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Drug resistant infectious diseases

The March of the Superbug



New infectious diseases are popping up everywhere and becoming more and more resistant to our attempts to fight them. Superbug is one of them. It seems that the number of people infected is growing, and recently there was an outbreak in an Ontario jail. How do we prevent them? Can we control infectious diseases? We've identified some CIHR-funded health research experts to answer some of your queries about Superbug and other issues such as the importance of infection control. Dr. Allison McGeer, CIHR-finded researcher, Director, Infection Control, Mount Sinai HospitalProfessor, University of Toronto. Dr. Donald E. Low, CIHR-funded researcher, Microbiologist-in-Chief, Department of Microbiology, Mount Sinai Hospital.

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Superbug's march 'shocking' Not confined to hospitals. Aggressive drug-resistant strain infecting healthy people: survey

By Sharon Kirkey, Canwest The number of cases of a superbug that spreads through the body, causing everything from painful boils to bleeding in the lungs, is increasing in Canada and while most are acquired in a hospital, one in six is now coming from the wider community - infecting otherwise healthy people, even children. This represents a new means of infection for a disease that has been in hospitals for years, but has been largely unknown beyond their walls. What's more, the new community strain of drug-resistant staphylococcus aureus (known as methicillin-resistant staphylococcus aureus) is a different kind of animal, doctors say - a "fully-loaded," more virulent, more aggressive pathogen than the "old-style" hospital germ and one that's capable of causing more severe infections. "This really worries me. This is very serious stuff," said Dick Zoutman, director of infectious diseases atKingston General Hospital in Ontario. "It tends to be resistant to some drugs, but not all. It attacks very aggressively and makes very healthy people in the community very sick." The superbug can cause aggressive infections of the bone and spine as well as severe pneumonia. Zoutman said he's hearing "shocking stories" from colleagues in the U.S. - where community-acquired MRSA is spreading rapidly - of what the bug is capable of doing to otherwise healthy children, including severe soft-tissue infections and infections in multiple joints. Deaths have been reported in Texas involving teens who developed a rare form of pneumonia because of MRSA, including a healthy 14-year-old Dallas boy who died last year, four days after he went home from school with a mild fever. Now, the latest results from the national surveillance for MRSA to be made public today - based on data from 48 large adult and pediatric hospitals in all provinces except Prince Edward Island - show that for every 1,000 people admitted to hospital in Canada, eight are either infected with or carrying MRSA. The survey included five Quebec hospitals. The Public Health Agency of Canada has not identified which hospitals were included in the survey, to encourage them to continue reporting their infection rates. Overall, there were 5,787 "newly identified" MRSA cases during the 2006 surveillance period, of which 3,561, or 62 per cent, were acquired in the hospital, seven per cent in other acute care hospitals and eight per cent in long-term care facilities. Community-acquired MRSA accounted for 893, or 15 per cent, of the reported cases, meaning the patients arrived at the hospital already infected. The remaining seven per cent of cases were of unknown origin, according to the report being issued by Public Health Agency of Canada. "Whichever way you cut it, whether you look at it per 1,000 admissions, per 10,000 patient days, the overall rates of MRSA that we're seeing in our Canadian hospitals from coast to coast is increasing. There's no two ways about it," said John Conly, professor of medicine, microbiology and infectious diseases at the University of Calgary and Calgary Health Region. "We're seeing more cases of infection and more cases of people who are carrying or colonized." The infection begins with what looks like a spider bite, a red, very tender area that rises up and comes to a head just like a small boil. If not treated promptly, the lesions can develop into large, spreading abscesses in the soft tissues that can grow to the size of a baseball, or even a grapefruit. People develop fever, malaise and flu-like symptoms. In some cases, MRSA can cause hemorrhagic pneumonia, or bleeding in the lungs. The strain contracted in hospital, which causes wound infections and pneumonia, tends to be resistant to a number of antibiotics and it colonizes more patients than it infects, Conly said. The new community strain, on the other hand, appears more nimble and seems to spread more readily. It's also moving out of traditional risk groups, such as intravenous drug users, the homeless, prisoners, people infected with HIV and members of the military. It has infected college and high-school athletes, and schools in Chicago and Boston have reported students infected with MRSA. The bug is spread through physical contact, through open cuts and scrapes, poor hygiene and sharing soap, towels, creams, razors and other personal items. About one-third of the population carries the staph germ, whether it's drug-sensitive or drug-resistant. It's the most common cause of boils and infected cuts, scrapes and surgical wounds. The community bug is starting to creep into hospitals, Conly said. He said doctors will report, at an coming meeting in Montreal of infectious disease specialists, that a small cluster of cases occurred in an intensive care unit in Calgary within the past year. Some hospitals have starting swabbing all patients to check for MRSA. But new studies suggest the community strain tends not to be found in the nose, but rather in the groin or rectal areas, "so if they're relying on nose cultures, they may be missing a large number of them," Conly said. Zoutman said Canada urgently needs more systematic surveillance of infection rates. Surveillance for MRSA, which started in 1995, is based only on a sampling of Canadian hospitals. "This needs to become a big-budget item," Zoutman said. "This needs to happen nationally so that people who are trying to control these diseases have the information."

MRSA outbreak strikes Ontario jail

by CBC News Four inmates at an eastern Ontario jail have been placed in isolation after contracting a type of bacterial infection resistant to ordinary antibiotics, the Ontario Ministry of Correctional Services has confirmed. Spokesman Stuart McGetrick said the inmates diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) at the Brockville jail are being treated with special antibiotics and are expected to recover. He added that the jail is taking other special precautions to deal with the infections. "Areas of the institution that the inmates were previously housed in have been thoroughly cleaned," McGetrick said. "Things like bed linen used by the inmates undergo special laundry treatment." MRSA usually causes only mild infections, but can progress to large boils, hemorrhagic pneumonia or flesh-eating disease in rare cases. It rarely affects healthy people and is most often seen in hospitals and nursing homes, where it is considered a problem because it is resistant to the antibiotics penicillin and methicillin. Therefore, it must be treated with vancomycin, an antibiotic that is only used as a last resort because it is extremely irritating to human tissue. The Ministry of Correctional Services was asked about the infections after the CBC received calls from two prisoners who were worried about the outbreak. Inmate Thomas Jacques said he asked a nurse about it, but wasn't satisfied with her answer. "She's like, 'Oh, well, don't worry about it, just wash your hands,'" he said. "Well, OK, we wash our hands, but even if we touch the bars, we're still going to end up catching it if we have an open wound or something, you know." Jane Futcher, director of clinical services for the Leeds, Grenville and Lanark district health unit that includes Brockville, said she isn't surprised that the infections are showing up in jails. "You look at our jail system and you also have some people who have been living on the streets ... so their immune systems are probably not the best," she said. Public health officials have said they are seeing an increase in MRSA infections outside medical institutions, at places such as daycares and locker rooms. However, they don't know the extent of the problem, as there is no requirement to report infections to local health units.


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