Yourlawyer.com (Hospital Infections News)

Midwest States Have Highest Performing Hospitals

Wed, 15 Oct 2008 00:00:00 -0700

A new study about hospital performance revealed that if all hospitals performed as well as the best performing facilities, that 237,420 U.S. Medicare deaths could have been prevented in the years between 2005 and 2007.

The rankings, which were conducted by HealthGrades, an independent healthcare ratings company, found that the best performing facilities are located in the Midwest. The new study also found that any given patient experiences a 70 percent lower chance of dying at one of the top-ranked facilities in comparison to those appearing in the lowest-ranking segments. The rankings looked at 17 procedures and conditions that prompted hospital visits. Also, the study found that over half of all Medicare patient deaths reviewed were linked to four conditions: Sepsis, with is a systemic response to infection; pneumonia; heart failure; and respiratory failure. HealthGrades announced it is releasing its 11th annual hospital quality survey today.

This is not the first time researchers have reviewed the ways in which a hospital can kill a patient with blame being focused on everything from exhausted doctors and staff to antibiotic-resistant microbes. The study did release some good news and reported that the nation’s in-hospital risk-adjusted mortality rate improved and is at 14.2 percent on average from 2005 to 2007. Also, the nation's best-performing hospitals saw a reduction in their death rates at a much faster rate than poorly performing hospitals.

Some demographics emerged out of the study. For instance, the region with the lowest overall risk-adjusted mortality rates was the East North Central region, which is comprised of Illinois, Indiana, Michigan, Ohio, and Wisconsin. The East South Central region—comprised of Alabama, Kentucky, Mississippi, and Tennessee—saw the highest mortality, or death, rates.

A separate report released earlier this month by a different group, noted that the South is the worst place to live if seriously ill. That study and report focused on palliative care, which is an emerging specialty focusing on patients' quality-of-life rather than “elusive cures” for diseases. The best palliative care is offered in Vermont, Montana, and New Hampshire.

Meanwhile, in August we reported that hospitals in 23 states would no longer bill patients for very serious medical mistakes such as operating on the wrong body part or wrong person, or giving a patient the wrong blood. The list of such medical errors has doubled since February, in part over an MSNBC.com analysis that revealed that hospital associations in 11 states urged their members to waive payment for errors called “never events,” so named because they should never happen at all. It remains unclear how many private patients and insurers are being billed for medical mistakes; however, a July study conducted by the federal Agency for Healthcare Research and Quality estimated that preventable errors occurring during or after surgery may cost employers nearly $1.5 billion annually. Effective October 1, Medicare is no longer reimbursing hospitals for the extra costs of treating certain injuries, infections, and complications occurring post-admission. Non-payment policies are in place in Massachusetts, New York, and Pennsylvania; Cigna, Aetna, and Blue Cross Blue Shield will no longer pay for serious, preventable mistakes.

Viral Infection at Stony Brook University Medical Center Prompts Hundreds of Warning Letters

Wed, 06 Aug 2008 00:00:00 -0700

Over 400 patients recently treated at the Stony Brook University Medical Center have received a letter of caution from the hospital's director of quality control. It seems two health care providers who work at the Long Island facility were sickened with a viral illness.

A physician, only identified as a medical resident, as well as a nurse both recently came down with a virus named Fifth Disease, which is caused by Human Parvovirus B-19. The condition's name originates from being the fifth disease in a line of inevitable childhood rash-producing disorders: Measles, Rubella, Scarlet Fever, and Duke's, which is also referred to as Fourth Disease.

Dr. William H. Greene, chief quality officer for the Stony Brook University Medical Center, located in Stony Brook, New York, said 480 letters were sent to affected patients by overnight mail last Friday. Potentially affected patients were those who were in the labor and delivery area of the hospital or in the maternal-fetal clinic in the five-week period between June 26 and July 28. "We're trying to be as cautious and as transparent as possible," Greene said. "The best medicine is communication and information. That's why we're so proactive in trying to let people know, even though we believe the risk of transmission is low."

Most people catch the infection as children, Greene explained, noting that Human Parvovirus B-19 is contagious prior to the appearance of a "slapped face rash," characteristic of Fifth Disease and so named because a bright red rash appears that looks as if the patient was slapped. A lacy red rash on the trunk and limbs is also common and sometimes the rashes may itch. Fifth Disease can be accompanied by a low-grade fever, malaise, or the feeling of having a cold a few days prior to the rash, which resolves in about seven to 10 days. While there have been no other reports of illness, it remains unclear how the two workers became infected.

The hospital set up a hotline for those patients who received letters to discuss Parvovirus B-19 and Fifth disease with a medical professional. Memos have also been sent to Stony Brook staff members who may have had contact with the two infected providers during the dates. Dr. Jane Seward, deputy director of viral diseases at the Centers for Disease Control and Prevention (CDC), said Fifth Disease is "not a nationally notifiable disease,” so the government does not keep official tallies. "It's likely many hundreds of thousands of cases occur every year," she said, adding that the infection may be asymptomatic and produce no symptoms.  Seward said Human Parvovirus B-19 is not related to the parvoviruses that affect animals.

Adults with no immunity can be infected with Human Parvovirus B19 and can have no symptoms or can develop the typical rash of Fifth Disease, as well as joint pain or swelling, or both. Usually, joints on both sides of the body are affected with hand, wrist, and knee joints most affected. Joint pain and swelling usually resolves in a week or two, but can last several months.

NY Hospitals Urged to Adopt Aggressive Anti-Infection Protocols

Wed, 09 Jul 2008 00:00:00 -0700

New York’s state Department of Health just a released a report revealing that the rate of hospital infection in surgical intensive care units (ICUs) linked to central line intravenous hookups was 3.7 for each 1,000 days that patients had such a hookup. The 2007 national rate was 2.7 infections for each 1,000 days, showing that NY patients had a 37% greater chance of infection over the national average. A central line is a tube into a major vein that allows doctors to administer medication or monitor patient condition.

The infection data, which did not include hospital-specific information, was publicized in compliance with a 2005 law requiring NY to track infection trends. Next year, health officials are expected to publicize infection rates by facility; however, in September, the Health and Hospitals Corporation (HHC) began publicizing infection and death rates at its 11 hospitals. "The only acceptable infection rate is zero, so hospitals that settle for being below average are dangerous places to be," said Betsy McCaughey, founder of the Committee to Reduce Infection Deaths,

State health officials said they could not explain the disparity between infection rates in New York and nationwide, however, they said NY City’s rate of central line-associated infections was lower than that in upstate hospitals, and that upstate infection rates raised the statewide average. In New York City, 2.8 of 1,000 central lines in medical ICUs resulted in infections, compared to 3.6 upstate; 2.7 of 1,000 central lines in surgical ICUs resulted in infection versus 4.8 upstate.

McCaughey criticized the state for leaving infections off a list of preventable hospital errors that the state's Medicaid program will no longer pay for effective October 2008 and compared the state policy unfavorably to a federal policy announced last summer by the Center for Medicare and Medicaid Services, which will not reimburse hospitals for infections and other preventable hospital errors. "Medicaid has a responsibility to use its purchasing power to pressure hospitals to eliminate infections," McCaughey said. "New York taxpayers should not be paying to treat infections that shouldn't happen." Meanwhile, a nonpartisan congressional report released in April stated that the U.S. government could do more to force hospitals to prevent infections that are killing up to 99,000 people annually.

Claudia Hutton, a spokeswoman for the state's health department said the new Medicaid policy does not include infections in the list of errors it would not pay for because that initiative was concentrated on the types of things that "never, ever should happen," such as operating on the wrong patient or on the wrong body part. "Infections you want never to happen, but infections, there's a more likely risk that they can happen," she said.

Last year alone, 94,000 Americans developed MRSA—methicillin-resistant S. aureus; most were infected in healthcare facilities and 19,000 died. The Centers for Disease Control (CDC) says drug-resistant infections in hospitals must be fought with multiple strategies: Better hospital hygiene, enhanced cleaning, and testing.

Antibacterial Wipes May Be Spreading Super Bugs in Hospitals

Wed, 04 Jun 2008 00:00:00 -0700

Today, disinfecting wipes and alcohol-based hand gels are widely used in hospitals, schools, and other public settings to kill the germs that cause infectious disease. And, it is estimated that Americans spend a staggering $1 billion annually on these and other antibacterial products; however, with the rise in deadly antibiotic-resistant superbugs, their direct impact on the spread of infectious disease is not clearly understood.

In a study that focused only on the wipes, researchers found that instead of preventing hospital-acquired infections like the mutated form of staph infection called methicillin-resistant Staphylococcus aureus (MRSA), the wipes could actually be spreading bacteria when used improperly by hospital staffers.

About 100,000 cases of invasive MRSA occur annually in the United States according to the US Centers for Disease Control and Prevention (CDC) and, shockingly, most of these infections occur in hospitals and other health-care settings. According to research earlier this year conducted at McGill University Health Center, Montreal, Canada, over 20 percent of its MRSA patients were dead within one year. MRSA, is now considered even more dangerous than previously believed and, once seen chiefly in hospitals, MRSA is now striking healthy people outside of hospitals and nursing homes and has emerged as a community-based—as opposed to hospital-derived—disease.

Disinfectant wipes are among the most common products used in such healthcare facilities in the prevention of the spread of MRSA and other infectious pathogens. In a study presented today in Boston at the annual meeting of the American Society for Microbiology, researchers from Cardiff University's Welsh School of Pharmacy reported that when used improperly, antibacterial wipes may spread bacteria rather than remove or kill them. Researchers Jean-Yves Maillard, PhD, Gareth Williams, PhD, and colleagues observed hospital staffers using the wipes to disinfect hospital rooms. "We saw that there was a tendency to use one wipe on consecutive surfaces, such as bed rails, computer monitors, and keyboards," Williams said.

The researchers used the wipes in this way in laboratory tests designed to measure their ability to remove and kill the bacteria that cause staph infections, including MRSA. While most wipes tested did remove large numbers of bacteria from contaminated surfaces, they also transferred live bacteria to uncontaminated surfaces when used in more than one place. Some wipes that claimed to kill bacteria were found to transfer live bacteria from one surface to another, the researchers report. "The message is that they have to be used properly," Williams says. That means using one swipe per wipe on a single surface, Maillard adds.

According to 2005 CDC figures, nearly 19,000 people died in the U.S. from MRSA infections; 94,000 were seriously sickened. Of 19,000 patients studied in 2005, 2,000 were healthy people contracting community-based MRSA. In Canada, about 220,000 people are sickened; an additional 8,000 to 12,000 die annually. Also, well-known but not widely publicized, patients surviving MRSA often require amputations to cure infections. "Our study suggests that MRSA can be a potentially serious infection in the community leading to increased mortality," the investigators concluded, adding that the "judicious use of antibiotics is essential to prevent these quite deadly community-acquired MRSA infections," given the emergence of antibiotic resistance when antibiotics are used indiscriminately.

C. Diff Cases Up by 10,000 Per Year

Thu, 29 May 2008 00:00:00 -0700

Last month, we reported that cases of potentially deadly diarrhea-related infections—known as CDAD or Clostridium difficile-associated disease—are seriously and dangerously on the rise, increasing in U.S. hospitals by over 200 percent between 2000 and 2005. “It is the next major germ threat,” said Betsy McCaughey, the former lieutenant governor of New York state and current head of the Committee to Reduce Infection Deaths (RID), an agency focused on improving infection control in hospitals and health care settings. This incredible spike has experts worried. Now, a recent study reveals that the number of people hospitalized with a C. diff super bug is growing by over 10,000 cases annually.

C. diff is a spore-forming, toxin-producing bacterium that infectious disease experts say is growing in speed and virulence similar to methicillin-resistant Staphylococcus aureus—MRSA—and is moving from within hospitals to the community at large. MRSA sickened over 94,000 and caused nearly 19,000 deaths in the U.S. in 2005. Like MRSA, C. diff has become multi-drug-resistant. C. diff is now crippling the healthy, has become antibiotic resistant, is a regular threat in healthcare facilities, and has been linked to nearly 300,000 hospitalizations in 2005, more than double the number in 2000.

C. diff is part of the natural flora, or bacteria, in the colon and is an ancient bacterium. Many people can, and do, carry it naturally and it can live in us without causing disease; carrying C. diff does not mean we have an infection. As a matter-of-fact, it is common in our bodies following birth. The problem arises because what we don't have is the receptor for the toxin—the molecular key that unlocks C. diff's toxin-spewing capacity. Newer, mutant C. diff is fully equipped with the receptor and is capable of boosting toxin amounts causing infections ranging from mild diarrhea to a deadly illness wherein a patient’s entire colon is removed and sometimes leading to death. Because C-diff has grown resistant to some antibiotics that work against other colon bacteria, when patients take those antibiotics, competing bacteria die and C-diff rages and spreads in the body. 

Virulent C-diff was rarely seen before 2000.  "The nature of this infection is changing. It's more severe," said Dr. L. Clifford McDonald, a Centers for Disease Control and Prevention (CDC) expert not part of the study. "There may be some overuse and inappropriate use of antibiotics," said Dr. Marya Zilberberg, a University of Massachusetts researcher and lead study author. Worse, the new C. diff—The North American Phenotype 1/027—is thought to be about 20 times more toxic than previous strains and has been responsible for deadly outbreaks in Europe, Canada, and the U.S. in recent years; New York is one of 23 states the CDC has identified as having the highly toxic, mutant strain.

The Zilberberg study concluded that 2.3 percent—or 5,500—cases in 2004 were fatal, nearly double the 2000 figures; earlier research concluded C. diff is the underlying cause of thousands of deaths annually. C. diff is an acute health concern in Canada, where it was blamed for 260 deaths at seven Ontario hospitals recently and 2,000 deaths in Quebec since 2002.

C-Diff Threatens More Hospital Patients

Thu, 24 Apr 2008 00:00:00 -0700

Cases of potentially deadly diarrhea-related infections—known as CDAD—are on the rise, increasing in U.S. hospitals by over 200 percent between 2000 and 2005. According to a new report by the federal Agency for Healthcare Research and Quality, 300,000 people contracted Clostridium difficile-associated disease (CDAD) and 8,600 died in 2005. Also, there was a 74 percent rise in CDAD cases recorded between 1993 and 2000 and over two million patients contracted CDAD between 1993 and 2005. “It is the next major germ threat,” said Betsy McCaughey, the former lieutenant governor of New York state and current head of the Committee to Reduce Infection Deaths (RID), an agency that focuses on improving infection control in hospitals and health care settings. This incredible spike has experts worried.

C. diff—or clostridium difficile—is a spore-forming, toxin-producing bacterium that infectious disease experts say is growing in speed and virulence similar to methicillin-resistant Staphylococcus aureus—MRSA—and is moving from within hospitals to the community at large. MRSA sickened over 94,000 and caused nearly 19,000 deaths in the U.S. in 2005. Like MRSA, C. diff has become multi-drug-resistant. Only previously affecting the elderly, hospitalized patient, a bolder strain of C. diff is now crippling the healthy.

C. diff is part of the natural flora, or bacteria, in the colon and is an ancient bacterium. Many people can, and do, carry it naturally and it can live in us without causing disease. Carrying C. diff does not mean we have an infection. As a matter-of-fact, it is common in our bodies following birth. The problem arises because what we don't have is the receptor for the toxin—the molecular key that unlocks C. diff's toxin-spewing capacity. Newer, mutant C. diff is fully equipped with the receptor and is capable of boosting toxin amounts, making C. diff lethal. C. diff can cause infections ranging from mild diarrhea to a deadly illness wherein a patient’s entire colon is removed.

C. diff produces hardy spores that can remain on surfaces—bedpans, toilet seats, floors—for weeks. “It’s on every surface,” McCaughey said. “They get the spores on their hands and their food arrives and they ingest the spores with their dinner rolls.” Alcohol does not work; only bleach can kill the spores.

Worse, there is a new, more virulent strain of C. diff thought to be about 20 times more toxic than previously known strains. The North American Phenotype 1/027 strain has been responsible for deadly outbreaks in Europe, Canada, and the U.S. in recent years and New York is one of 23 states the Centers for Disease Control and Prevention (CDC) has identified as having the highly toxic, mutant strain.

CDAD can be resistant to many traditional antibiotics, forcing use of the stronger vancomycin, but some infections are vancomycin-resistant, making them difficult or impossible to cure. The best treatment is prevention, McCaughey said. Hospitals must improve their hygiene practices and patients must be vigilant about not touching surfaces and keeping their hands out of their mouths. “This is a killer bacterium and we can’t be lazy about it,” she said.

More Action Needed on Hospital Infections

Thu, 17 Apr 2008 00:00:00 -0700

A nonpartisan congressional report released this week states that the U.S. government could do more to force hospitals to prevent infections that are killing up to 99,000 people annually. As part of the report’s recommendations, regulators could consider mandating certain core standards, such as hand washing, for which the government could tie reimbursements. It is believed that by setting priorities for those measures which work best, some of the $5 billion in extra costs resulting from hospital infections could be stayed, the Government Accountability Office report said.

The report criticized the U.S. Department of Health and Human Services (HHS) for not coordinating data across agencies and not requiring hospitals to apply recommended practices. "HHS is not exploiting its leverage to reduce or eliminate hospital acquired infections," Cynthia Bascetta, director for health issues at the Government Accountability Office told a U.S. House of Representative committee hearing on Wednesday. "We concluded that leadership from the secretary is required." Experts feel mandating proven practices would be relatively inexpensive; however, health care practitioners would need payment incentives and guidance from regulators and accrediting agencies on the best practices. Meanwhile, Medicare, just expanded the list of hospital-acquired conditions for which it would cut funding. Medicare, the state-federal health insurance plan, spends almost $400 billion on care for about 44 million elderly and disabled people.

Don Wright, a public health official at HHS, acknowledged efforts are needed to improve coordination among agencies saying, "HHS recognizes more work and leadership is necessary to enhance patient safety in this regard.” According to experts, U.S. health care system providers tend to be paid on a fee-for-service basis, which, by its very nature, rewards excess care. "Unfortunately in some ways we get what we pay for," Leah Binder, the chief executive at the Leapfrog Group, a nonprofit that represents employers. "We pay the same even when errors occur that jeopardize a patient's health or life; indeed we pay more for poor performance," said Binder, a former hospital executive.

Peter Pronovost, head of the Quality and Safety Research Group at Johns Hopkins University, told the panel that another problem is the ongoing concern with “trendy” new drugs and technologies and not infection prevention and correct patient care. For instance, last year alone, 94,000 Americans developed MRSA—methicillin-resistant S. aureus; most were infected in healthcare facilities and 19,000 died. The Centers for Disease Control (CDC) says drug-resistant infections in hospitals must be fought with multiple strategies: Better hospital hygiene, enhanced cleaning, and testing. A handful of U.S. hospitals routinely screen and test for MRSA and have found it to be very effective, with one study showing a 50-percent infection reduction. Three states and the Veterans Administration have also ordered MRSA screenings. But the CDC says that testing alone is not sufficient and will not order screenings. The overarching feeling is that the CDC is discounting significant and growing evidence indicating that aggressive hospital testing could significantly cut down the spread of hospital-generated MRSA. Given that the epidemic started with hospital-generated MRSA and with nearly 100,000 MRSA cases last year—20% ending in death—this seems a legitimate course of action.

Hand Gel Sanitizers Not Much Help in Hospitals

Wed, 30 Jan 2008 00:00:00 -0800

A study of sanitizing hand gels that have become popular with doctors and nurses turned up interesting results. The Nebraska Medical Center’s found alcohol-based hand gels do not offer sufficient protection in killing germs and slowing the spread of hospital acquired infections.

Doctors and nurses will often skip soap and water in favor of hand gel believing that gels work quicker and better on killing bacteria than traditional soap and water; however, hand gels In the Nebraska Medical Center, medical workers nearly doubled their use of the alcohol-based gel but doing so had no impact in decreasing the rate of hospital acquired infections among patients. Dr. Mark Rupp, the doctor who let the study, pointed to a variety of issues, including rings and fingernails that are too long and hard to clean, poor catheter handling, and treatment areas that had not been sanitized. "Hand hygiene is still important, but it's not a panacea," said Rupp, an infectious disease specialist at the University of Nebraska Medical Center.

Rupp’s study contradicts the Centers for Disease Control and Prevention (CDC) hospital guidelines that say better hand hygiene—whether by frequent washing or use of sanitizing gels—has been shown to cut the spread of hospital infections, a growing problem in the U.S. The spread of infection-causing germs in U.S. hospitals is responsible for an estimated 1.7 million infections and 99,000 deaths annually, according to the CDC and include drug-resistant staph, urinary tract infections, and ventilator-related pneumonia, among others. "There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem," Rupp said. Rupp’s study appears in the January issue of Infection Control and Hospital Epidemiology.

Some research has shown that alcohol-based hand gels are more effective, faster, and easier to use than soap and water. The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.   More gel dispensers were placed in the ICUs; usage rose from 37 percent to 68 percent in one unit and 38 percent to 69 percent in the other. Compliance for hospital hand washing is estimated to be about 40 percent. Every two months, bacteria samples were taken from health workers' hands, which were found to be cleaner when using gels. Infection rates in both ICUs were relatively low, according to the study and researchers found no significant relationship between hand gel use and infections among patients. In fact, in one unit, the infection rate rose when hand gel was widely available and its use promoted.

Rupp said hospital-borne infections cannot be stopped by better hand hygiene alone since infections are not limited to person-to-person contact and suggests hand gels be combined with other measures, such as better cleaning of hospital units, proper insertion and maintenance of catheters, and antibiotic use only when necessary to help curb the incidence of drug-resistant bacteria and super bugs. Rupp suggested workers not wear rings and trim nails more than CDC recommendations; bacteria are present when the nail only extends just beyond the fingertip.

Hospital Acquired Infections Linked to Catheters

Tue, 08 Jan 2008 00:00:00 -0800

Hospital acquired infections are being caused at an alarming rate by lax catheter policies. The situation is so serious, that apparently, one of the best ways to get an infection in the hospital is to have a urinary catheter installed. Astoundingly, nearly half of all hospital acquired infections are in the urinary tract and most of these are linked to catheters. Yet, despite the well-established danger and prevalence—and even though hospitals nationwide are being pressured to reduce infection rates—a new study finds that they are doing very little to reduce infection risks from catheters. The report, which is to appear in the January 15th issue of Clinical Infectious Diseases, says that even the most basic steps to make catheters safer—such as tracking those patients fixed with them—are often not taken. Dr. Sanjay Saint of the Veterans Affairs Ann Arbor Healthcare System and the University of Michigan led the study.

The research team surveyed hundreds of hospitals nationwide regarding their catheter policies and found that over half had no system for monitoring which patients had catheters; even more did track for how long catheters remained in the patients. There was also insufficient use of those types of catheters that are less likely to cause infection and of portable bladder-scanning devices that confirm for doctors whether or not a patient really needs to be fitted with a catheter. Most hospitals did not even have a system to remind their staff that a patient has a catheter in his/her body, the study found. “Despite reasonable evidence supporting the use of urinary catheter reminders,” the researchers wrote, “fewer than one in 10 hospitals in this country used this simple and economically attractive method for preventing unnecessary catheterization.”

Developing infections in hospitals is not new in this country. In 2006, 94,000 Americans developed MRSA with most of them infected in healthcare facilities. Recent deaths included five school children, players from four NFL teams, and some NYC firefighters. Center of Disease Control estimates place the 2006 MRSA death toll at 19,000 Americans.

But infections are not the only hospital risk reported in recent days. A study published last week revealed that nearly one-third of all patients experiencing misfiring or quivering hearts in U.S. hospitals do not receive life-saving defibrillator shocks within the critical first two minutes of cardiac arrest. This, despite the fact that The American Heart Association recommends that stopped hearts be shocked within the first two minutes. The study confirming the importance of the two-minute period for survival was published in the New England Journal of Medicine, which also ran an accompanying editorial piece indicating a person might be better off suffering cardiac arrest in a casino rather than a hospital. Researchers from 369 hospitals in the National Registry of Cardiopulmonary Resuscitation found that being black or having a cardiac arrest outside of regular weekday working hours also significantly delayed the time it took for hospital workers to shock the heart. "We now have to develop systems of care within the hospital to improve defibrillation times nationally," said Paul Chan of the Mid-America Heart Institute in Kansas City, Missouri, who led the study in the New England Journal of Medicine.

7 children are infected by bacterium at L.A. hospital

Sat, 16 Dec 2006 00:00:00 -0800

White Memorial Medical Center near downtown Los Angeles has closed its neonatal and pediatric intensive care units to new admissions after seven children became infected with a virulent bacterium, including one baby who probably died as a result, hospital officials said Friday.

The Boyle Heights hospital shut its busy neonatal unit Dec. 4 after identifying an outbreak of Pseudomonas aeruginosa, which is believed to have infected five babies.

Then Friday, White Memorial closed its high-level pediatric unit after learning that two older children were infected with the bacterium. Dr. Rosalio Lopez, the hospital's chief medical officer, said he is unsure if the new cases are linked to the outbreak among babies.

Neither unit will be reopened until "we believe it is safe for the patients to be admitted," Lopez said, adding that other parts of the hospital are not affected.

White Memorial officials said they believe that the most likely cause of the outbreak is improper cleaning of a laryngoscope blade, a piece of equipment used to insert breathing tubes. They are working with local, state and federal health investigators to conclusively determine the source.

Lopez said the hospital has tightened its infection control practices, notified the families of patients in the affected units and given antibiotics to all babies remaining in the neonatal unit as a precaution.

"Our first priority is to continue to work with the families affected in this situation," Lopez said. "We're totally committed to providing our patients safe care."

Any critically ill babies born at the hospital now are being taken to a special isolation area to be stabilized before being transferred to other hospitals. High-risk pregnant women are also being advised to consult with their doctors to determine if they should go to White Memorial or another hospital.

About 90% of the hospital's patients are Latino.

'Being extremely cautious'

Los Angeles County public health officials say that their investigation is ongoing and that the number of infected patients may change as test results come in.

"They are being extremely cautious," Dr. Laurene Mascola, chief of the county's acute communicable disease control unit, said of the hospital.

P. aeruginosa is a common bacterium found in water and soil and can be spread through body contact, fluids and water. In most people, it is not deadly or even dangerous, because their immune systems can ward off infection.

But that is not the case in patients with weakened immune systems, such as premature babies, patients with cancer or AIDS and those on breathing machines.

In such situations, the bacterium can cause a variety of infections depending on where it enters the body. These include respiratory, urinary tract and blood infections.

It can spread rapidly and, in some cases, be unstoppable.

Babies in the neonatal unit are especially at risk for infections, because they are often connected to ventilators, tubes, monitors and other equipment that give bacteria an easy pathway to the body.

"It's a group of patients that are very vulnerable," said Dr. Arjun Srinivasan, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention. "They're very sick, so they are at risk of these infections. The care that's delivered for them is very complicated."

The bacterium is particularly deadly for extremely premature and underweight infants, said Dr. Leandro Cordero, director of the newborn intensive care unit at Ohio State University Medical Center. His hospital had an outbreak a decade ago that sickened about 10 infants, most of whom died.

Babies born before 27 weeks of gestation and weighing less than 2 pounds already have a 40% to 50% chance of dying from other causes, Cordero said. But that mortality rate can rise to 70% to 80% with a P. aeruginosa infection, he said.

Experts said doctors face a Catch-22 with these tiny patients. They can't live without medical interventions, but such steps can increase their risks of other problems.

"Those infants have no chance at survival without all the types of invasive devices that they have," said Dr. William Jarvis, an expert in hospital infections who previously worked at the CDC. "But those devices obviously place those patients at risk, because they are bypassing the normal body defense mechanisms."

The bacterium is hardy and like the more familiar Staphylococcus aureus, or staph can develop resistance to common antibiotics. Experts recommend that infected patients be isolated from others and that units known to harbor the bacterium receive deep cleanings.

Since Nov. 30, 33 patients have been treated in White Memorial's neonatal unit. Of the five babies who were infected, three died, Lopez said, but only one death appears to have been caused by the infection. Eighteen babies showed no signs of the bacterium. The remaining 10 had colonies of P. aeruginosa in their noses or rectums but no signs of infection.

Thirteen babies remain in the neonatal intensive care unit, Lopez said. The 28-bed unit is in a specialty care tower that opened in April.

Hospital officials said they are seeking outside reviews of all deaths in the neonatal unit since Nov. 30.

Other such outbreaks

Several outbreaks of P. aeruginosa have been identified previously in neonatal nurseries around the country.

From 1997 to 1998, 16 newborns died at Children's Hospital of Oklahoma. An investigation found that the bacterium had been found under the fingernails of two nurses, although researchers said they were unsure if that was the mode of infection.

In 1997, Children's Hospital Boston had to close its neonatal unit after four newborns died from P. aeruginosa infections.

After a 1999 P. aeruginosa outbreak in which five infants were sickened and one of them died, Prince George's Hospital Center in Maryland hired a full-time technician just to clean equipment in the neonatal unit. It has not seen an outbreak since, said Abdul Zafar, director of infection control for the system that runs the hospital.

Mascola of L.A. County said her agency did not release information on the outbreak at White Memorial before the hospital came forward Friday, because there was no risk of harm to the general public.

"We don't go public with any outbreak unless its something that the public needs to know about that's going to affect their health," she said.

According to the CDC, about 2 million patients suffer hospital-acquired infections annually, accounting for 90,000 deaths and $4.5 billion in healthcare costs.

C. difficile outbreak linked to nine hospital deaths

Sun, 29 Oct 2006 00:00:00 -0700

Public health authorities have yet to contain an outbreak of C. difficile-related diarrhea in a St. Hyacinthe hospital that has been linked to the deaths of nine patients since July.

At present, 22 patients most of them elderly are still sick with Clostridium difficile-associated disease at the Centre hospitalier Honore Mercier. The superbug is suspected to be lurking on five floors of the building, despite the fact housekeeping staff have twice washed down patient rooms with bleach.

The outbreak is baffling authorities because it comes as rates of C. difficile infections have been declining across Quebec, especially in the Montreal region.

Quebec's top public health officer, as well as a leading expert on C. difficile, dismissed claims yesterday by the hospital that an entirely new, hypervirulent strain has emerged in St. Hyacinthe, about 65 kilometres east of Montreal.

Rather, a lack of infection-control measures is probably to blame, suggested Mark Miller, head of a national surveillance group on C. difficile for the Public Health Agency of Canada. Miller said the hospital has probably been hit with a strain called NAP1/027 the same one that has circulated in Quebec since 2004.

That strain is 20 times more toxic than older strains of C. difficile and has directly or indirectly caused the deaths of 2,000 Quebecers.

"With the strain we have here in Quebec, there's no room for errors and no room for being lax," Miller said.

"You have to have excellent infection control all the time. You have to have great housekeeping all the time. If you become lax, the hospitals have shown that this strain causes outbreaks."

The infections started occurring in the 202-bed hospital on July 23 a couple of months after extensive renovations were undertaken to eliminate a fungus that was discovered in the walls.

Ghislaine Archambault, the hospital's communications director, said workers are in the process of disinfecting half the building. What's more, visits have been limited to one person per patient and children under 2 are not allowed in the hospital. Visitors are also advised to wash their hands before entering the hospital and after seeing patients.

"We want to ask the public to help us," Archambault said.

"We'll get through this."

Patients who are sick with C. difficile are being isolated. Certain pieces of equipment have been sterilized, curtains have been replaced and furniture is not being moved around.

Archambault said the hospital has faced two outbreaks the first in August and the second in recent weeks. Housekeeping staff scoured the hospital after the first outbreak.

Proper sanitation is good but is not enough, Miller said. Early diagnosis and treatment of C. difficile diarrhea must be made, and patients must be isolated without delay, he added. If those measures are not carried out immediately, an outbreak will occur, he said.

Across the province, the rate of C. difficile infections in large hospitals was eight per 1,000 admissions last month. That's down from a province-wide rate of 24 at the height of the epidemic in 2004.

At Montreal's Jewish General Hospital where Miller works as chief of infectious diseases the rate of infection dropped last month to its lowest level in 13 years.

For smaller hospitals, the average rate last month was four C. difficile cases per 1,000 admissions.

"It continues to improve every month," Miller said, the exception being St. Hyacinthe.

Horacio Arruda, provincial director of public health, said he doubts Honore Mercier has been beset by a new strain.

"It's clear that if you don't react fast to an outbreak, you'll get more cases," he said, adding he's satisfied with the hospital's measures.

"If you look at hospitals in Quebec, there are some that have seen increases and others that have seen decreases," said Jacques Bisson, of the Association to Defend Victims of Nosocomial Infections. "It all depends on how a hospital manages the problem of nosocomial infections and how they keep up with proper hygiene and prevention."

The provincial government is monitoring the situation at the hospital, said Isabelle Merizzi, an aide to Health Minister Philippe Couillard. "We have confidence in the rapid response by the hospital," Merizzi said.

It's doubtful the C. difficile bacterium was a direct cause of death in all nine patients at the hospital. Some of the patients were suffering from multiple illnesses, Archambault said, and C. difficile was a contributing factor in their deaths.

After initially playing down the C. difficile epidemic, the provincial government last year invested $25 million to fight hospital-acquired infections.

Similarly virulent strains of C. difficile have caused outbreaks in four U.S. states as well as in Britain and the Netherlands.

Study: Hospital staffs have poor hygiene

Sat, 21 Oct 2006 00:00:00 -0700

A new study suggests most hospital-acquired infections are the result of poor hospital procedures and are not caused by patient maladies.

The study by the Bethesda, Md.-based, American Journal of Medical Quality blames poor hygienic procedures by hospital staff members for the growing number of infections that afflict patients nationwide and cause thousands of deaths each year, The Washington Post reported.

"It's the process, not the patients," said David Nash, the journal's editor and chairman of the Department of Health Policy at Thomas Jefferson University in Philadelphia.

Nash said physicians, nurses and other healthcare professionals should do more to promote hand washing, take greater care in donning gowns and other infection-preventing clothing and use antibiotics more selectively.

And, Nash told the Post, patients should speak up more, even asking doctors and nurses, "Did you wash your hands?" before allowing themselves to be treated.

Staph Infection Warning Issued by Metro Health

Wed, 23 Aug 2006 00:00:00 -0700

A staph infection is spreading in San Antonio and the Metropolitan Health Department wants parents to be on the lookout for it, especially since kids are back in school. But this is a warning for everybody.

It's not a pretty sight. It is a staph infection that can spread throughout your body in a matter of days.

It may start out looking like a minor skin problem.

"It can look like a spider bite" says Dr. Bryan Alsip, chief of Clinical Services for the San Antonio Metropolitan Health Department. "Sometimes even a mosquito bite or even a small cut that looks like it's infected."

It is called Methicillin Resistant Staph Aureus, or M.R.S.A.

Doctors say this type of staph is resistant to certain antibiotics, making it harder to treat.

It can easily spread between student athletes or kids on a school playground, where there is skin to skin contact.

"Anytime you bring people together in large groups, you're more likely to get infections and M.R.S.A. is certainly one of those," adds Dr. Alsip.

Since the beginning of the month, there have been more than 500 cases of M.R.S.A. reported at the eight Texas Med Clinics around San Antonio.

"M.R.S.A. is becoming more common in the communities and we're seeing larger numbers," says Dr. Alsip.

Dr. Alsip says aside from a skin lesion, parents should watch for symptoms like fever, soreness or redness around the infection. If you notice red streaks, that could be a sign the infection has spread to the blood stream.

So how do you prevent an M.R.S.A. infection? Doctors say washing your hands should protect you.

Dr. Alsip also says people who frequent gyms or saunas should watch out for any skin problems.

VU doctors say skin infections going misdiagnosed

Wed, 23 Aug 2006 00:00:00 -0700

Two local physicians are warning that 60 percent of people entering both the Vanderbilt University Medical Center and Monroe Carell Jr. Children’s Hospital emergency departments with seemingly innocuous skin infections such as spider bites or abscessed boils might be suffering from an infection that is resistant to common antibiotics and could be, in extreme cases, life-threatening.

Those seeking medical attention might actually be suffering from a skin infection caused by methicillin resistant staphylococcus areus (MRSA), bacteria that are resistant to common antibiotics, according to the physicians, Dr. William Schaffner and Dr. Buddy Creech, both Vanderbilt-based.

The news from VUMC comes on the heels of a study published last week in the New England Journal of Medicine and written by Dr. Gregory Moran of the University of California at Los Angles.

The study was conducted in conjunction with 10 medical schools across the nation. Though neither the VUMC doctors nor Vanderbilt were directly involved with the study, Schaffner and Creech have studied the far-reaching effects of the skin lesions.

Creech, a VU assistant professor of pediatric infectious diseases, spends 80 percent of his time on MRSA research on children. He said in 2004 there was almost a ten-fold increase in the number of healthy children harboring the bacteria in their noses. In contrast, in 2001 there were only four in 500 children who had the bacteria.

“Fortunately, we have alternative antibiotics that are prescribed to treat MRSA,” Creech said. “But slowly we’ll come to lose those as well.”

If untreated or treated in a delayed manner, sufferers of the skin infections could potentially lose a limb or even die.

Creech and his colleagues are currently looking at “candidate vaccines” being developed and the impact of those vaccines on the community-acquired MRSA.

Over-prescription of antibiotics might be one reason MRSA has spread so rapidly, according to Schaffner, chair of the VUMC Department of Preventive Medicine. Schaffner said he regularly sees patients in the VUMC emergency room with similar conditions.

“Six out of 10 people have the infection and end up getting misdiagnosed,” he said. “This is not anything anyone would have guessed even two years ago.”

According to Schaffner, the finding has interesting implications because MRSA cannot be treated with regular antibiotics.

“The bacterial environment in which we live has changed, so doctors will have to change their treatment practices,” he said.

MRSA first appeared in the 1960s when people were exposed to it in hospital settings. Common symptoms include bumps and boils on the skin, skin redness and fever, and spider bite-looking rashes.

According to Schaffner, the bacterium is now a community-originating organism and has spread to Europe and Australia.

“We have to get the word out [about MRSA] to practicing physicians away from academic centers and have not been 100 percent successful even today,” Schaffner said.

One of the ways to reduce the incidents of MRSA, which spreads primarily through contact, is to follow common health precautions such as washing hands frequently and wearing gloves and gowns (especially for health personnel who work with wound drainage).

Community-based, resistant staph infections on the rise

Sun, 20 Aug 2006 00:00:00 -0700

More than half of patients arriving at emergency rooms with skin lesions have drug-resistant staph infections, and doctors aren't necessarily following all the steps to make sure they prescribe the correct antibiotic, a new study shows.

Experts advise doctors to first drain the sores and then culture the infection before prescribing an antibiotic.

This treatment regimen is not new, said M. Lindsay Grayson, a leading expert on infectious disease who wrote an editorial that accompanied that study.

"However, over the years many doctors have simply assumed that the staph strain causing the infection will be susceptible to the routine antibiotics they choose," said Grayson, a professor of medicine at the University of Melbourne in Australia.

Methicillin-resistant Staphylococcus aureus, or MRSA, infections occur frequently among people who have been hospitalized or who have been taking antibiotics for an extended period.

However, these infections have become increasingly common among people who haven't been near hospitals or other health care settings.

Previously, the Centers for Disease Control and Prevention estimated that at least 12% of drug-resistant staph infections are picked up in the community and have no link to health care settings.

But a study published in the latest New England Journal of Medicine found that 59% of skin and soft tissue infections among patients seen at 11 emergency rooms around the country were caused by community-associated MRSA infections.

Although more than 80% of those patients were treated with antibiotics, doctors prescribed an inappropriate drug in 57% of the cases.
When 'normal' staph goes bad

MRSA infections are resistant to commonly prescribed antibiotics called beta-lactams, which include methicillin, penicillin and amoxicillin.

"This finding suggests a need to reconsider empirical antimicrobial choices for skin and soft-tissue infections in areas where MRSA is prevalent in the community," the study says.

"The high prevalence of MRSA among patients with community-associated skin and soft-tissue infections has implications for hospital policies regarding infection control," the article states. "Standard precautions (including the use of gowns and gloves by health care workers for contact with wound drainage) should be used for all patients."

Staph bacteria normally are carried on the skin or in the noses of healthy people.

If staph enters the body, which usually happens through cuts on the skin, it can cause infections that range from pimples and boils that can be treated without antibiotics to more serious complications such as surgical wound infections, bloodstream infections and pneumonia.

Though scientists aren't sure how MRSA infections migrated from hospitals into the community, factors such as crowded living conditions, cuts on the skin, poor hygiene and close skin-to-skin contact have been associated with spreading the infection, the CDC says.

Many cases are found among children, athletes, prisoners and military recruits, they say.
Local efforts

MRSA is not a reportable illness in Wisconsin, but some Milwaukee doctors say they've been seeing more community-associated MRSA infections in their practices.

"Community-associated MRSA is definitely here to stay," said David Fisk, an assistant professor of medicine in the division of infectious diseases at the Medical College of Wisconsin who practices at Froedtert Memorial Lutheran Hospital. "It's something we have seen, like wildfires, taking over for the last four or five years."

In 2004, there were 202 patients admitted to Froedtert with MRSA infections, compared with 222 cases seen in 2005, said Charles Edmiston, a professor of surgery at the Medical College of Wisconsin and epidemiologist with the hospital.

The hospital estimates that 250 to 260 cases will be seen this year.

Froedtert has initiated a two-year study to determine how cases of community-associated MRSA happen among people with diabetes because they are at high risk for development of skin infections, Edmiston said.

Physicians at Wheaton Franciscan Healthcare-St. Francis typically see about 10 cases of community-associated MRSA each month, said Pat Skonieczny, an infection control coordinator for the hospital.

"This is a growing burden in the public health field," said Paul Biedrzycki, the Milwaukee Health Department's manager of disease control and prevention. "We need to increase our intervention and prevention efforts to fight these infections."

And a lot of that can start with the basics, such as good hygiene and hand-washing, Fisk said.

Study Finds MRSA Most Common Cause Of Skin Infections In Patients Presenting In Nation's ER's

Sat, 19 Aug 2006 00:00:00 -0700

Think that's a spider bite on your arm? Think again. It could be methicillin-resistant Staphylococcus aureus, or MRSA, a type of staph infection increasingly seen in communities across the nation that is resistant to antibiotics most commonly used to treat skin infections.

UCLA researchers report in the Aug. 17 issue of The New England Journal of Medicine that MRSA is the most common cause of skin and soft-tissue infections among patients presenting in emergency rooms across the country. MRSA is resistant to the antibiotics used for years to treat these skin conditions, such as cephalexin and dicloxacillin.

"The study points to the rising prevalence of this type of MRSA and the need for clinicians to culture infections and make sure the proper antibiotic is administered to treat MRSA," said Dr. Gregory J. Moran, the study's principal investigator and a clinical professor of medicine in the department of emergency medicine and the Division of Infectious Diseases at Olive View-UCLA Medical Center.

Since the 1960s, MRSA has been found in health care settings, generally among patients who have been hospitalized or are in nursing homes. In the last few years, however, a new type of MRSA has emerged, affecting people with no connection to health care settings. Outbreaks of these new strains of MRSA have been reported among athletes, correctional facility inmates and military recruits. Still, the UCLA study demonstrates that the infections appear to be common in people who are not connected to any particular risk group.

"We noticed more patients showing up in our emergency room with infections that turned out to be community-associated MRSA and wanted to see if this was the case nationwide," said Dr. David Talan, an author of the study and a professor of medicine in the Division of Infectious Diseases and chief of the department of emergency medicine at Olive View-UCLA Medical Center.

Community-associated MRSA most often manifests itself on the skin as a boil or pimple that can be swollen, red and painful, and have discharge.

Researchers cultured the acute skin or soft-tissue infections of 422 patients seen at 11 metropolitan emergency rooms in the United States during August 2004.

Out of those patients, 249, or 59 percent, were found to have MRSA. The proportion of infections caused by MRSA in various cities ranged from 15 to 74 percent.

Further characterization of the MRSA samples, performed at the Centers for Disease Control and Prevention, revealed that one genetic type accounted for 97 percent of the samples.

"This one genetic type of MRSA is appearing in metropolitan areas across the country," Moran said. "More research will determine how prevalent it is in other parts of the nation."

Researchers tested the antibiotic resistance of the isolated MRSA samples and found that in 57 percent of cases, doctors had prescribed an antibiotic to which the bacteria were resistant.

"Doctors need to change what they've done for decades, since traditional antibiotics don't work against MRSA," Talan said. "We encourage physicians to reconsider antibiotic choices for skin and soft-tissue infections in areas where MRSA is prevalent in the community."

Talan notes that most MRSA cases are mild, and having the infection drained and keeping it clean resolves the problem. But when antibiotics are needed, it's important to prescribe an effective medication. Sometimes these infections may require hospitalization and, in rare cases, may even be life-threatening.

"It's important for us to identify and properly treat MRSA in order to halt further progression of serious infections and to prevent recurrence," Moran said.

Researchers tested the effectiveness of different types of antibiotics on the MRSA samples and found that 95 percent were susceptible to clindamycin, 6 percent to erythromycin, 60 percent to fluoroquinolones, 100 percent to rifampin and trimethoprim-sulfamethoxazole, and 92 percent to tetracycline.

The next step, according to Moran, is to compare these different antibiotics in real patients in order to identify an optimal treatment.

The study revealed several potential risk factors for community-associated MRSA. Patients with MRSA were more likely to report a spider bite as the reason for the skin lesion, perhaps thinking it was a bite in absence of other skin problems. Those with MRSA also were more likely to have close contact with a person with a similar infection.

"However, none of these risk factors were consistent enough to help doctors identify cases of MRSA it appears now that everyone is at risk," Moran said. "So if you think you have a spider bite or other type of skin lesion that is not healing, you want to see your doctor to make sure it's not an infection like MRSA."

Dr. Rachel J. Gorwitz, an author of the study and a medical epidemiologist at the Centers for Disease Control and Prevention, noted the importance of educating patients in order to avoid transmission. She offered the following guidance:

Wash hands often with soap and water to keep them clean, or use an alcohol-based hand sanitizer (if hands are not visibly soiled).
Don't share towels, razors or other personal items.
Avoid contact with other people's wounds or bandages.
Keep breaks in your skin clean and covered and watch for signs of infection, such as redness, warmth and swelling.
See your doctor if you notice signs of infection; don't try to drain a boil yourself at home.
If you have a skin infection, keep the infected area covered with a clean, dry bandage until it is healed; wash your hands thoroughly after changing the bandage and put used bandages in the trash.

Staph skin infections on rise in U.S.

Thu, 17 Aug 2006 00:00:00 -0700

A once-rare drug-resistant germ now appears to cause more than half of all skin infections treated in U.S. emergency rooms, say researchers who documented the superbug's startling spread in the general population.

Many victims mistakenly thought they just had spider bites that wouldn't heal, not drug-resistant staph bacteria. Only a decade ago, these germs were hardly ever seen outside of hospitals and nursing homes.

Doctors also were caught off-guard most of them unwittingly prescribed medicines that do not work against the bacteria.

"It is time for physicians to realize just how prevalent this is," said Dr. Gregory Moran of Olive View-UCLA Medical Center, who led the study.

Another author, Dr. Rachel Gorwitz of the Centers for Disease Control and Prevention, said: "I think no one was aware of the extent of the problem."

Skin infections can be life-threatening if bacteria get into the bloodstream. Drug-resistant strains can also cause a vicious type of pneumonia and even "flesh-eating" wounds.

The CDC paid for the study, published in Thursday's New England Journal of Medicine. Several authors have consulted for companies that make antibiotics.

Researchers analyzed all skin infections among adults who went to hospital emergency rooms in 11 U.S. cities in August 2004. Of the 422 cases, 249, or 59 percent, were caused by methicillin-resistant Staphylococcus aureus, or MRSA. Such bacteria are impervious to the penicillin family of drugs long used for treatment.

The proportion of infections due to MRSA ranged from 15 percent to as high as 74 percent in some hospitals.

"This completely matches what our experience at Vanderbilt Children's Hospital has been," said Dr. Buddy Creech, an infectious-disease specialist whose hospital was not included in the study. "Usually what we see is a mom or dad brings their child in with what they describe as a spider bite that's not getting better or a pimple that's not getting better," and it turns out to be MRSA.

The germ typically thrives in health-care settings where people have open wounds and tubes. But in recent years, outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels. Dozens of people in Ohio, Kentucky and Vermont recently got MRSA skin infections from tattoos.

The good news: MRSA infections contracted outside a hospital are easier to treat. The study found that several antibiotics work against them, including some sulfa drugs that have been around for decades. A separate study in the journal reports the effectiveness of Cubicin, an antibiotic recently approved to treat bloodstream infections and heart inflammation caused by MRSA.

However, doctors need to test skin infections to see what germ is causing them, and to treat each one as if it were MRSA until test results prove otherwise, researchers said.

"We have made a fundamental shift in pediatrics in our area" and now assume that every such case is the drug-resistant type, Creech said.

And, doctors need to lance the wound to get rid of bacteria rather than relying on a drug to do the job.

"The most important treatment is actually draining the pus," Gorwitz said. Many times that is a cure all by itself, she said.

The study was done in Albuquerque, N.M.; Atlanta; Charlotte, N.C.; Kansas City, Mo.; Los Angeles; Minneapolis; New Orleans; New York; Philadelphia; Phoenix; and Portland, Ore.

Patients Ill With 'Superbug' Often Given the Wrong Drugs

Thu, 17 Aug 2006 00:00:00 -0700

The drug-resistant "superbug" formally known as methicillin-resistant Staphylococcus aureus, or MRSA is now the most common cause of skin and soft-tissue infections treated in 11 US hospitals, found a study published in the New England Journal of Medicine.

Although rates varied considerably among the hospitals, MRSA was blamed for 59 percent of skin infections overall in the facilities involved in the study, reported a team of investigators from UCLA and the CDC.

Most of the time, MRSA is harmless, but on rare occasions, it can be serious even fatal. MRSA infection often manifests as a painful boil or pimple, usually swollen and red.

Commonly misidentified as spider bites, MRSA infections can cause sores, lesions, and pneumonia. It used to show up primarily among hospital and nursing home patients, but is now a common bacteria that is estimated to be present in about a third of the US population at any given time.

In the recent hospital study, 99 percent of the patients treated for skin infections had acquired MRSA outside the hospital. Almost all of those cases were caused by the USA300 strain that is now prevalent across the US.

Physicians should take drug resistance into account when treating skin infections, urges Rachel Gorwitz of the CDC, co-author of the study. She advises doctors to take cultures from skin infections to identify the strain of bacteria responsible.

In 57 percent of the cases followed by the researchers,infected patients were prescribed the wrong drugs that is, medications the bacteria were resistant to even though there are several drugs available that are effective in treating MRSA.

Tough-to-treat infection now all too common

Thu, 17 Aug 2006 00:00:00 -0700

MRSA Skin Infections Flooding Emergency Department

Wed, 16 Aug 2006 00:00:00 -0700

Methicillin-resistant bacteria are taking emergency room doctors back to the pre-penicillin days, when skin infections were lanced and drained.

Methicillin-resistant Staphylococcus aureus (MRSA) infection has become the most common cause of skin and soft tissue infections seen in metropolitan emergency departments, and half-century-old therapeutic approaches are being revisited to combat it, according to two studies in the Aug. 17 New England Journal of Medicine.

More than three-fourths of all skin and soft tissue infections treated at 11 university-affiliated emergency departments in 2004 were colonized with S. aureus and 59% overall were methicillin resistant, reported Gregory J. Moran, M.D., of the Olive View-UCLA Medical Center here, and colleagues.

The areas with the highest MRSA prevalence were Atlanta at 72%; Kansas City, at 74%; and Charlotte, N.C., at 68%. Los Angeles had a 51% MRSA prevalence while New York was the lowest at 15%.

By comparison, MRSA was an uncommon cause of skin and soft tissue infections prior to 2000, hovering around 3% depending on geographic location.

Dr. Moran and colleagues in the EMERGEncy ID Net Study Group prospectively looked at these infections at the 11 metropolitan centers. Specimens from the 422 adult patients were cultured at each hospital using standard methods and those that were found to be S. aureus were sent to the CDC for further characterization.

In an editorial, M. Lindsay Grayson, M.D., of the University of Melbourne, Australia, called the investigation by Dr. Moran and colleagues a "landmark study," detailed the "amazing extent to which community-associated MRSA, particularly the USA300 clone, has spread through the U.S. population."

He commented that treatment options are "weighted in favor of surgical drainage as the priority intervention--a concept better known to clinicians before the days of penicillin."

USA300 isolates accounted for nearly all of the MRSA isolates (97%) while a single strain called USA300-0114 accounted for 74% of these. Almost all of the MRSA samples tested had SSCmec type IV characteristic of community-associated MRSA and the Panton-Valentine leukocidin (pvl) toxin gene, which has been associated with spontaneous skin and soft-tissue infections and necrotizing pneumonia.

Although resistant to the antibiotic methicillin, most of the MRSA specimens were still susceptible to clindamycin (95%) and fluoroquinolones (60%). All were vulnerable to rifampin and trimethoprim-sulfamethoxazole. Only 6% were susceptible to erythromycin.

Most patients were treated with the combination of incision and drainage and antibiotics (66%). Another 10% received only antibiotics and 19% underwent incision and drainage alone. Five percent received neither. The most commonly used antibiotics were antistaphylococcal penicillin and cephalosporin (64%).

The antibiotic used conflicted with the results of the susceptibility testing for 57% of patients. However, consistent with other reports, this did not make any significant difference in the outcome.

"This absence of an association?suggests that most simple skin abscesses, even when caused by MRSA, can be cured with adequate drainage alone," Dr. Moran and colleagues wrote.

Other basic practices recommended by Dr. Grayson included surgical drainage and debulking of abscesses, use of older narrow-spectrum antimicrobial agents, and prevention of transmission by:

Improved hand hygiene,
Cleaning of shared equipment between uses,
Separation of patients with staphylococcal infections,
Avoidance of overcrowding, and
Selective decolonization.

The study was supported by a cooperative arrangement with the CDC. Some of the authors of Dr. Moran's study reported funding from Schering-Plough, Pfizer, Aventis, Cubist, and Otho-McNeil. Dr. Grayson has had funding from Pfizer and Bayer.

An open-label study in the same NEJM issue found that the antibiotic Cubicin (daptomycin) was as good as standard therapy for bacteremia and endocarditis caused by S. aureus.

Cubicin itself is an older treatment that was abandoned because to toxicity issues more than a decade ago, but is back with a new dosing regimen, reported Vance G. Fowler, Jr., M.D., M.H.S., of Duke, and colleagues.

Of the 124 patients randomized to 6 mg/kg of body weight of Cubicin intravenously each day, 44.2% had a "successful" outcome after the endpoint of 42 days compared with 41.7% of the 122 patients who received low-dose gentamicin plus an antistaphylococcal penicillin or vancomycin.

Complicated bacteremia, right-sided endocarditis, and MRSA infections had similar success rates.

The Cubicin group had higher, though insignificantly so, rates of microbiologic failure (19 versus 11 patients, P= 0.17) and of adverse events that led to treatment failure due to the discontinuation of therapy (17 versus 8, P= 0.06) compared with the standard therapy group.

However, standard therapy led to more clinically significant renal dysfunction compared with Cubicin (26.3% versus 11.0%, P= 0.004).

Dr. Grayson noted several limitations of the study including the fact that "although this trial was randomized, it was an open-label study with the clinical outcome assessed in a blinded fashion. Thus, although bias in assessing treatment efficacy may have been controlled, bias in reporting and acting on adverse events was not."

He also noted that "although the study aimed to recruit 90 patients who could be evaluated in each treatment group (to assess a potential treatment difference of ?20% ), only 79 patients who received Cubicin and 60 patients who received standard therapy were fully evaluated."

He pointed out that 32% of 19 patients who received Cubicin and had microbiologic treatment failure had isolates that had developed resistance to daptomycin Thus, he said "clinicians should be aware that if treatment with this agent appears to be failing, the emergence of resistance should be carefully assessed."

He concluded that despite these important concerns and caveats, Cubicin "may be cautiously considered as a potential treatment option for some patients with S. aureus bacteremia."

The Cubicin study was supported by Cubist Pharmaceuticals and Dr Fowler and many of the co-authors reported having served as consultants for Cubist Pharmaceuticals. In addition, two of the co-authors are employees of Cubist Pharmaceuticals.

Hospital group slams state's C. diff reporting system

Sat, 05 Aug 2006 00:00:00 -0700

A new state reporting system for infections known as C. diff is flawed, says a hospital association lawyer, calling into question the accuracy of hospital cases reported last week by the Ohio Department of Health.

The Health Department since January has collected and posted on its Web site infections from Clostridium difficile, an intestinal bug acquired at hospitals and nursing homes. The state last week issued an interim report detailing rates at individual hospitals. The report showed about 14 percent of hospitals had not followed reporting requirements.

Rick Sites, legal counsel for the Ohio Hospital Association, said some data submitted by hospitals is missing. Sites said he didn't know how much information was lost, but he said the number appeared to be significant.

"We want to work closely with [the Health Department] on this issue and solve it," Sites said. "I think the reporting process needs to be studied."

Department spokesman Jay Carey said Friday that there is no problem with the computerized reporting system. Carey said that in some cases local health departments, which take the information from hospitals and enter it in the state system, didn't save data or enter it correctly.

"I think it was more an operator deal than a software glitch," said Carey, adding that another report will be issued this month.

"Some of the data wasn't in the right place at the right time to be in the July report. It will be in the August report," Carey said.

A virulent strain of C. diff has become a lethal public health threat responsible for outbreaks in Ohio and other states. The infections strike mostly elderly patients and those given antibiotics, which destroy protective natural bacteria in the intestines.

Hospitals say they have stepped up prevention efforts. But taming the bug has been a challenge for infectious-disease experts.

Last week, the Health Department reported about 3,000 C. diff infections at Ohio hospitals from January through June. The agency for the first time established rates, based on patient volume, to give hospitals a benchmark for gauging infections over time.

Some say public reporting motivates hospitals to improve infection control, but six months of data is not enough to single out facilities.

Sites, of the hospital association, said he had asked the Health Department to delay the report because of reporting problems.

Kevin Miller, president and chief executive of Ashtabula County Medical Center, said in an e-mail that he was told in July his hospital had not reported required data. But the hospital reported regularly and the city health department confirmed that it gave the data to the state, he said.

"It, therefore, makes me question the accuracy of the entire database," Miller wrote Friday.

Likewise, Lake Hospital System reported cases that the county health department sent to the state, said hospital spokeswoman Julieann Strogin. But the state report shows data missing for both of the system's hospitals.

"Why the state hasn't received it, I have no idea," Strogin said.

Hospital Infections Drug Resistant Bacteria Lawsuit

Sat, 05 Aug 2006 00:00:00 -0700

Hospital Infections - Drug Resistant Bacteria

Each year over 1.7 million Americans will get a drug-resistant infection from a hospital and 100,000 of them will die. In the United States, more people die from hospital infections than breast cancer and AIDS combined. Thousands of other victims of hospital infections escape death but are left with serious life altering injuries including paralysis. Disturbingly most of these infections can be prevented through the implementation of stricter sanitary and bacterial testing procedures. If you or a loved one was diagnosed with a serious infection during or after a hospital stay contact Parker Waichman Alonso, LLP today to have an attorney evaluate your case.

Shocking Hospital Infection Statistics

•    2 million patients get health care associated infections each year
•    100,000 deaths from health care/hospital infections each year
•    $30 billion spent to treat health care/hospital infections each year

Hospital infections are commonly drug resistant and lethal. The bacteria in these infections replicate and mutate so aggressively that even the most potent antibiotics can not kill them. The most common strains of lethal bacteria found in hospital patients are detailed below:

Methicllin-resistant Staphylococcus aureus (MRSA) – This strain of lethal staphylococcus or staph is responsible for approximately 120,00 hospital infections per year. Patients can die within days of being infected.

Psedomonas aeruginosa – This deadly strain of bacteria causes lower respiratory infections. It is responsible for 18% of hospital acquired pneumonia and is incredibly resistant to antibiotics.

Klebsiella pneumoniae – Lethal hospital-borne bug that infects the urinary tract, bloodstream and gut. Reported cases are up 50% in the last five years and there is a 66% mortality rate in untreated patients.

Vancomycin-resistant Enterococcus faecium (VRE) – Responsible for 10% of all hospital infections. Bacteria usually infects the blood, urinary tract and wounds. Patients with compromised immune systems are particularly susceptible to infection.

Clostridium difficile – Linked to 400,000 cases of severe diarrhea each year. New mutation of this bacteria produces 20 times the toxin of the old version. Infection is often fatal.

Free Lawsuit Case Consultation
If you or a loved one has suffered from a hospital-borne bacterial infection you may have valuable legal rights. Complete the case evaluation form on the right of this page to have your case immediately evaluated by a qualified attorney. If you prefer to call Parker Waichman Alonso, LLP, you can call 1-800-LAW-INFO (1-800-529-4636) 24 hours per day.