Times Health Guide: MRSA Infection


SAN FRANCISCO — In a matter of days, it jumped from a routine press release to a medical controversy.

On Monday, a team of researchers led by doctors from the University of California at San Francisco announced that gay men were “many times more likely than others” to acquire a new strain of drug-resistant staphylococcus, a nasty, fast-spreading and potential lethal bacteria known as MRSA USA300. And sure enough, the study, published online in the Annals of Internal Medicine, was quickly picked up by reporters round the world and across the Internet, including a London tabloid which dubbed the disease “the new H.I.V.

But for gay men in the Castro neighborhood here, which was an early epicenter for the AIDS epidemic and a current hot spot for MRSA, the report also seemed to cast an unfair, and all too familiar, stigma on their sexuality.

“The way they keep targeting gays as if gays alone are responsible for it, its like H.I.V./AIDS all over again,” said Colin Thurlow, 60, who is gay and lives in San Francisco. “And we’re sick and tired of it.”

The report also inadvertently offered ammunition for many antigay groups, including the conservative Concerned Women for America, which issued a release on Wednesday citing the “sexual deviancy” of gay men as leading to AIDS, syphilis and gonorrhea.

“The medical community has known for years that homosexual conduct, especially among males, creates a breeding ground for often deadly disease,” the release read.

Another group, Americans for Truth About Homosexuality, also cited the report as a way of proving that “homosexual behavior is unhealthy.”

“Why aren’t all schoolchildren being taught that there are special health risks associated with homosexual behavior and that they should ‘just say no’ to homosexuality?” read a released posted on the group’s Web site.

National gay rights groups were quick to label such talk as “hysteria,” even as researchers as the university scrambled to clarify their findings. On Friday, it issued an apology, saying their release had “contained some information that could be interpreted as misleading.”

“We deplore negative targeting of specific populations in association with MRSA infections or other public health concerns,” it concluded. Dr. Henry Chambers, one of the report’s authors and a professor of medicine at the university, said he was surprised by how the report had been spun.

“I think we were looking at this from a scientific point of view and not projecting any political impact,” he said. “We were focusing on the data. You want to make sure it’s as right as possible and written up in a form that reviewers would understand what you’re trying to say, and do it in a clear manner so it’s not subject to misinterpretation. Which is what happened later, it appears.”

One of the major sore points for some critics was a quote attributed to the report’s lead author, Bien Diep, a researcher who said he was concerned about “a potential spread of this strain into the general population.”

Mr. Diep, 29, said on Friday he regretted not being more thorough in communicating his research to reporters. He said that the term “general population” was part of medical jargon used in the report, which did not translate well.

“It’s really meant to be used to mean all inclusive, including the men-who-have-sex-with-men population,” he said.

Worries about the negative press resonated even as some gay men here expressed concern about the disease itself. The report looked at nine San Francisco hospitals in 2004 and 2005. A separate part of the study, conducted at an AIDS clinic in the city from 2004 to 2006, found that gay men were 13 times more likely to be infected with MRSA USA300.

Josh Figurido, 27, a bartender at Metro, a popular gay bar in the Castro, said he had only heard about the strain this week, but was already taking precautions when it came to sex. “I’m definitely going to be a lot more careful with what goes on,” he said.

But Mr. Figurado said he was less concerned about antigay rhetoric. “It’s not just gay people that get it,” he said. “You can get it anywhere.”

Indeed, the Centers for Disease Control and Prevention in Atlanta, which helped finance the study, affirmed on Wednesday that the disease was not sexually transmitted or limited to a certain type of person. It is transmitted through skin-to-skin contact, the agency said in a statement, and is widespread in hospitals and among hospital workers.

“These infections occur in men, women, adults, children and persons of all races and sexual orientations,” the statement read, adding that while the particular strain identified in the report had been found in gay men, it had also been found in people who were not gay.

For those who do come down with the disease, there are various treatments, including antibiotics. Preventive measures include frequently cleaning hands, clothes and open wounds. MRSA can cause painful sores, which should be lanced and treated to prevent the disease’s spread.

Jason Overcash, 37, a sales representative who lives near the Castro and is gay, said he was upset by the initial presentation of the report, which he said seemed geared to panic people both inside and out of the Castro.

“The way they presented it, it makes people think if they come here, they’re going to get MRSA,” he said.

That is an experience Mr. Overcash says he knows all too well: he contracted MRSA in 2002, and soon found a lesion on his left buttock. “It got to be like a golf ball in a matter of 36 hours,” he said. He tried three different antibiotic treatments, even as the lesions spread, before finally knocking it out.

“It was horrible, and that’s why I’m super hyper-aware of it,” Mr. Overcash said. “Because I don’t ever want to go through that again.”

Nueva cepa de Stafilococo Meticilino Resistente en varones homosexuales


Fuente: La Nacion 

NUEVA YORK (The New York Times).- Una nueva cepa altamente resistente a los antibióticos de la bacteria Staphylococcus aureus resistente a la meticilina (MRSA, según sus siglas en inglés) se está expandiendo en la población de varones homosexuales de San Francisco y Boston, informaron investigadores.

Según un estudio publicado en revista Annals of Internal Medicine , la bacteria parece propagarse más fácilmente a través del sexo anal, pero también a través del contacto casual piel con piel y al tocar superficies contaminadas con la bacteria.

Los autores del estudio advirtieron que a menos que los laboratorios de microbiología sean capaces de identificar esta cepa y que los médicos prescriban las antibióticos apropiados, la infección podría extenderse rápidamente a otros grupos y convertirse en una amenaza mayor.

El estudio se basa en el análisis de los registros de clínicas de San Francisco y Boston, y de nueve centros médicos de San Francisco. El distrito Castro, de San Francisco, posee el mayor número de residentes homosexuales de los Estados Unidos. Uno de cada 588 de sus residentes contrajo la infección por esta nueva cepa multirresistente de MRSA, halló el estudio, en comparación con una de cada 3800 personas de todo San Francisco.

Los investigadores sugieren que lavarse con agua y jabón quizás sea la forma de frenar la transmisión a través del contacto piel a piel, en especial después de una relación sexual.

La infección puede causar abscesos y úlceras cutáneas, así como puede provocar neumonía, problemas cardíacos o infecciones del torrente sanguíneo (sepsis).

Las MRSA son bacterias que solían hallarse en los hospitales, pero en los últimos años también se las encuentra en infecciones adquiridas en la comunidad. La nueva cepa, llamada MRSA USA300, es difícil de tratar porque no sólo es resistente a la meticilina. “Es resistente al menos a otras tres drogas”, dijo el doctor Henry Chambers, autor del estudio.

Importance of the environment in meticillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning


The Lancet Infectious Diseases DOI:10.1016/S1473-3099(07)70241-4

 

Review

The Lancet Infectious Diseases Early Online Publication, 31 October 2007

Dr Stephanie J Dancer MD email address a Corresponding Author Information

 

Summary

 

In the UK, we continue to debate the importance of hospital cleaning in relation to increasing numbers of patients acquiring meticillin-resistant Staphylococcus aureus (MRSA). However, there is little direct evidence for the effectiveness of cleaning because it has never been afforded scientific status. Hospital hygiene is usually assessed visually, but this does not necessarily correlate with microbiological risk. A more robust case for hospital cleaning can be presented by considering the evidence for all the stages of the staphylococcal transmission cycle between human beings and their environment. Cleaning has already been accepted as an important factor in the control of other hardy environmental pathogens, such as Clostridium difficile, vancomycin-resistant enterococci, norovirus, and Acinetobacter spp. This Review will show why the removal of dirt might have more impact on the control of MRSA than previously thought. Introduction of additional cleaning services is easier than improvements in hand-hygiene compliance.

 

Affiliations

a. Department of Microbiology, Southern General Hospital, Glasgow, UK

Corresponding Author InformationCorrespondence to: Dr Stephanie J Dancer, Department of Microbiology, Hairmyres Hospital, Eaglesham Road, East Kilbride G75 8RG, UK. Tel +44 (0)1355 585000

First Watch


                   
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Vitamin D Not Associated with Overall Cancer Mortality

Serum vitamin D levels are not associated with overall cancer mortality, although high levels may be linked to reduced mortality from colorectal cancer in particular, reports the Journal of the National Cancer Institute.

Using data from NHANES III, researchers examined the association between baseline levels of serum 25(OH)D and cancer mortality during a median follow-up of about 9 years. Nearly 17,000 people aged 17 or older were included.

After multivariable adjustment, vitamin D was not associated with overall cancer mortality — a finding that held true in analyses stratified by sex and ethnicity. However, when site-specific cancers were evaluated, colorectal cancer mortality decreased significantly as vitamin D level increased.

Editorialists conclude: “While vitamin D may well have multiple benefits beyond bone, health professionals and the public should not in a rush to judgment assume that vitamin D is a magic bullet and consume high amounts of vitamin D.”

JNCI article (Free abstract; full text requires subscription)

JNCI editorial (Free)

Related Journal Watch link(s):

Physician’s First Watch coverage of a study showing a link between vitamin D supplementation and reduced all-cause mortality (Free)

                   
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Washing Surfaces in Hospitals Reduces Spread of MRSA

Basic hospital cleaning should take a higher priority if infections like methicillin-resistant Staphylococcus aureus are to be brought under control, concludes a review published online in Lancet Infectious Diseases.

The author, looking back on studies examining the epidemiology of MRSA and other staph infections, finds the organisms to be long-lived, even when not colonizing patients or their caregivers. She points to the profusion of electronic gear at the bedside, all offering hand-touch sites from which MRSA can spread. Infection-control recommendations, including those from the CDC, stress visible cleanliness as a performance criterion, even though less than half of the “visibly clean” wards were microbiologically clean.

Recommending more spending for cleaning, she concludes: “We do not yet know exactly what impact cleaning could have on control, but this ignorance should not be used as an excuse for doing nothing.”

Lancet Infectious Diseases article (Free abstract; full text requires subscription)

CDC report on managing multidrug-resistant organisms in healthcare settings (Free PDF)