The fight against MRSA

April 11, 2012

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


Super Pillow

November 23, 2011

I’ve always had a ‘thing’ about bringing my own pillow (if possible) whenever I overnight away from home. And, that includes when I’m admitted to hospital… my non-allergenic, frequently washed pillow comes too plus a supply of my own pillowslips.

Why? There are lots of reasons why but chief amongst them is hygiene. I’ve never liked the idea of burying my head in someone else’s pillow. The crisp, white pillowslips found on hospital/hotel pillows, do not reassure me. According to an article in yesterday’s paper, my reservations are well-justified…

A recent clinical trial carried out by Bart’s Hospital and the London NHS Trust, concluded that the risk of infection from bedding is “grossly underestimated”. “Dead skin, bodily fluids and dandruff found on hospital pillows made them a potential source of more than 30 types of infection”. Read on… if you dare!

Pillow aims to halt the spread of superbugs

Carol Ryan

AN IRISH company has invented a pillow that may help to reduce the risk of picking up a hospital-acquired infection (HAI) such as MRSA from lying on contaminated bedding.

Gabriel Scientific’s “SleepAngel” pillow was the subject of a clinical trial by Barts and the London NHS Trust, which found its product to be more hygienic than regular hospital pillows.

Several international studies have found that hospital bedding can harbour bacteria if they become contaminated with the bodily fluids of a patient who has an infection.

While regular washing is a standard infection-control measure in all Irish hospitals, the Barts study concluded that the risk of infection from bedding is “grossly underestimated in clinical practice”, and that regular cleaning may not be enough.

The inventors of the SleepAngel pillow, Billy Navan and David Woolfsen, both worked in the health industry and saw the problems caused by superbugs in Irish hospitals. They thought the risk of infection from pillows was being overlooked in hospital hygiene policies and spent nine years creating their infection-control pillow.

Most of that time was spent searching for a material that could keep germs out of the interior stuffing while still allowing the pillow to “breathe”. A membrane normally used in heart stents was incorporated into a specially designed filter.

During the Barts study, their product was put to work alongside standard NHS pillows in UK hospital wards. Both were used on cardiac, vascular and respiratory wards and tested after three months.

The results showed high levels of contamination in the standard pillows. Some had bacteria levels which were described by Dr Arthur Tucker, who led the study, as a “bio-hazard”. Dead skin, bodily fluids and dandruff found on the pillows made them a potential source of more than 30 types of infection ranging from flu to leprosy. The SleepAngel pillows tested negative for interior contamination and were much less likely to have bacteria on the outside.

There was also some unpleasant news about domestic pillows – apparently you are never alone in bed because after two years of use, one-third of a pillow’s weight is made up of dust mites, dead skin and bacteria.

Infection control has become a big challenge for hospitals in recent decades. Dr Brian O’Connell, medical director at the National MRSA Reference Laboratory in St James’s Hospital, explained that the superbug problem first surfaced in Ireland during the 1980s and quickly became “endemic” in some hospitals. Rates of infection have declined in the past few years but cross-infection still creates a huge extra workload for hospital staff and puts patients at risk.

Of real concern is stopping the spread of MRSA, a strain of the common Staphlococcus aureus bacteria that has developed resistance to antibiotics, making it difficult to treat. If the bacteria gets into the system through a break in the skin it can cause infections but, in more serious cases, can lead to life-threatening diseases.

The HSE Infection Control Action Plan estimates that about 25,000 in- patients develop a HAI every year in Ireland.

The cost of treating and preventing HAIs is €23 million per year and about one-third of infections are thought to be preventable.

Source: HEALTHplus – The Irish Times


Confused about MRSA?

October 20, 2007

Hardly a day passes without another MRSA story hitting the headlines. People are right to be concerned about this resistant superbug but sometimes the stories do not match the facts, and misunderstandings occur. I am no expert when it comes to talking about MRSA but I have learnt enough through my own experience of MRSA infection, to be able to share some facts with you.

So, what does it mean when someone says “I’ve got MRSA”?

This seems to be an area where much confusion exists. First of all, it should be clarified that a person can be either ‘colonised’ with or ‘infected’ by MRSA. People who are colonised usually have no symptoms but they still have the potential to pass on the bacteria by touch. Those who have an infection caused by MRSA are usually unwell and will require treatment.

MRSA Colonisation

The significance of being ‘colonised’ with MRSA is often poorly understood. Some people harbour the bacteria in their nostrils or on the surface of the skin without being aware that they are colonised, and they remain well. It is possible to pick it up on your skin by simply touching a contaminated surface or indeed from another person who is colonised but it will not cause harm unless it enters your system through microscopic breaks in the skin. When someone is found to be colonised it does not mean that they will automatically go on to develop an infection. As long as you are well there is no need to be unduly alarmed. You should remain extra vigilant for any unusual skin complaints or if you develop a high temperature and seek medical attention if in any doubt. You will be given instructions on how to de-colonise yourself with topical agents such as nasal ointment and bodywash/shampoo to eradicate nasal and skin carriage. It is important to remember however that a colonised person is a ‘carrier’ of MRSA and has the potential to colonise/infect others through contact. This is the reason why stringent infection control measures are required in hospitals as patients who are already ill, are at high risk of developing an MRSA infection. Many people are carriers without realising it and therefore it is really important that everyone takes the necessary precautions to prevent the spread of bacteria. Hospital visitors should observe good hand hygiene and use alcohol gel on their hands before and after visiting a patient. Ideally, hospital visiting should be kept to a minimum.

MRSA Infection

When somebody receives a diagnosis that they are ‘infected’ with MRSA they are usually already unwell. MRSA is not only restricted to hospital settings. Community-Acquired MRSA (CA-MRSA) is a rapidly emerging public health problem in the USA but it is rarely seen in Ireland. It causes pimples and boils and can infect wounds and grazes. A culture (swab) is required to determine the sensitivities of the bacteria and the duration of treatment will depend on severity of illness and clinical response. However the most prevalent form of MRSA seen in Ireland is Hospital-Acquired (HA-MRSA) infection. It thrives in hospitals where people are in close proximity and may have their defences already weakened by illness. Those who have had recent surgery or who are immuno-compromised are also at high risk of infection. The hospital environment also tends to be rife with multi-resistant bacteria as a result of the heavy use of antibiotics. The types of infections seen are wound infections, chest infections, bone infections or bloodstream infections and these have the potential to cause serious illness, or even death. Hospital acquired infections can be very difficult to treat and usually require long-term intra-venous treatment with a combination of antibiotics.

A reduction in antibiotic consumption levels, frequent and proper hand washing, and improved basic hygiene levels in hospitals are all essential to reduce the level of contamination. Hand hygiene is the single most effective defence against the spread of MRSA. This means that staff, patients and visitors alike all have a simple but important role to play in the fight against MRSA.