where both of my parents are in rapid decline at the moment.

Today, apart from frequent trips to the loo, I’ve done nothing but loll around in the garden enjoying the sunshine. The pain in my head has eased but I’m not out of the woods yet. If I go quiet again next week, please don’t worry. Wimbledon fortnight starts tomorrow. Bring it on!

Antibiotic Stewardship

Did you realise that at least 50 per cent of antibiotic use in Irish hospitals is inappropriate? One of the foremost concerns in modern medicine is antibiotic resistance. Antibiotics are the first line of defence against many infections but overusing or misusing them can cause more harm than good.

The HSE Health Protection Surveillance Centre (HPSC) has published an updated set of expert guidelines, to promote rational antibiotic prescribing in Irish hospitals. The recommendations range from the relevant structures and personnel that should be in place in all hospitals, to specific interventions that should be considered once essential structures are in place. The guidelines, if adhered to, will save money in the long run.

The Guidelines for Antimicrobial Stewardship in Hospitals in Ireland aim to cut antibiotic resistance and improve patient safety. They represent huge savings as the costs associated with people being infected with a resistant bug, can be enormous. Antibiotic stewardship, which implies quality prescribing, is distinguished from antibiotic control, which implies limiting use. The primary rationale for antibiotic stewardship is the prevention or reduction of antibiotic resistance.

The guidelines recommend the appointment of teams of clinical microbiologists, infectious disease consultants and antimicrobial pharmacists in every acute hospital across the country. Approximately 20 hospitals already have antibiotic pharmacists in place and these hospitals have seen the biggest reductions in antibiotic use. This scheme has the potential to make a real difference in the fight against hospital infections. I welcome it with open arms.

Hot off the press

Steph might be going home from hospital tomorrow. No kidding! I mean home to stay, to sleep in my own bed. The osteomyelitis is in retreat and I’m on the fast road out of here.

The surgical team paid a visit early this morning to review my blood tests and discuss the plan to change from intra-venous to oral antibiotics. Within an hour, my head had been examined endoscopically and the surgeon reported back that good progress had been made. The raw bone inside my head is covered with granulation tissue, a sign that normal healing is taking place.

By lunchtime, microbiology had approved a change onto oral antibiotics and my current treatment for colitis had been reviewed by the gastroenterology team. Matilda now sits forlorn beside my bed, no longer required. Instead, I’ve a feast of antibiotics to swallow at regular periods throughout the day.  A  24-hour test run is underway to see if the colitis can withstand the new regime. If I maintain a stable path overnight, the central line to my chest will be removed and I will be allowed home by tomorrow evening to continue treatment from the comfort of my own home.

I just thought you might like to know.  Fingers (and legs) crossed.

UPDATE: (Wednesday 11 am) It’s for definite! The central line is now out of my chest and I’m on my way home today. Yabba, dabba do! Next post from home.

No White Flag

This is my nurse (thanks Grannymar).

I’m back! Well, sort of… if you know what I mean. I got home from hospital on July 10th on oral antibiotics but it turned out to be a shortlived escape.

Six days later, I was back in A&E with all the old symptoms again. The osteomyelitis has returned in the bones of my skull and the colitis has flared up again too.

There will be no white flag above my bed. I won’t put my hands up and surrender. I’ll let it pass (more anon).

Full credit to Dido (I love this song).