RE: Re: C Diff and other killer bugs!

January 3, 2007

Here’s something that was in one of the UK national newspapers on 18th

December. The links are probably more helpful to those of us in the UK

but the article is interesting (if not a little long!) There has also

been an outbreak in Canada recently reported of a more virulent strain

of c. diff which is fatal more quickly. I can’t remember the website

address but I’ll post it if I ever find it again!

Q & A: MRSA and other killer superbugs

Superbugs - including MRSA and the virulent stomach bug clostridium

difficile - cost the NHS £1bn a year and though most cases are reported

in hospitals they can be caught anywhere. What are these infections, and

what can be done to halt their spread? Batty explains

Monday December 18, 2006

SocietyGuardian.co.uk <http://www.societyguardian.co.uk/>

What is MRSA?

MRSA is the most prevalent type of hospital-acquired infection in

England, which strikes around 100,000 people each year and costs the NHS

£1bn, accounting for 44% of cases. MRSA, which stands for

methicillin-resistant staphylococcus aureus, is one of a family of

staphylococcal bacteria. First identified in the 1960s, it is resistant

to conventional antibiotics, including penicillin and methicillin.

Experts have so far uncovered 17 strains of MRSA, with differing degrees

of drug resistance. US scientists have detected a strain called VRSA,

which is resistant to vancomycin - the drug used to treat MRSA when all

others have failed.

How dangerous is MRSA?

It is estimated that between 20% and 40% of people in the UK carry MRSA,

mostly in the nose or on the skin. So-called community-acquired MRSA

(C-MRSA) is usually relatively harmless for the general population,

although it can cause boils or other minor infections. However, patients

in hospital tend to be older, sicker and weaker than the general

population, making them more vulnerable to the bacteria. MRSA can cause

significant infections in deep wounds, on medical devices such as

artificial hip joints or heart valves, or if it gets into the

bloodstream via intravenous catheters, particularly in severely ill

patients, such as those undergoing chemotherapy. Bloodstream MRSA

infections can lead to kidney, liver and heart failure.

What about the new killer MRSA?

A rare mutation of C-MRSA produces the lethal toxin Panton-Valentine

Leukocidin (PVL), which killed the 18-year-old Royal Marine

- in November 2004. PVL destroys white blood cells, leaving

the immune system too weak to fight the infection. Signs of infection

include pneumonia, coughing up blood and very high temperatures. Only a

quarter of victims survive PVL if it spreads to the lungs. It was

thought the disease had been eradicated in the 1950s, but a

microbiologist who gave evidence at Mr -'s inquest said she

had seen two cases of PVL in nine weeks. The Health Protection Agency,

which tackles infectious diseases, has revealed that two people - a

patient and a healthcare worker - died in a West Midlands hospital in

September 2006 after contracting PVL.

What about clostridium difficile?

A virulent new strain of bacteria, clostridium difficile (C diff), is

linked to three times as many deaths as MRSA. The bacterium was

responsible for 934 deaths among 44,500 patients infected by it in

England last year. Dozens of hospitals - about a quarter in England -

had to close wards in the last 12 months because of outbreaks.Unlike

MRSA, C diff is not resistant to antibiotics and not officially

recognised as a superbug by the Department of Health (DoH). It is a

common bacteria carried harmlessly in the gut of half of all children

aged under two and many adults. But it causes diarrhoea, which can be

life-threatening in elderly patients. In 2004, 1,300 people in England

died after contracting C diff in hospital.

The increase in cases - a rise of 32% over 2002-03 and 23% over 2003-04

- is blamed on the use of antibiotics, which kill off other bacteria in

the gut that would have ensured C diff did not become toxic. Another

problem is that C diff is not killed off by measures used to combat

other hospital-acquired infections. It produces hardy spores, which are

not destroyed by the alcohol wipes now used by doctors and nurses to

prevent the spread of most bacteria. Surfaces must be cleaned with

bleach and hands should be thoroughly washed with soap and water. A

survey of hospital trusts by NHS inspectors found that 40% had failed to

address the inappropriate use of antibiotics, and around the same

proportion did not have space to isolate infected patients.

How prevalent is MRSA in hospitals?

MRSA has reached epidemic levels in UK hospitals. Cases of MRSA in

England and Wales have increased by 600% in the last decade, and by 3.6%

to 7,647 in 2003-04 alone, according to government figures. But the

public spending watchdog, the National Audit Office (NAO), has estimated

that deaths from hospital-acquired infections, including MRSA, are as

high as 5,000 a year.

Earlier this year, the Conservative party estimated that around 96,000

hospital patients in England were carrying MRSA in 2004. This is 13

times greater than the DoH figures for the same year, which only cover

cases where MRSA is detected in patients' blood. Records from 63 of

England's 175 hospital trusts obtained under the Freedom of Information

Act revealed that 34,432 inpatients were found to be carrying the

superbug in 2004. This equates to an average of 547 cases per trust and

a national total of nearly 96,000.

What do the latest figures show?

Overall in England, levels of MRSA dipped slightly in 2005, from 7,233

to 7,087, according to the Office for National Statistics. But the

number of cases falls far short of a government target to halve the

number by 2008. The number of deaths related to MRSA increased by almost

a quarter over 2003-04. MRSA is now six times more likely to be a factor

in the deaths of people in NHS hospitals than anywhere else. A total of

1,168 people had MRSA recorded on their death certificate as a principal

cause of death or a contributory factor in 2004, a rise of 213 from the

previous year.

Why have MRSA rates risen so rapidly?

The most commonly cited cause is poor hygiene in hospitals. the Public

services union Unison blames the decline in hospital cleaning staff

numbers for the increase in infections. Since the 1980s, when the NHS

started to contract out cleaning to the private sector, the number of

cleaners has almost halved - from 100,000 to 55,000 in 2003-04. Doctors

and nurses have also been accused of failing to always wash their hands

between treating patients. The Patients Association believes that large

NHS deficits have led some hospitals to cut their cleaning contracts,

further increasing the risk of infection.

The overuse of antibiotics is also blamed for the rising rates of

infection. Over-reliance on the drugs has helped speed up the ability of

germs to mutate for self-preservation. Many people ignore their doctor's

advice to finish an entire course of antibiotics. This means that not

all the bugs are killed off and the ones that survive are most likely to

be drug resistant. Ministers claim that the rise in infection rates is

linked to advances in medicine allowing people to live longer, but

requiring more major operations that can lead to infection. The drive to

cut waiting lists by filling every hospital bed is also blamed for

increasing numbers of infections, as it is not always possible to

isolate affected patients.

What is the government doing to tackle MRSA?

Surveillance of MRSA and C Diff is now mandatory for hospitals. One 50%

of hospitals trusts are on course to meet the government target of

reducing the number of MRSA bloodstream infections by half by April

2008. Earlier this year control teams were sent into the 20 hospitals

with the worst MRSA infection rates. The Health Act (2006) introduced a

statutory hygiene code for hospital and care homes in England.

What do the experts say?

The microbiologist Mark Enright, of Imperial College, London, warns that

government initiatives, such as more frequent handwashing by doctors and

nurses, were insufficient to control the rise of MRSA. This is because

more than 95% of UK patients who contract hospital superbugs are

infected with the two most virulent types of MRSA, uncommon in other

countries. He says rates of infection would only fall significantly by

screening all patients and isolating those with strains 15 and 16 of

MRSA.

Be in the know

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Full text

Department

<http://image.guardian.co.uk/sys-files/Society/documents/2005/03/08/MRSA

..pdf> of Health: trust by trust MRSA rates (pdf)

National

<http://image.guardian.co.uk/sys-files/Society/documents/2004/07/14/0304

876.pdf> Audit Office report (pdf)

Department

<http://image.guardian.co.uk/sys-files/Society/documents/2004/07/12/MRSA

report.pdf> of Health: MRSA action plan (pdf)

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RE: Re: C Diff and other killer bugs!

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