Invisible Staph Brings Down 200 lb. Football Player

As a defensive tackle for the Washington Redskins, Brandon Noble had the strength to bring down a 200-pound running back — but, sidelined with a staph infection, he struggles to pick up his baby. "It felt like someone was lighting me on fire," he said. "It was really painful."

It began in April 2004, when Noble was overcome with intense pain and flu symptoms. Doctors discovered he had MRSA — which stands for methicillin-resistant staphylococcus aureus — a debilitating staph infection resistant to most antibiotics.

"One of the doctors, when I was checked into the ER, said, you know, 'If you had waited even another 24 hours, we could potentially be talking about either life or death or losing a leg,' " Noble said.

Stories like Noble's are becoming more common among professional and amateur athletes across the country. Community acquired MRSA is sending more than 130,000 people to the hospital each year, according to the Centers for Disease Control and Prevention — and outbreaks hit sports teams because players often have open wounds and are in close contact.

"If you go back to the locker room and there are guys sharing towels, sharing whirlpools or sharing weightlifting equipment," said Dr. John Francis of the Johns Hopkins University School of Medicine, "there's a risk of this bacteria commonly found in your skin to then be passed from one individual to another."

The first signs of MRSA are easy to miss. They can be as simple as a red bump on the skin. People often don't see a doctor until it has started spreading, and becomes much more dangerous.

In San Diego, Tynan Murray came down with MRSA while playing for his high school football team.

"It was really scary," said Vicki Francis, Tynan's mom. "They couldn't get his fever down. Nobody knew what was wrong with him." Murray is fine now and takes precautions.

To keep from getting MRSA medical experts recommend … covering all wounds, no matter how minor, not sharing towels and wiping down sports equipment.

Brandon Noble says he'll probably never be able to play professional football again. "The kind of repercussions that can come from it [MRSA] are shocking and scary," he said. All he really wants now is to have enough energy to be a dad.

Nosocomial Etiologies in UTIs

Nosocomial etiologies in UTI include the following:

Gram-negative enterics, 50%
Fungi, 25%
Enterococci, 10%
Nosocomial etiologies in surgical-site infections include the following:
S aureus, 20%
Pseudomonads, 16%
Coagulase-negative staphylococci, 15%
Enterococci, fungi, Enterobacter species, and Escherichia coli, less than 10% each


Catheter-Associated Urinary Tract Infections

Catheter-associated urinary tract infections (CAUTI) are the most common nosocomial (hospital acquired) infection. Each year, more than 1 million patients in U.S. acute-care hospitals and extended-care facilities acquire such an infection. CAUTI is the second most common cause of nosocomial bloodstream infection, and studies suggest that patients with CAUTI have an increased institutional death rate, unrelated to the development of urosepsis.

Each year, urinary catheters are inserted in more than 5 million patients in acute-care hospitals and extended-care facilities. Catheter-associated urinary tract infection comprises >40% of all institutionally acquired infections (1-4). Nosocomial bacteriuria or candiduria develops in up to 25% of patients requiring a urinary catheter for >7 days, with a daily risk of 5%. CAUTI is the second most common cause of nosocomial bloodstream infection, and studies suggest that nosocomial CAUTIs are associated with substantially increased institutional death rates, unrelated to the occurrence of urosepsis.

Although most CAUTIs are asymptomatic, rarely extend hospitalization, and add nominally to the direct costs of acute-care hospitalization, asymptomatic infections commonly precipitate unnecessary antimicrobial-drug therapy. CAUTIs comprise perhaps the largest institutional reservoir of nosocomial antibiotic-resistant pathogens, the most important of which are multidrug-resistant Enterobacteriacae other than Escherichia coli, such as Klebsiella, Enterobacter, Proteus, and Citrobacter; Pseudomonas aeruginosa; enterococci and staphylococci; and Candida spp.

Excluding rare hematogenously derived pyelonephritis, caused almost exclusively by Staphylococcus aureus, most microorganisms causing endemic CAUTI derive from the patient's own colonic and perineal flora or from the hands of health-care personnel during catheter insertion or manipulation of the collection system. Organisms gain access in one of two ways. Extraluminal contamination may occur early, by direct inoculation when the catheter is inserted, or later, by organisms ascending from the perineum by capillary action in the thin mucous film contiguous to the external catheter surface. Intraluminal contamination occurs by reflux of microorganisms gaining access to the catheter lumen from failure of closed drainage or contamination of urine in the collection bag.

Recent studies suggest that CAUTIs most frequently stem from microorganisms gaining access to the bladder extraluminally, but both routes are important. Some studies suggest that the extraluminal route may be of greater relative importance in women because of the short urethra and its close proximity to the anus. Investigators have found that antecedent heavy periurethral cutaneous colonization is an important risk factor for CAUTI in both men and women.

Most infected urinary catheters are covered by a thick biofilm containing the infecting microorganisms embedded in a matrix of host proteins and microbial exoglycocalyx. A biofilm forms intraluminally, extraluminally, or both ways, usually advancing in a retrograde fashion. The role of the biofilm in the pathogenesis of CAUTI has not been established. However, antiinfective-impregnated and silver-hydrogel catheters, which inhibit adherence of microorganisms to the catheter surface, significantly reduce the risk of CAUTI, particularly infections caused by gram-positive organisms or yeasts, which are most likely to be acquired extraluminally from the periurethral flora. These data suggest that microbial adherence to the catheter surface is important in the pathogenesis of many, but not all, CAUTIs. Infections in which the biofilm does not play a pathogenetic role are probably caused by mass transport of intraluminal contaminants into the bladder by retrograde reflux of microbe-laden urine when a catheter or collection system is moved or manipulated.

A prospective study in which catheterized patients were cultured daily by a technique capable of detecting very low-level bacteriuria, as low as 1 CFU/mL (7), showed that isolation of any microorganisms from an intraluminal specimen, even 3-4 CFU/mL, is highly predictive of CAUTI. If intercurrent antimicrobial therapy is not given, the level of bacteriuria or candiduria almost uniformly increases to >105 within 24-48 hours, demonstrating the vulnerability of the catheterized urinary tract to infection once any microorganisms gain access to the lumen of the catheter and the bladder. The very heavy use of systemic antimicrobial drugs in catheterized patients, which has been found in most studies, probably keeps the rate of CAUTI considerably lower than it would be otherwise, but unfortunately selects for the resistant organisms that produce most nosocomial CAUTIs.

Most clinicians use a clean-voided specimen showing >105 CFU/mL as the criterion for "significant" bacteriuria (i.e., true infection) for noncatheterized patients. However, once any microorganisms are identified in urine from a patient's indwelling catheter, unless suppressive antimicrobial-drug therapy is being given or started, progression to concentrations >105 CFU/mL occurs predictably and rapidly, usually within 72 hours. Thus, most authorities consider concentrations >102 or 103 CFU/mL, in urine collected with a needle from the sampling port of the catheter, to be indicative of true CAUTI. This concentration can be reproducibly detected in the laboratory, and this definition is useful for therapeutic decisions and epidemiologic research.

Large, prospective studies in which catheterized patients were cultured daily and which used multivariable techniques of statistical analysis identified risk factors independently predictive of increased risk for CAUTI. Females have a substantially higher risk than males (relative risk [RR] 2.5-3.7), and patients with other active sites of infection (RR 2.3 - 2.4) or a major preexisting chronic condition (such as diabetes [RR 2.2-2.3], malnutrition [RR 2.4], or renal insufficiency [RR 2.1-2.6]) also are at higher risk. Inserting the catheter outside the operating room (RR 2.0-5.3) or late in hospitalization (RR 2.6-8.6), presence of a ureteral stent (RR 2.5), or using the catheter to measure urine output (RR 2.0) further increase the risk.

Talking Bacteria and How to Shut Them Up

Bacteria are more gregarious than previously thought. Not only do they routinely engage in small talk among themselves, but research is showing that many are also multilingual and can communicate with members of other species.

"When we think about bacteria, we think about them as being tiny single-celled organisms that live these very asocial reclusive lives," said Bonnie Bassler, a molecular biologist at Princeton University. "In fact, bacteria have developed language, and the language is chemical."

Speaking at the annual meeting for the American Association for the Advancement of Science earlier this year in Washington, Bassler explained that in addition to being able to communicate with members of their own species, many bacteria can also talk to members of other species using a universal chemical language.

Bacteria are able to communicate with one another through a process known as quorum sensing.

Here's how it works: Individual bacteria secrete signaling molecules called autoinducers into their environments, and as the number of bacteria in a colony increases, so does the concentration of the signaling molecule.

Once a critical mass, or quorum, of bacteria and auto inducers are reached, specific behaviors can be initiated.

Quorum sensing allows bacteria to coordinate their behaviors on a global scale and to act like enormous multicellular organisms, Bassler explained. The types of behaviors initiated by quorum sensing are typically those that are beneficial only when performed as a group, such as the release of toxins or the formation of aggregates called biofilms.

"The goal of quorum sensing is to count," Bassler said. Bacteria in the wild are not typically found in homogenous groups, but rather coexist in diverse communities with other bacterial species. "We don’t think anymore that it does bacteria any good to only count its own species; they have to be able to take a census of the rest of the population."

One way they do this is through quorum sensing. In addition to autoinducers that are species-specific, many bacteria also produce a universal autoinducer, known as AI-2, which can be understood across different bacterial species.

AI-2 was first discovered in a bioluminescent species of marine bacteria capable of giving off visible light, but it has since been identified in hundreds of other species. "This is a generic language," said Bassler. "It’s the trade language that says 'other.'"

Many scientists believe the discovery of AI-2 could lead to the development of a new class of antibiotics.

"If we could keep the bacteria from talking or listening, we might be able to develop new kinds of therapeutics," Bassler said.

Because such a drug would not kill the bacteria directly, but only disrupt their activity and prevent them from releasing their toxins, it would not encourage the development of resistance—a problem that is plaguing many current antibiotics. Bassler believes there are probably other molecules like AI-2.

"There are probably many more molecules to be found that tells who the other guy is as well," she said. "We’re only at the beginning of this field."

©Whitehead Institute for Biomedical Research

By Ker Than
Special to LiveScience

What is a Hospital Acquired Infection?

A Hospital Acquired Infection is literally, an infection caught while hospitalized. The medical term for a Hospital Acquired Infection is "nosocomial." Most nosocomial infections are due to bacteria. Since antibiotics are frequently used within hospitals, the types of bacteria and their resistance to antibiotics is different than bacteria outside of the hospital. Nosocomial infections can be serious, difficult to treat and deadly.

A nosocomial infection is strictly and specifically an infection "not present or incubating prior to admittance to the hospital, but generally occurring 72 hours after admittance."

The microorganism Staphylococcus Epidermidis is harmless on human skin, but it is the leading cause of Hospital Acquired Infections and infections of indwelling medical devices. S. Epidermidis is associated with an enormous number of infections in people with prosthetic joints, replacement heart valves, and intravenous catheters, and antibiotic resistance makes it tough to battle. Moreover, the mechanism through which the organism becomes so pathogenic once the protective barrier of the skin is removed remains unclear.

The word "nosocomial" is made up of two Greek words. The prefix "noso-" comes from "nosus" meaning disease and "-comial" comes from "komeion" meaning to take care of. Nosocomial could therefore refer to any affliction acquired by a patient while under medical supervision, but it doesn't. It now refers more narrowly to a hospital-acquired infection.

Rise of Deadly Superbugs Should 'Raise Red Flags' Everywhere

A pair of new studies confirms recent fears that bacteria are growing increasingly resistant to drugs and that you can be infected anywhere. The number of cases of "superbugs," as researchers call them, has been increasingly steadily in recent years, the reports conclude. The best medicine? Wash your hands a lot. Both studies are detailed in a June 15 issue of the journal Clinical Infectious Diseases.

The deadly microscopic creatures evolve to deal with antibiotics, such as penicillin, partly because doctors prescribe the medications inappropriately, scientists say. When antibiotics are used for non-bacterial illnesses, or when prescriptions are not taken for the full cycle, the bugs that endure pass on their drug-resistant traits to subsequent generations.

One of the most vexing superbugs is methicillin-resistant Staphylococcus aureus, or MRSA. This bacteria used to be acquired mostly in hospitals, but now more people are getting it elsewhere. It can cause skin infections, severe bloodstream infections and even death.

Researchers at the Baylor College of Medicine and Texas Children’s Hospital found that over three years, the number of MRSA infections acquired outside hospitals in Texas had more than doubled. Researchers said the study should "raise red flags for health care workers everywhere."

"There have been deaths related to this organism, although the vast number are skin and soft tissue infections," said lead researcher Sheldon Kaplan.

Avoiding MRSA infections is surprisingly simple: Follow Mom's advice."If you get a cut or an abrasion, try to keep it clean and dry" Kaplan said, and don’t share towels or washcloths. Most importantly, he said, "Wash hands, wash hands, wash hands."

A study released in March found standard soap and 10 seconds of scrubbing to be among the most effective ways to get rid of bacteria. Other bacteria have come to resist multiple drugs. And if regular drug-resistant bacteria weren’t bad enough, some bacteria have become multidrug resistant (MDR). What if nothing works?

Researchers at the Beth Israel Deaconess Medical Center and Harvard Medical School studied the prevalence of bacteria resistant to three or more drugs over a six-year period. From 1998 to 2003, there was a significant increase in the incidence of patients carrying multidrug resistant (MDR) bacteria when they were admitted. Tree of the four species of MDR bacteria that the researchers examined, including E. coli, saw rising numbers of cases.

"We need to learn more about ways to prevent the spread of multidrug resistance," said Aurora Pop-Vicas, lead author of the second study. "What everybody wants to avoid is having an infection with an MDR bacteria resistant to all the antibiotics currently available."

Both studies mirror findings by the U.S. Centers for Disease Control and Prevention, which found 17 percent of drug-resistant staph infections in three regions were caught outside hospitals.

By LiveScience Staff

The 1st Vaccine Against HAIs

National Institute of Health
September 1, 2006

Each year, hospital-acquired infections sicken 2,000,000 people, killing about 80,000 of them. These infections add nearly $5 billion a year to U.S. healthcare costs. Moreover, many kinds of bacteria have grown resistant to the antibiotics used to eliminate them. A simple treatment for hospital patients, nursing home residents, and others at risk for hospital acquired infections would yield major benefits.

Recently, scientists reported a successful test of a vaccine against one of the most common causes of hospital-acquired infections, Staphylococcus Aureus bacteria. The method for creating the vaccine also holds promise for vaccines that target other disease-causing organisms, including those that could be used in a terrorist attack. The new Staph vaccine is the latest product of research begun decades ago as scientists sought a vaccine to protect infants and young children against Haemophilus Influenzae type B (Hib). This often-fatal bacterial infection was the leading cause of meningitis among children under five in the U.S.

In 1983, John Robbins, M.D., and Rachel Schneerson, M.D., set up an NICHD laboratory to develop vaccines that were effective against bacteria. The two developed a vaccine to target the simple sugar molecule, or polysaccharide, on the surface of the bacteria that causes Hib. Polysaccharide vaccines were a major improvement on existing vaccines, which consisted of whole bacteria that had been killed or weakened and which could cause severe side effects. After testing the vaccine, the NICHD scientists found that it was safe and that it stimulated protective levels of antibody in adults and older children. Antibodies are molecules made by the immune system. Like tiny guided missiles, they zero in on a particular substance, tagging if for later destruction by the immune system. Scientists supported by NIAID did further testing and, with the added involvement of industry, three Hib polysaccharide vaccines were produced and licensed in 1985. But infants and very young children – those most at risk of Hib infection – could not be immunized with the first formulations of Hib vaccine because of their immature immune systems. To overcome this problem, Robbins and Schneerson modified the vaccine, creating what is known as a conjugate polysaccharide Hib vaccine. To make the vaccine, the researchers chemically attached, or conjugated, the sugar molecule to a protein molecule. The infants’ immune systems easily recognized the protein molecule, and, in the process, learned to recognize the sugar molecule as well. Before this vaccine, Hib infected about 20,000 U.S. children under age five each year, causing about 12,000 cases of meningitis and 1,000 deaths. The Hib vaccine is now routinely used to immunize infants and children in the U.S., Canada, Western Europe, and many other nations. As a result, meningitis caused by Hib has all but disappeared in these countries. In the U.S., universal childhood vaccination with Hib saves a total of $2.9 billion (medical and indirect costs) each year.

The trial with the new Staph vaccine was conducted in patients with kidney disease receiving dialysis treatment. These patients were chosen because they are at high risk of infection and are among the least likely to respond to immunization. The vaccine protected the patients for a short time against the two strains of S. Aureus that cause 85 percent of Staph infections. Booster shots will be tested to lengthen the period of immunity. More research will be directed to making the vaccine effective against other strains of staph. Similar vaccines against other hospital-acquired infections are now being designed.

Deadly Bugs Survive for Weeks in Hospitals

The bug that causes potentially deadly staph infections in hospitals can survive for weeks on a bed sheet or a computer keyboard, a new study finds.

Staph is the most common hospital-born infection in the United States. Consequences range from mild discomfort to death.

Particularly vexing is the bacteria methicillin-resistant Staphylococcus aureus (MRSA), which can cause conditions ranging from mild skin infections to serious surgical wound infections, pneumonia or blood infections.

The bacterium is one of several emerging "superbugs" that are increasingly difficult to control with conventional drugs because they've evolved a resistance to antibiotics. Recent studies have shown MRSA is cropping up outside hospitals at an increasing rate.

"The potential of MRSA to be transferred from person to person, in large part, depends on its ability to survive on environmental surfaces," said Kris Owens of Ecolab, Inc. in Mendota Heights, Minnesota.

In the study, two strains of MRSA were placed on various types of surfaces. The researchers found detectable levels of the organism on acrylic fingernails after eight weeks, on computer keyboard covers after six weeks, and on bed linen after five days.

The research was presented today at the General Meeting of the American Society for Microbiology.

"The results of this study clearly demonstrate the need for frequent hand washing and environmental disinfection in health care settings," Owens said.

By LiveScience Staff

Dirty Little Secrets

"The number of people needlessly killed by hospital infections is unbelievable, but the public doesn't know anything about it. For years, we've just been quietly bundling the bodies of patients off to the morgue while infection rates get higher and higher." That's what Dr. Barry Farr, a leading infection-control expert told The Chicago Tribune.

The Chicago Tribune's investigative series, UNHEALTHY HOSPITALS, penetrates the healthcare industry's long hidden facts about the rising rate of infection-related, preventable hospital deaths. This comprehensive analysis of 5,810 hospitals nationwide, examined the records of 75 federal and state agencies, plus internal hospital files, patient databases and court cases around the nation. The Tribune calculated 103,000 deaths in 2000 from hospital grown infections - 75% were pereventable. [Excerpt below]

A hidden epidemic of life-threatening infections is contaminating America's hospitals, needlessly killing tens of thousands of patients each year.These infections often are characterized by the health-care industry as random and inevitable byproducts of lifesaving care. But a Tribune investigation found that in 2000, nearly three-quarters of the deadly infections - or about 75,000 were preventable, simply the result of unsanitary facilities, germ-laden instruments, unwashed hands and other lapses.

Deaths linked to hospital bacteria represent the fourth leading cause of mortality among Americans, right behind heart disease, cancer and strokes, according to the Federal Centers for Disease Control and Prevention. Hospital infections often are preventable by adopting simple, inexpensive measures. Strict adherence to clean-hand policies alone could prevent the deaths of up to 20,000 patients each year, according to the CDC and the U.S. Department of Health and Human Services.

Hospitals provide ideal reservoirs for germs, with temperature-controlled environments and a steady stream of germ-carrying strangers pouring through the doors each day. Germs that wouldn't be harmful to healthy people in their homes or at work can turn deadly for patients too young, too old or too weak to fight the infection.

In Chicago in 1998, as fever-ridden healthcare workers tended to patients and as others worked without always washing their hands, eight children died of an infection that spread from the Misericordia Home on the Southwest Side into a hospital. The flulike outbreak, which the city of Chicago never revealed to the public, was halted weeks later after three dozen sick health-care workers were ordered to stay home. In a Detroit hospital, as doctors and nurses moved about the pediatric intensive care unit without washing hands, infections killed four babies in the same row of bassinets, according to court records and interviews. But it took three months for administrators to close the nursery for cleaning. Staphylococcus germs thriving inside a West Palm Beach, Fla., hospital invaded more than 100 cardiac patients, killing 13, according to court records. The survivors underwent painful and debilitating surgery, as rotting bone was cut from their bodies.

The health-care industry's penchant for secrecy and a lack of meaningful government oversight cloak the problem. Hospitals are not legally required to disclose infection rates, and most don't. Likewise, doctors are not required to tell patients about risk or exposure to hospital germs.

Even a term adopted by the CDC, nosocomial infection, obscures the true source of the germs. Nosocomial, derived from Latin, means hospital-acquired. CDC records show that the term was used to shield hospitals from the "embarrassment" of germ-related deaths and injuries.

To document the rising rate of infection-related deaths, the Tribune analyzed records fragmented among 75 federal and state agencies, as well as internal hospital files, patient databases and court cases around the nation. The result is the first comprehensive analysis of preventable patient deaths linked to infections within 5,810 hospitals nationally.

The Tribune's analysis, which adopted methods commonly used by epidemiologists, found an estimated 103,000 deaths linked to hospital infections in 2000. The CDC, which bases its numbers on extrapolations from 315 hospitals, estimated there were 90,000 that year.

The CDC links infections to patient mortality both directly and indirectly. Direct cases typically involve patients who specifically died of complications caused by an infection. Indirect cases involve infections that played a major role in a patient's death, but may not have been the primary cause.

For every death linked to an infection, thousands of patients are successfully treated each year. And many hospitals battle infections with diligence and the latest technology. But the Tribune investigation found that breakdowns occur more frequently than patients suspect and that the consequences often are deadly.

Government and hospital industry reports analyzed by the Tribune reveal that serious violations of infection-control standards have been found in the vast majority of hospitals nationally. Since 1995, more than 75 percent of all hospitals have been cited for significant cleanliness and sanitation violations.

In thousands of cases observed by federal or state inspectors, surgeons performed operations without washing hands or wearing masks. Investigators discovered fly-infested operating rooms where dust floated in the air during open-heart surgeries in Connecticut. A surgical assistant used his teeth to tear adhesive surgical tape that was placed across an open chest wound during a non-emergency procedure in Florida.

Hospital cleaning and janitorial staffs are overwhelmed and inadequately trained, resulting in unsanitary rooms or wards where germs have grown and multiplied for weeks, sometimes years, on bed rails, telephones, bathroom fixtures - most anywhere. The state of some of our hospitals is a shame. A dirty shame.