Your friendly local Staph

Transatlantic Spread of the USA300 Clone of MRSA
To the Editor: The emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is of great concern. USA300, the predominant epidemic clone in numerous outbreaks in closed communities in the United States,2 is also increasingly seen in Europe.3 International travel and the increasing trend of training or working abroad among health care workers probably contribute to its global spread. This recent contribution to a magazine shows the deplorable lack of communication in the medical world . In the 1980´s I was urging that swabs be taken of the throats of all medical staff. I then realised that if you excluded the carriers of this lethal disease you would eliminate the majority of staff in the hospitals of the world. It seems that the people who care are the people who (unknowingly) kill!.

MRSA [methicillin resistant staphylococcus aureus]
DRUG RESISTANT germs spreading through Britain's Hospitals are being blamed for the 'for the deaths of dozens of patients Doctors, are, alarmed because, the germ is resistant to virtually all common antibiotics. It has been identified in at least 32 London hospitals, and "outbreaks "have occurred in Nottinghamshire, Yorkshire, and East Anglia." Infected hospitals had to close wards and intensive care units and isolate patients' who are carriers Dr. Richard Smith assistant editor of the "British. Medical Journal said the potential is frightening the Bacteria are' only susceptible to one antibiotic, vancomycin and could eventually become resistant to that too, "
The strain the methicillin resistant staphylococcus aureus, 'bacteria I (MRSA), known, as Super Staph " was First identified in an Essex hospital in 1981. Patients particularly at risk include the, elderly; those with open wounds, and people undergoing transplant, surgery, heart operations and kidney dialysis. Complications caused by the infection are believed to have contributed to, at, least 30 deaths since, April.
Dr Jean Bradley, chairman of working party, examining, the problem in the North East Thames Region said " It, has caused deaths in people who were basically well before they came into hospital. They have had an operation and died from the infection. The germ, which usually lives harmlessly or up the nose, is easily spread from patient to patient on the hands of medical or nursing staff
Although it is the same bacteria that often causes wounds to become infected, the dangerous, antibiotic resistant strain can lead to fatal blood poisoning as it fails to respond to ordinary treatment Scientists have' been warning for decades that over use of antibiotics could lead, to the emergence of resistant strains
A similar epidemic has been wreaking havoc in hospitals in Eastern Australia since the late, 1970s and has caused the deaths of hundreds of patients. One new London hospital the Homerton in Hackney was' forced to set aside an entire ward for MRSA infected when it opened in July.
Dr. Ken Grant district general manager for the City and. Hackney Health Authority said there was a significant increase in the number of people identified as carriers in. June and July
. We have been screening patients as they come in and, put carriers in a separate ward in the hope of 'eradicating. the infection. Staff with. the bacteria have, been I given anti microbial shampoo and nasal spray' " Basically problems arise when: staff and patients move from one hospital to another.
Virtually all the major London hospitals have. 'been 'affected, greatly adding to the cost of treatment. Guidelines for the control of outbreak have been. drawn ' up, by a working party of the Hospital Infection Society and the British Society for. Antimicrobial, Chemotherapy. Its report warns:' Effective' treatment of, serious infections has often proved difficult. The antimicrobial agents available are, often potentially. toxic, limited in number, difficult to administer and expensive. Isolation facilities are essential 'once an outbreak, ha& occurred.' The cost of an epidemic of MRSA is high. and the onus should be on prevention rather than cure.
Dr Paul Noone, consultant microbiologist at, the Royal. Free Hospital, North London,” said: "Hand washing' is, probably ably the single most important step to take. But nurses have to work under intense pressure because of the cuts. Where people are overworked, these hygiene measures tend to go. . The germ flourishes in hospitals because of the widespread use of antibiotics, which kill' competing bacteria and allow MRSA to, get a foothold.
. Experts have: blamed the indiscriminate use of antibiotics for the, emergence, of resistant. strains of bacteria, a phenomenon„ first noticed. In the 1950s when some types of infection that could no longer be treated" with penicillin were, identified.
There are a number of different strains of. Super Staph and all are vulnerable to treatment with vancomycin. Although other rarely used antibiotics can kill individual strains; treatment depends on rapid identification but doctors warn that all the remaining treatments are expensive and potentially toxic. They fear that if the bacteria also become resistant to vancomycm, medicine could be put back 50 years to the days when even minor infections could kill.
. Dr Ken Harvey, director of. Microbiology at the Royal Melbourne Hospital in Australia, where a particularly virulent strain of MRSA bacteria swept through the wards, said recently: 'We may, look back at the antibiotic era as just a passing. phase in the history of medicine, an era in which a great, natural resource was squandered and where the bugs proved smarter than the scientists
He is especially critical of 'doctors who constantly use broad-spectrum antibiotics an indiscriminate drug which kills a wide range of bugs in circumstances where they are unnecessary. " Broad spectrum, antibiotics are the refuge of the diagnostically 'destitute". he said.
The British Medical Journal is shortly to publish advice to GPs and hospitals on the best, way to control outbreaks of MRSA.