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

Yellowland

The colour yellow tends to have negative connotations. Traditionally, it’s been associated with cowardice and deceit. In hospitals, the colour yellow is used to indicate an infection control risk. Last week, Steph’s hospital chart was awarded another bright yellow sticker.

Yes, you guessed right… I’m infected with MRSA again! 

I’ve been fighting a constant battle with recurrent infections in my head since Christmas. Antibiotics gave temporary relief but the infection repeatedly recurred, accompanied by nasty headaches. Two weeks ago, I requested a hospital appointment to get nasal swabs taken and analysed. Shortly afterwards, I was informed that I was indeed MRSA positive. The prosthetic implant which was inserted into my nasal septum last November, was thought to be the source of the infection.

Pacemakers, artificial heart valves, catheters and many other surgical implants commonly become contaminated with bacterial biofilms. The longer a contaminated device remains in the body, the greater the risk of antimicrobial resistance developing. As my infection had been confirmed MRSA positive, I was advised to have the implant removed as soon as possible. Following consultation with my surgeon in Notts, the decision was taken to remove the prosthetic implant.

Sign on door to Steph’s room at the hospital

Last Tuesday, I was admitted to hospital as a day case and nursed in isolation while the prosthetic implant was removed under sedation. This involved another trip to the operating theatre but on this occasion, I remained conscious throughout. When you are MRSA positive, you’re last in the line for everything so as to minimise the risk of cross infection.

When the call finally came, I was whisked directly into an operating theatre, transferred onto the operating table and attached to the various monitors before being given intravenous sedation. I expected to be knocked out by the sedation but far from it. I was able to continue a conversation with the surgeon and anaesthetist while the implant was being yanked from my head. It felt a bit like having a wisdom tooth removed except that it was from my nose rather than my jaw. I was then wheeled straight back to my isolation room to sleep off the effects of the sedation before being discharged home.

It was hoped that the prosthetic implant would remain in place for at least two years to maintain healing of my septum. Instead, less than three months later, the implant now sits in a specimen container while I await further assessment. My head feels a great deal more comfortable now that the source of infection has been removed. What happens next, is anyone’s guess.

I may be labelled yellow… but I ain’t no coward. MRSA watch out!

Super Pillow

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

Take the MRSA Test

How much do you know about MRSA?

I challenge you to take the quiz here and test your knowledge of this resistant bacteria.

The quiz only takes a few minutes to complete.

I’d love to hear how you got on.

Source: MedicineNet.com

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!

Checking-In

My bum hadn’t even touched the seat when I heard my name being called out. It seems not everyone was prepared to brave the elements today as there was no queue and I was in and out of the hospital in double quick time. If only the health service worked like this all the time!

I struggled through the slush and biting easterly winds this morning to get to my hospital appointment. Having examined my head endoscopically, my surgeon was pleased to report his findings. While the three-times-daily sinus wash-outs are not a lot of fun, they seem to be doing the trick. There is no evidence of infection in my sinuses at the moment.

We then discussed the recent swab result and it’s consequences for me. As I’m clinically well right now, I do not require antibiotic treatment despite my positive MRSA status. However, should I develop an acute infection, I’ve been instructed to report to A&E as I’m now resistant to so many antibiotics, I can only be treated with hospital-prescribed antibiotics.

I left the hospital with a prescription for an antibiotic nasal ointment which is an effective topical treatment for methicillin-resistant Staphyloccus aureus (MRSA) and also instructions to continue doing the wash-outs.

I’m now officially on holiday from the hospital until after Christmas. Fingers crossed please, this holiday doesn’t get cut short.

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.

No words

I’ll cut to the chase.

I’ve just had a personal call from my surgeon. It’s not good news.

The swab of pus taken last week from the sphenoid sinuses in the centre of my skull, is MRSA positive… here we go again!

No words can adequately describe how I feel right now.

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.

Improving Patient Safety

In recent years a primary concern for patients being admitted to hospital has been the risk of contracting methicillin-resistant Staphylococcus aureus, commonly known as MRSA.

Many cases of MRSA arise from the transfer of germs from patient to patient due to lack of good hygiene. To address this, hospitals have revised their hygiene practice. Measures have included the introduction of hand-sanitising kits and tougher visitor regulations to reduce the risk of infections being brought in from outside. However, the concern over post-operative infections lingers.

The Royal College of Surgeons Ireland (RCSI) is introducing a Surgical Development Initiative for trainee surgeons which will focus on maximising patient safety and preventing infections following surgery. The RCSI initiative is being launched this month to the new group of surgical trainees who commence their basic surgical training in July. It has been developed specifically for trainees to improve practice in the areas of hand hygiene, the optimal use of antimicrobial prophylaxis, the care of wound sites after surgery and the prevention of bloodstream infection that can result from infected intravascular devices.

The RCSI’s new project is in line with the World Health Organisation’s (WHO) recent prioritisation of patient safety, to prevent healthcare-associated infection (HCAI) and its ‘Safe Surgery Saves Lives‘ initiative which is endorsed by RCSI.

In tackling post-operative infections, WHO has recently published it’s WHO Surgical Safety checklist. The 19-point checklist has shown improved compliance with standards and a decrease in complications from surgery in the eight pilot hospitals where it was used for evaluation. It demonstrated a decrease in mortality from 1.5 per cent to 0.8 per cent and a drop in surgical site infection (SSI) rates from 6.2 per cent to 3.4 per cent.

As someone who has battled against serious post-operative infections (MRSA, cellulitis and osteomyelitis), I welcome any initiative which will reduce the risk of surgical site and healthcare-associated infections.

The WHO surgical safety checklist is an essential aide to patient safety. This video demonstrates how the checklist is used at Great Ormond Street Hospital…

Information Source:  The Irish Times