Dr. Alexander Kallen of the CDC led the study and confirmed that some patients died within four days and many were not initially treated for MRSA, suggesting their doctors did not know that they were dealing with MRSA-provoked pneumonia. "It's obviously very concerning," Kallen said. "This is a disease that can strike otherwise very healthy people—adults and children.  Also, this is a disease that follows influenza."  Kallen also indicated that the disease has implications for preparing for the flu season and a possible flu pandemic.

Kallen’s team reviewed reports of community-acquired pneumonia caused by Staph aureus between November 1, 2006 and April 30, 2007 and found that, "Overall, 51 cases were reported from 19 states."  Their findings appear in the Annals of Emergency Medicine.  "More than three-quarters—79 percent—of the staph-caused pneumonia patients were infected with MRSA," Kallen said.

The patients’ average age was 16.  One-third had confirmed influenza; however, nearly half—40 percent—were healthy.  According to the researchers, 24 patients died within an average of four days following a pneumonia diagnosis. Those infected with the flu were about twice as likely to die from the staph-caused pneumonia.  "The key message to realize is that during the winter season, especially when influenza is circulating, physicians need to be thinking about this as a cause."

Staph aureus is common and generally about 30 percent of all people are colonized with staph at any given time.  This means that these people have the staph bacteria living on their skin or in their noses, but are not ill.  "You shake hands with someone and you get MRSA and MRSA colonizes you," Kallen said.

Staph can get into the lungs and cause disease and some studies indicate that when people are infected with flu, the virus can help shut down the natural processes for ensuring the lungs clear, thus allowing the staph bacteria to grow in the lungs.

In April we reported a disturbing increase in the number of children dying from both the flu and MRSA.  At that time, state and federal disease investigators began tracking the situation and Massachusetts’s health authorities linked two childhood flu deaths to MRSA and found that nationally, of 74 children known to have died from the flu in the US in 2006-07, 22 also had staph, most MRSA.  The CDC expressed deep concern and began planning on executing a monitoring network for patients co-infected with flu and MRSA during the next flu season.  Experts say that data and other findings could assist doctors in preventing flu-MRSA cases from turning fatal.

It has long been recognized that the overuse of antibiotics to treat minor ailments has helped to encourage the development of drug-resistant pathogens.  Because of that, many doctors have drastically cut back on the amount of antibiotics they prescribe.  But according to Keep Antibiotics Working, the use of the drugs within the livestock industry is an even bigger threat to public health.  According to the group, about 70 percent of the antibiotics used in the livestock industry are used in a “non-therapeutic” way.   For instance, antibiotics are a common ingredient in feeds to promote growth and compensate for unsanitary animal living conditions.  According to the group, this type of antibiotic use exposes bacteria to low levels of the drugs for an extended period of time – the ideal conditions for allowing pathogens to develop antibiotic resistance. 

According to a 2002 analysis by the group Alliance for the Prudent Use of Antibiotics, the elimination of non-therapeutic antibiotic use in food animals could greatly reduce antibiotic resistant pathogens.  For that reason, Keep Antibiotics Working, a coalition of consumer, environmental, science and humane organizations, has written to FDA Commissioner Andrew von Eschenbach, MD, urging the Agency to take immediate action on two fronts-MRSA and cephalosporin-resistant bacteria--to protect the efficacy of medicines that fight lethal bacteria.  The coalition's letter details evidence showing that the use of drugs in livestock is contributing to the current MRSA epidemic in Europe and suggests it could play a similar role here. The research includes a recent study published in the U.S. Centers for Disease Control and Prevention's journal Emerging Infectious Diseases that links a new MRSA strain initially found only in pigs to more than 20 percent of all human MRSA infections in the Netherlands.  Research published this fall in Veterinary Microbiology found MRSA was also prevalent in Canadian pigs and pig farmers, pointing again to animal agriculture as a source of the deadly bacteria.

Despite these studies and others from Europe dating back to 2005, the United States does not systematically test pigs, cattle, and other food animals for MRSA. As a result, the US public health establishment does not know whether the use of antibiotics in food animals in the United States is contributing to the reported surge of MRSA cases in the United States.

The coalition's letter also pointed to the proposed agricultural use of a 4th generation cephalosporin, cefquinome, which belongs to a class of drugs used to treat serious and life-threatening infections in patients with compromised immune systems. In September 2006, the FDA's Veterinary Medicine Advisory Committee rejected the claim that this use be considered safe, but the drug's manufacturer, Intervet (recently acquired by Schering-Plough), has yet to withdraw their application for FDA approval. Advocates, joined by the American Medical Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics, fear approval despite the majority opinion of the FDA's own experts.

MRSA is a bacterium that causes staph infections on various parts of the body. Most often, it causes mild infections on the skin, causing pimples or boils. But it can also lead to more serious skin infections or infect surgical wounds, the bloodstream, the lungs, or the urinary tract. Depending on where the MRSA infection occurs, it can be life threatening. MRSA is difficult to treat, because it is resistant to many common antibiotics. The Centers for Disease Control  says MRSA infections kill about 250 people each day. About 90,000 Americans come down with drug resistant MRSA every year, and of that about 19,000 die from the infection.

According to this latest MRSA study, hospitalizations  caused MRSA more than doubled between 1999 and 2005, soaring from 127,000 to nearly 280,000.  The study concluded that MRSA and staph infections are now "endemic, and in some cases epidemic" in many U.S. hospitals, long-term care facilities and communities.

The researchers who conducted the MRSA study also found that patterns of infection have changed as well.  Traditionally, MRSA infections were problems in hospital and other patient settings.  However, in the past several years, there has been a dramatic increase in the number of MRSA infections acquired outside of hospital settings. At the same time, there was no change, up or down, in the number of deaths from hospital-associated staph or MRSA infections.   The study's authors say this means that antibiotic-resistant infections are spreading more rapidly in the community while the epidemic of drug-resistant infections in hospitals continues unabated.  The end result of this, the study authors wrote, is an increase in patient suffering and the length of time patients spend in the hospital - in addition to direct health care costs, estimated to be more than $6 billion annually.

And as MRSA infections become more frequent, the bacteria's ability to resist antibiotics becomes stronger.  The upsurge in MRSA has increased demand for vancomycin, a powerful antibiotic often used when other antibiotics fail.  However, as the use of this drug has increased, public health officials have begun getting more frequent reports of vancomycin-resistant MRSA, a development that will only serve to make the epidemic of drug resistant staph even worse.

The researchers offer several suggestions to address the spread of MRSA infections. These include national surveillance or reporting requirements for these infections, more research to explore the interaction between community-and hospital-associated infection, stepped-up efforts to control hospital infection and increased investment in the development of a staph vaccine.

Recently, MRSA has moved from its historic hospital setting with new cases being found in public settings and reaching younger, healthier people.  A new study indicates that many antibacterial products have some value, but a product made with benzethonium chloride kills common types of non-hospital, or community associated, MRSA bacteria better than other compounds.

MRSA generally begins with cuts or minor wounds or skin infections and is a fully preventable disease and very treatable in early stages.  When there is a small eruption on the skin and before MRSA reaches the bloodstream, the infection is easily treated with general-purpose antibiotics, the sore is bandaged and kept clean, and the infection is cured.  There is no down time and patients can resume activities with no risk of falling ill or contaminating others.  Without treatment or with incorrect diagnosis and treatment, the infection spreads rapidly and can lead to respiratory failure and surgeries, attacking vital organs like the lungs and heart.  Survivors are not always returned to their pre-MRSA condition, losing limbs, hearing, and full use of damaged organs.  MRSA killed more people than AIDS in 2005.

Researchers are looking at antibacterial creams and ointments treatment and, in laboratory studies, scientists compared three types of compounds for their effectiveness in killing four MRSA strains most commonly found in public settings:  Neomycin and polymyxin, polymyxin and gramicidin, and benzethonium chloride with tea tree and white thyme oil.  The study revealed the benzethonium chloride product killed the community-associated MRSA bacteria more rapidly and worked well against all four tested strains.  Although all of the products had some antibacterial effectiveness, only the benzethonium chloride compound had a true bactericidal (reducing bacteria by a factor of 1,000) effect against all tested MRSA strains.

Although there's not a lot of data about the effectiveness of topical, antibacterial products in infection prevention, researchers know it takes large numbers of bacteria to produce an infection and antibacterial treatments can greatly reduce their number.  Tec Laboratories, a company that sells the benzethonium chloride product, funded the research.

• 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.

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

• The patient should be isolated from unnecessary contact with staff and other patients in a single room, or share a room with other patients who have MRSA.
• Linen and clothing should be carefully sterilized.