Re: MRSA - Beware!
From: Joe (forcep@intercom.net)
Tue Dec 27 18:54:00 2005
Yes, just had my first positive one in young girl in armpit. Joe C
Lynn D. Montgomery, M.D. wrote:
> Interesting discussion. I had my first breast abscess in almost 18 years of
> practice that required surgical debridement and it grew out MRSA. Kind of
> shocked both me and the general surgeon - who interestingly stated that she
> is seeing more and more MRSA infections that seem to arise in unexpected
> places...
> Lynn
>
> Lynn D. Montgomery, M.D.
> Maternal-Fetal Medicine, OB/GYN
> Rocky Mountain Women's Health
> 2835 Fort Missoula Rd., Suite 304
> Missoula, Montana, 59804
> 406-549-0978
> fax 406-549-0987
> e-mail: apgar10@montanadsl.net
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Anna
> Meenan, MD
> Sent: Tuesday, December 27, 2005 8:40 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: MRSA - Beware!
>
> The antibacterial hand sanitizers still kill everything except C.Diff.
> Antibiotic overuse and LACK of handwashing the most likely culprits IMHO.
>
> Anna Meenan, MD
>
> At Tue, 27 Dec 2005, Richard Chudacoff, MD wrote:
>
>>Do you thing any of this is related to the use of antibacterial soaps,
>>which are now so prevalent in the US?
>>
>>--
>>Richard Chudacoff, MD, FACOG
>>
>>-----Original Message-----
>>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Anna
>>Meenan, MD
>>Sent: Sunday, December 25, 2005 11:07 AM
>>To: Multiple recipients of list OB-GYN-L
>>Subject: Re: MRSA - Beware!
>>
>>If the data are indeed 5 years old, then I KNOW the rate of MRSA
>>carriage has got to be higher. Just in the last year I am seeing cases
>>of MRSA infection in previously healthy people, and the FP literature I
>>read confirms this. We saw an 18-month-old in clinic with multiple
>>MRSA abscesses on the skin of his abdomen and flank. I used to tell
>>people whose (usually elderly and infirm) relatives were diagnosed with
>>MRSA in the hospital not to worry when they brought them home, because
>>it did not cause infection in healthy people. Well, that advice is no
>>longer valid.
>>
>>It means that we all have to work harder to avoid unnecessary
>>antibiotic prescribing, and to me that includes doing beta-strep
>>prophylaxis during labor for indications not supported by CDC guidelines.
>>
>>Anna Meenan, MD
>>
>>At Sat, 24 Dec 2005, RModugno@aol.com wrote:
>>
>>>ATLANTA, Dec. 22 - In the first national census of Staphylococcus
>>>aureus, more than 89 million Americans were colonized, according to
>>>researchers
>>
>>here,
>>
>>>and 2.3 million were carrying a methicillin-resistant strain, the
>>
>>so-called
>>
>>>superbug.
>>>Data from the National Health and Nutrition Examination Survey
>>>(NHANES), collected in 2000 and 2001, showed that S. aureus
>>>colonization is common, although methicillin-resistant S. aureus
>>>(MRSA) colonization in the
>>
>>general
>>
>>>population is unusual, according to Matthew Kuehnert, M.D., of the
>>>CDC
>>
>>here.
>>
>>>The rate of S. aureus colonization was about 32% and the rate of MRSA
>>>colonization was less than 1%, Dr. Kuehnert and colleagues reported in
>>>the
>>
>>Jan. 15
>>
>>>issue of the Journal of Infectious Diseases.
>>>On the other hand, they noted, these data come from a snapshot of the U.S.
>>>population taken almost five years ago and colonization rates may have
>>
>>changed
>>
>>>since then.
>>>Indeed, more recent studies -- although not national in scope --
>>>showed
>>
>>rates
>>
>>>of MRSA colonization ranging from 3% to 22%, according to three
>>>infectious disease specialists, in an accompanying editorial.
>>>"The times -- along with MRSA colonization rates -- are, indeed,
>
> changing,"
>
>>>wrote Clarence Buddy Creech II, M.D., Thomas R. Talbot, M.D., and
>>>William Schaffner, M.D., all of Vanderbilt in Nashville.
>>>However, they noted, while colonization usually precedes infection,
>>>relatively few colonized people will go on to develop staphylococcal
>>
>>disease.
>>
>>>In 2000 and 2001, nasal samples for S. aureus culture, as well as
>>>sociodemographic data, were obtained from 9,622 people (older than one
>>
>>year) who were
>>
>>>taking part in the NHANES survey.
>>>The prevalence estimates were weighted to represent the general U.S.
>>>population, because the survey itself over-samples low-income people,
>>
>>pregnant
>>
>>>women, adolescents, people older than 60, non-Hispanic blacks, and
>>>Mexican Americans, Dr. Kuehnert and colleagues wrote.
>>>After adjustment, the survey found:
>>> * The S. aureus colonization prevalence was 32.4%, with a 95%
>>>confidence interval ranging from 30.7% to 34.1%, which worked out to
>>>89.4
>>
>>million
>>
>>>Americans, with the range from 84.8 to 94.1 million.
>>> * The MRSA prevalence was 0.8%, with a 95% confidence interval
>>
>>ranging
>>>from 0.4% to 1.4%, or 2.3 million people (ranging between 1.2 and 3.8
>>
>>>million.)
>>> * The risk of S. aureus colonization was highest among those
>
> between
>
>>>six and 11 years old.
>>> * Among non-Hispanic whites and Mexican Americans, men were
>>>significantly more likely to be colonized by S. aureus than women.
>>>The
>>
>>odds ratios were
>>
>>>1.5 and 1.3, respectively, with 95% confidence intervals of 1.3 to 1.8
>>>and
>>>1.1 to 1.6.
>>> * Non-Hispanic white men and Mexican Americans were significantly
>>
>>more
>>
>>>likely to be colonized than non-Hispanic blacks. The odds ratios were
>>>1.7
>>
>>and
>>
>>>1.2, respectively, with 95% confidence intervals of 1.4 to 2.0 and
>>>1.1 to 1.4.
>>>On the other hand, people who were 60 or older were more than four
>>>times as likely to be colonized with MRSA as were those 19 or younger.
>>>The odds
>>
>>ratio
>>
>>>was 4.3, with a 95% confidence interval from 1.2 to 14.8.
>>>Also, women were twice as likely to have MRSA colonization as men.
>>>The
>>
>>odds
>>
>>>ratio was 2.0, with a 95% confidence interval from 1.2 to 3.4.
>>>Finally, non-Hispanic blacks were three times as likely to have MRSA
>>>as
>>
>>were
>>
>>>Mexican Americans (odds ratio 3.1, confidence interval 1.2 to 8.3),
>>>but
>>
>>there
>>
>>>were no other significant differences on the basis of race or ethnicity.
>>>The researchers noted several limitations. In addition to the
>>>possibility that prevalence rates have changed, they said it is
>>>possible that some of
>>
>>the
>>
>>>colonies were transient, that a cohort effect might have skewed the
>>
>>demographic
>>
>>>findings, and that some associations may not have been detected,
>>
>>especially
>>
>>>for MRSA, because of relatively small sample size.
>>>Also, they said, several factors that could affect colonization, such
>>>as previous antimicrobial exposure, were not analyzed and could
>>>confound the
>>
>>data
>>
>>>for MRSA colonization.
>>>The Vanderbilt editorialists pointed out that the results of NHANES
>>
>>analysis
>>
>>>are consistent with smaller, regional and local studies carried out at
>>>the same time. Indeed, sites as widespread as Chicago, Nashville,
>>
>>Charlottesville,
>>
>>>Va., and San Francisco had "small but noteworthy" reservoirs of MRSA,
>>>at prevalence rates ranging from 0.6% to 2.8%.
>>>But MRSA-driven staphylococcal infection is rising, in some cases,
>>>reaching as high as 75% of all community-associated staphylococcal
>>>disease in
>>
>>children,
>>
>>>they said.
>>>In a study of 500 healthy children in Nashville, published earlier
>>>this
>>
>>year,
>>
>>>they found 9.2% were colonized with MRSA - more than 10 times higher
>>>than
>>
>>a
>>
>>>2001 study that used the same method in the same community.
>>>Such findings "highlight the changing epidemiologic profile of MRSA in
>>>the community," they say.
>>>********************************************************
>>>Robert Modugno MD MBA FACOG
>>>********************************************************
>>>********************************************************
>>>Marietta, GA
>>
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