MRSA - Methicillin Resistant Staphylococcus Aureus 

  Staphylococcus  - Once MRSA was just a simple germ  

Staphylococcus - A genus of spherical bacteria of the family Micrococcaceae, is the best known species of which are universally present in very great numbers, on the mucous membranes and skin of humans, and some other warm-blooded animals. The term staphylococcus, generally used for all the species, refers to the cell's habit of assembling in grapelike clusters. Staph, is a commonly used slang name for this bug.

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Staphylococci are microbiologically characterized as gram-positive -  in young cultures, and non-spore-forming, non-motile, facultative anaerobes - not requiring oxygen. 

The cells average 1 μm - micrometer; 1 μm = 0.00l mm,  in diameter and are usually clustered.

Micrometer - also called Micron, metric unit of measure for length equal to 0.00l mm, or about 0.000039 inch. Its symbol is μm, or one millionth of a meter. The micrometer is commonly employed to measure the thickness or diameter of microscopic objects, such as microorganisms and colloidal particles. Minute distances, as, for example, the wavelengths of infrared radiation, are also given in micrometers.

Significant to humans, are two variants of the species Staphylococcus. Aureus, an important agent of wound infections, boils, pustules, and other human skin infections, and one of the most common causes of food poisoning. Staphylococcus. Aureus, also causes udder inflammation, or mastitis, in domestic animals and breast infections in women.

It has become a difficult hospital pathogen because of its resistance to antibiotics. Staphylococcus. Aureus epidermis is a milder pathogen that is opportunistic in persons with lowered resistance. Many strains of Staphylococcus Aureus are now resistant to penicillin. This is because Staphylococcus Aureus has evolved or mutated, simply by accident, to make a substance called ß-lactamase - pronounced beta-lactamase, that degrades penicillin, destroying its antibacterial activity. Tests done on any Staphylococcus Aureus grown from such specimens can then decide how sensitive the organisms is to antibiotics and if it is a Methicillin resistant (MRSA) organism. These test usually take 2-3 days.

Bactericidal - Bactericides - Capable of killing bacteria. Common bactericides are some antibiotics, antiseptics, and disinfectants. many cleaning products are sold, that claim or state to kill all or 99% of all known germs. There are many antibiotics, antiseptics, and disinfectants that will readily kill bacteria, but may also kill or damage the host you wish to cure. Bleach will kill 99.9% of all known micro-organisms but will also kill any person who hosts the germs, you want to attack.

   Vancomycin Resistant Staphylococcus Aureus 

June 1997

The recently publicized finding of a strain of Staphylococcus Aureus showing resistance, or reduced susceptibility, to Vancomycin has caused considerable concern, especially since the low level of the resistance means that such strains may be missed in routine laboratory anti-microbial susceptibility tests. Dr Keiichi Hiramatsu of Juntendo University, Tokyo, Japan, who described the characteristics of the Vancomycin-resistant strain, has provided a summary and a provisional method for detection available on EMC's web site for Anti-microbial Resistance. An account of his findings will be published in Journal of Anti-microbial Chemotherapy in July 1997. 

The number of MRSA deaths doubled in four years between 1999 and 2003, official statistics show.

Ministers have set ambitious targets to tackle the problem - and point to a significant drop in infections during 2004, but the Tories say not enough is being done.

   How is infection or indeed colonization with MRSA diagnosed? 

To identify a MRSA infection, samples of skin, blood, urine, pus, other fluids are taken from the patient. Samples are determined on what area of the body the infection is emanating.

These are then sent to a microbiology laboratory, where any bacteria present in the sample is placed in a Petri dish  - a round shallow covered dish used for the culture of bacteria etc.

Culturing is placing the particular specimen into a Petri-dish which has a sterile, sometimes warm sweet medium ideal for it to grow. This process can take several days. A bacteriologist will then examine the results under a microscope.

Bacteriologists are highly trained to successfully identify a myriad of micro-organisms, they are able to pick out particular microscopic organism, e.g. bacteria, protozoa, and viruses,  as easily as you could pick out your parents in a line-up.

Colonization with MRSA is detected similarly, using swabs of a person's skin or from the inside of the nose / throat.

    Other Factors  

 Methicillin  Resistant  Staphylococcus  Aureus 

 Bacteria - a diverse group of ubiquitous micro organisms 

 MRSA - Methicillin Resistant Staphylococcus Aureus 

By Roy G Symonds BA   © 2004 - 2006

This website has said for years, that out of all the dilemmas that face Humankind, the one that will definitely get us in the end, is the humble bug - Bacteria - a diverse group of ubiquitous micro organisms, that is our smallest, but potentially our most threatening adversary. They know no bounds and because their breeding-cycle can be measured in minutes, they evolve at an amazing rate. It could be said that they have the potential to evolve and therefore adapt, at a rate 750,000 times greater than our own. It is hard for us to conceive how we can keep pace with them really.

And just as they have a multi-myriad collection of species and kinds, we also are just as unique. Every human is unique, made up of a unique group of genes and coding. Therefore every person reacts in a unique way to germs, coughs and diseases. Genes can be described as having, or giving, a propensity, an inclination or tendency to act in a particular way. So some of us will be more resistant, or even extra resilient in germ-warfare, by having a better natural protection. Then, some will not.

This is not only due to our inherited make-up but other factors, such as age and health. In any horrendous and hideous epidemic, there is always 1% that will be naturally immune; Mother Nature's way of continuing her work. Therefore MRSA, will not kill all of us, just 99%.

By some accounts, in the United Kingdom, five thousand plus people, mostly hospital patients, die every year from a MRSA related infection. These are, to the greater extent, unnecessary deaths, as it can be significantly avoided with good house-keeping. 

Taking strict regard to sinks, toilets, corridors; in fact any area that can be contaminated from some outside source. Taking strict regard to the quick and efficient disposal of contaminated waste.

Nurses, doctors and auxiliaries should be totally aware that it is almost definite that they will be carrying either MRSA or some other potentially life-threatening microbe. They must wash their hands and lower arms religiously. Especially in between patients. They should be aware that they must be vigilant to the fact that they will be touching implements, doors, paperwork that will undoubtedly be carrying bacteria. 

Has anyone considered that the new trend of doctors, in Britain, not wearing white coats anymore, might be a factor. It would take a brave person to say this has had no detrimental consequence.

Staphylococcus Aureus is just one germ, but it is all around us and probably has been since the beginning of time, in one form or another. In secret random tests in hospitals, of doors, corridors, elevator buttons, etc,  eight samples out of every ten produced evidence of MRSA.

In random tests, not only is it on our skin and clothes, a third of Westerners carry MRSA in their noses, other orifices, and other skin areas. In the many cases that contain the Staphylococcus Aureus that is MRSA, why have these carriers not been affected by this. Well actually the skin, nose, the ear and even the stomach and all the connecting pipe work are actually outside of the body.

So the skin keeps the germs out, but when the bug finds a way in, via cuts, drips or surgery, it can mean a harmless infection; just a high temperature, or lethargy,  blood-poisoning, or for some it might mean certain death. This again depends though, on our own personal propensity to deal with it. Moreover, it will also depend on the particular strain of the bacteria, and the environment it is in. A warm wet place like live blood will encorage it to multiply beyond calculation, and a higher strain will be impervious to the body's defenses. Simple wounds that have been treated and stitched, have turned into pus-filled sores, that have resisted healing.

The now famous Flesh-Eating Disease, was just one type of ubiquitous microorganism, that was quite resilient, but only had an effect on the lower dermis; it ate away at the inner layer of our skin thus giving our outer skin layers nothing to hold onto, revealing bare flesh and giving the impression that the victim was being eaten alive. Again this was down to dirty hands or implements not being completely cleaned.

But why has this germ become resistant to antibiotics? 

There are many reasons. For one, bacteria has the potential to evolve and adapts at a speed 750,000 times faster than we do, therefore anything that we throw at it, whilst it will kill it, it must kill all of it. Any not killed, will live on to fight another day and this is why you MUST take all of your course of antibiotics.

Most patients will take only half of a course of anti-biotic tablets prescribed by a doctor, even though the label states clearly that the whole course MUST be taken.  It is because after a day or two, you will feel better, due to the impact of the drug, and the body's own defences enthused with this outside help. But whilst you might be slightly better armed to conquer this particular one in a billion billion microbes, others might  not, and even then the thing might mutate, and you will be back where you started.

Because we have taken so long in battling this problem, it has grown stronger everyday, perhaps lying dormant, contained or in stasis for a millennium, only to one day find a human host and a society willing to take it for granted, thinking that we are invulnerable to this miniscule mite.

Bacteria multiply so much more quickly than us, this mutation factor is therefore much increased, giving a far greater chance for a bacteria to be produced that are immune to normal antibiotics. 

MRSA, is much more prevalent in hospitals, again due to many reasons. Any super-strain will have a far greater influence on someone weakened after an operation, illness, or other infection or disease.  Patients by their very position have a weakened immune system. An older person's immune system does not work so efficiently or voraciously as it once did, and if the patient is living in a hospice  environment, that is just a melting-pot of infectious entities, that are just queuing up to do their dirty deed, they will be at risk.

So it is the duty, the God-given and legal duty for hospitals, auxiliaries, nurses and doctors to protect their patients, from the dangers that MRSA will convey. 

It boils down to simple hygiene and good practice. Taking regard to susceptible areas like under beds, sinks, toilets, corridors, stairs, lockers, elevators, floors, kitchens and most importantly the operating-room. The fluff under beds can carry germs and small particles act like air-craft, carrying germs in the air until they can parachute into an open wound.

So a major element of this problem lies in the hands of the hospital staff. Every patient can and must ask their health care worker,  if they have washed their hands. 

Every health care worker must take it for granted that they could cross contaminate another patient, from one that is fit and healthy and well armed to fight MRSA, to a person who is not, and therefore could potentially face death. Just ONE bacteria could reproduce itself into a billion cells in no time at all.

So it is clear that there must be a clear link between today's cleaning standards and the increase in cases of MRSA related diseases. Only a few years ago, the cleaning of hospitals was done in-house, but to save money cleaning services have been contracted out. Obviously to the greater extent, to companies who think that they understand the mechanics of such an important task, and how actually important it is, but also they want to make as much profit as possible. We believe that the standard should be an ultra-high one and nothing else.

A recent secret / undercover inspection was made by a BBC journalist, who employed an agent to get a job as a cleaning operative. The findings made it very apparent that large hospitals in the UK, turning over not only large numbers of patients, but large amounts of money, are grossly under maintained. In the interview for the job, the cleaning company stated that they took their training seriously. The training lasted under ten minutes. The trainer emphasized ways of getting the job done quickly as opposed to getting the job done well, and said that if it looked clean, leave it. The same cleaning cloth was blatantly used to clean the toilet and then the sink. When the reporter enquired that if this was safe, the experienced trainer told him that it was fine.

The fundamental problem here is that we cannot see MRSA. When asked about what he thought about the dangers of MRSA, he had no knowledge that this serious microbe actually existed, and had worked as a cleaning supervisor for over five years. Ultimately this is the fault of hospital chiefs, but government must also take the blame, especially as statistic-taking has never been so widespread in the NHS.

Behind the scenes in the cleaning storage areas, in health-care workers changing rooms, and private eating areas dust, fluff and dirt was everywhere. Many large hospitals in the UK, even under the publicity and information that is being shouted out by many concerned bodies, are still time-bombs to completely unnecessary illnesses. In fact out of the 5,000 patients that die of preventable MRSA infections each year, how many relatives know the full facts? How many old people die pointlessly, only to have their deaths blamed on something unrelated.

A thousand hospital doctors were asked if they thought that cleaning standards in their workplace was good enough. Just under 62% said that they thought it was not high enough in today's high expectations.

 Government action has been slow, but now under the weight of adverse publicity they have launched a £200 million campaign to cut senseless incidents. A Super-Gel has been developed to kill all known germs. Nurses will have to wear their own personal dispenser, so that they can keep their hands germ-free at all times. We suspect though that rubber / latex gloves, or some other barrier, will have to be worn and these will be washed or treated as operative's hands will not stand up to this punishing wear and tear.

But is this enough? On this website we advise thousands of readers every year about the humble but daunting flea. We advise vacuuming thoroughly to suck up the eggs and larvae of the flea.

  This is to break their cycle of life. 

Drug Resistant Staphylococcus Aureus has been around in one form or another, for nearly half a century. If the cleaning is not made more effective the germs will still exist in another 50 years, so it is here that measures must be made, to break the cycle of death. 

If nothing is done, at its present rate of growth, within five years research claims that 100,000 could die each year. It could be you.

Some irony in all this, is that it has been reported that there are some large hospitals in Africa where most of the time, they do not have running water at all. Their case numbers of MRSA, is practically nil.

********************

A recent article in the Telegraph, in the UK, and also mentioned on mrsawatch recently commented on this subject.

"  The death from the hospital superbug MRSA of a baby less than two days old is extremely rare and suggests that he was born with the infection, according to doctors. "

The death of a baby, just 36 hours old and apparently healthy, remains something of a mystery, since his family, the staff who cared for him, the unit and the equipment all tested negative for the deadly bacterium.

But the infection is not unknown in babies. Provisional figures from the voluntary reporting system in infants under five show there were 52 cases last year. In 2003, there were 72 cases compared with 23 in 1997.

A study last year of 376 reports of MRSA in children in 1990 to 2001 showed 53 per cent of cases were in babies under a year old. The Health Protection Agency said MRSA infection in these babies had risen from one per cent of the total in 1990 to 13 per cent in 2001.

Dr Jeff Bissenden, a consultant paediatrician at the City Hospital, Birmingham, said: "Any consultant working in a paediatric unit will have seen a case. But the only way a baby could have died that quickly is if he was born with it. This is an extremely rare event."

If a baby became ill, doctors would probably start antibiotics, but unless there was a reason to suspect MRSA they would not select Vancomycin, the antibiotic of last resort   ".

CMV can be passed to the baby through the placenta. It can also be caught during birth or from breastfeeding

   Clostridium Difficile  

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Bacteria  - Microscopic single-celled organisms found wherever life is possible. Generally 0.0001–0.005 mm long, they may be spherical (coccus), rodlike (bacillus), or spiral-shaped (spirillum) and often occur in chains or clusters of cells. True bacteria have a rigid cell wall, which may be surrounded by a slimy capsule, and they often have long whip-like flagella for locomotion and short hair-like pili used in a form of sexual reproduction. A few bacteria can use simple chemical substances, including carbon dioxide from the atmosphere, to manufacture their own nutrients, but most require a source of carbon derived from living organisms (i.e. organic carbon) plus other nutrients for growth. Some bacteria can reproduce every 15 minutes, leading to rapid population growth.

The most important role of bacteria is in decomposing dead plant and animal tissues and releasing their constituents to the soil (see carbon cycle). Nitrogen-fixing bacteria in the soil or sea convert atmospheric nitrogen gas to nitrites and nitrates, which can then be used by plants (see nitrogen cycle). Cheese making and fermentation reactions depend on bacteria. Bacteria also play an important part in animal digestion, especially in ruminants. However, certain (pathogenic) species may cause disease while others, such as Salmonella, can cause food poisoning.

How Does Your Body Fight Infection?

Immunity   -  The resistance of the body to infection, especially resistance due to antibodies. Babies have passive immunity from antibodies transferred from the mother’s blood through the placenta. Active immunity involves the formation of antibodies after exposure to an antigen - bacteria that invade the body during an infection are antigens. The two different kinds of immune response produced by antibodies involve: white blood cells called T-lymphocytes - produced by the thymus, which produce cells with antibody properties bound to their surface and are responsible for such reactions as graft rejection; B-lymphocytes, which produce cells that release free antibody into the blood.

Leucocyte - lymphocytes - or white blood cell. A colorless cell found in large numbers in the blood. There are several kinds, all involved in the body’s defense mechanisms. Granulocytes and monocytes destroy and feed on bacteria and other microorganisms that cause infection -  see also phagocyte. The lymphocytes are involved with the production of antibodies.

Phagocyte   -  A cell that engulfs and then digests particles from its surroundings: this process is called phagocytosis. In vertebrate animals, phagocytes are a type of white blood cell that protect the body by engulfing bacteria and other foreign particles.

Immunization is the production of immunity by an injection containing antibodies against specific diseases e.g. tetanus and diphtheria, which provides temporary passive immunity, or by vaccination, which produces the longer lasting active immunity.

Antibody   -  A protein produced by certain white blood cells  - lymphocytes that reacts with a particular foreign particle e.g. a bacterium,  that has entered the body. The antibody helps to destroy the foreign particle, known as the antigen. If the same bacteria invade the body in future, many more of the same antibodies are produced, enabling the body to destroy the bacteria very rapidly and so resist infection. This provides the basis of  immunity. Antibodies are also responsible for the rejection of foreign tissue or organ transplants. See also monoclonal antibody.

Monoclonal antibody  -  A type of pure antibody that can be produced artificially in large quantities and used, for example, to distinguish the major blood groups. Mouse lymphocytes producing the required antibody are fused with mouse cancer cells; the resulting hybrid cells multiply rapidly and all produce the same type of antibody as their parent lymphocytes.

Whilst all this bodily protection sounds wonderful, the problem with MRSA, is that there is no defence to it, no answer to its attack.

Blood cells

There are a number of different cell types in circulation in the blood stream. Here's a quick review:

Red cells carry oxygen to the cells of the body. They are essentially bags of hemoglobin, the oxygen carrying molecule. Hemoglobin binds oxygen to iron atoms, which give the hemoglobin and thus the cells their distinctive red color.

Polymorphonuclear cells, or "polys" for short, fight bacterial infections by engulfing bacteria and digesting them. They form PUS and are the chief ingredient of an abscess.

Lymphocytes are the virus killers. There are two types of these:

T-cells which remember what germs we've been exposed to and how to kill them. T-cells are the key component of the immune system that is missing in AIDS.

B-cells that secrete the actual antibodies that attach to viruses and bacteria and identify them as things to be destroyed - rather like tagging the target with a laser so that the smart bomb will home in and blast the target.

Monocytes are cells that are related to lymphocytes but have a killing and cleaning function. They cruise through the tissues of the body cleaning up debris and killing any bacteria they find. They are often increased in viral infections - a reassuring finding that your doctor may note on your child's blood count.

Eosinophils are cells which are strongly related to allergy and the recognition of foreign things in the body like parasites.

Basophils are cells that are also part of the allergy and parasite recognition system.

Platelets are the cells that plug leaks in the vascular system, the clotting cells.