More on MRSA....new study

Hillbilly · Jan 21, 2008

there is an article in today's NYT? that reports that the MRSAUSA300 is a major health threat.

After Linking New Strain of Staph to Gay Men, University Scrambles to Clarify
By JESSE McKINLEY

SAN FRANCISCO ? In a matter of days, it jumped from a routine press release to a medical controversy.

On Monday, a team of researchers led by doctors from the University of California at San Francisco announced that gay men were ?many times more likely than others? to acquire a new strain of drug-resistant staphylococcus, a nasty, fast-spreading and potential lethal bacteria known as MRSA USA300. And sure enough, the study, published online in the Annals of Internal Medicine, was quickly picked up by reporters round the world and across the Internet, including a London tabloid which dubbed the disease ?the new H.I.V.?

Since this is a copyrighted article, I cannot produce it here...go to
http://www.nytimes.com/2008/01/20/us/20castro.html?th=&emc=th&pagewanted=print

For the complete article.

HOW is this related to the DR?
1) We talked about it in relation to DrChrisMD and her spider bites. Cobraboy mentioned a bout of this from contaminated gym equipment, and we have gyms here.
2) There is sizable homosexual population in the DR that do read these pages and should know about the risks.

HB

margaret · Jan 21, 2008

Difficult-to-Treat Staphylococcal Infections in Men Who Have Sex with Men -- , -- Annals of Internal Medicine

If you listen to the interview with one of the authors, towards the end of the interview he suggests hygiene (soap and water) as the key to preventing the spread of this bacteria.

Annals of Internal Medicine - Home

Doctors who are treating hard to treat skin infections will need to consider the "contact sport" of the patient and do a culture.

This is all due to the over prescribing of anitibiotics by physicians and patients who stop taking them once they feel better. These bugs are smarter than we are, they keep evolving.

KeithF · Jan 22, 2008

Hillbilly said:
t
http://www.nytimes.com/2008/01/20/us/20castro.html?th=&emc=th&pagewanted=print

"One of the major sore points for some critics..."

Was that really the best turn of phrase?

I was talking to Dominican about two years ago, trying to explain about MRSA. They had just bought some 'over the counter' antibiotics that would be prescription only in the UK. They bought four days supply because 'they knew' that would clear their sore throat up. And it did. They didn't know that this was a perfect environment for the infection to become resistant.

Our fault in the 'developed world' for over prescribing in the first place but then for not trying harder to educate people in the rest of the world. We got MRSA first, but you guys are going to be least prepared for dealing with it.

PS It is cultured by otherwise healthy people, mainly in the nose and arm-pits. In the UK we are finally introducing "deep cleaning" to try and combat it. About four years ago the way to deal with MRSA was to 'stop routine screening'... if you stop looking for something, you stop finding it... I kid ye not.

cobraboy · Jan 22, 2008

Beyond the actual disease, the problem with MRSA coming to the DR is that EVERY method of treating it is incredibly expensive, far, far beyond the ability of most Dominicans to pay for it, and prolly so much that health insurance plans may be reluctant to pay for it.

The only oral medication for it, Zyvox, cost me $2200 for a two week regimine. The other drugs are IV only and cost as much as $1000 a day; eveinif 1/3 the cost in the DR, that is still seriously expensive. Even the generic Zyvox was nearly $1000, and the efficacy is unknown.

It's some bad mojo, folks.

KeithF · Jan 22, 2008

What you have got going for you is lots of fresh air & sunshine and an 'outside' culture. MRSA lives on healthy people but clears from them quite easily in fresh air. Also soap & water are cheap, prevention rather than cure.

The problems begin when it gets into wounds or people who are otherwise vulnerable get it. And there you are correct, it's hard to shift and costs a lot.

I always knew gyms were an unhealthy idea anyway, when did you last hear of someone getting MRSA from a beach bar? Same with hospitals, people die there all the time. If I get ill, take me to the supermarket, I've never heard of anyone dying in a supermarket.

cobraboy · Jan 22, 2008

KeithF said:
What you have got going for you is lots of fresh air & sunshine and an 'outside' culture. MRSA lives on healthy people but clears from them quite easily in fresh air. Also soap & water are cheap, prevention rather than cure.

The problems begin when it gets into wounds or people who are otherwise vulnerable get it. And there you are correct, it's hard to shift and costs a lot.

I'm not sure research backs this up. Most folks have immunity to common staph, but not MRSA because it has genetically changed. The MRSA bacteria lives in the nostrils. It looks for a skin opening. When it gets there, it takes the body of a healthy person a while to build a defense. By then it can go nuts.

Gyms and athletic team locker rooms are generally populated by the healthiest among us, and those are places where it is beginning to run rampant.

On the positive side of the DR MRSA balance sheet, folks there have not been innundated by antibiotics all their lives, so possibly staph strains there have not become methicillin resistant.

Hillbilly · Jan 22, 2008

I can appreciate KeithF's sense of humor...as well as his anecdote regarding the over the counter sale and inadequate use of antibiotics. This is a land where the antibiotic resistant strain of TB has found its home!!.

However, those costs quoted by Cobraboy are truly incredible.

Let's hope that the use of soap and water gets a big play....

HB

I did not see this go up just before mine:

"On the positive side of the DR MRSA balance sheet, folks there have not been innundated by antibiotics all their lives, so possibly staph strains there have not become methicillin resistant.

And I have to disagree heartily! Here every Tom, Dick and Pedro go to Pharmacies to get antibiotics for coughs, colds and anything that they feel pooly from....(sorry for the convoluted grammar)...This is a nation of medicine takers, mostly self-prescribed!!!!! OMG! This is staph heaven...

cobraboy · Jan 22, 2008

Hillbilly said:
And I have to disagree heartily! Here every Tom, Dick and Pedro go to Pharmacies to get antibiotics for coughs, colds and anything that they feel pooly from....(sorry for the convoluted grammar)...This is a nation of medicine takers, mostly self-prescribed!!!!! OMG! This is staph heaven...

:surprised

Good point.

Yikes...

I'm curious: when you take a "physical" for your residencia (Chest X-ray and blood test), what are they looking for?

planner · Jan 22, 2008

I agree with HB. I watched a man in the pharmacy ask for a "cipro" - just one because he had a headache. When I asked him why this he told me last time I had a headache this made it go away!

Most likely it was the glass of water he washed it down with that made the headache go away! It definately was NOT the cipro. Of course they do not understand this.

Self medicating and over medicating is rampant here.

drloca · Jan 22, 2008

cobraboy said:
:surprised

Good point.

Yikes...

I'm curious: when you take a "physical" for your residencia (Chest X-ray and blood test), what are they looking for?

Generally, and I cant comment on the DR specifically, the screening physical for immigration/residencia is to rule out TB (chest xray) and STD's (syphilis) in the blood work as well as HIV.

drloca · Jan 22, 2008

planner said:
I agree with HB. I watched a man in the pharmacy ask for a "cipro" - just one because he had a headache. When I asked him why this he told me last time I had a headache this made it go away!

Most likely it was the glass of water he washed it down with that made the headache go away! It definately was NOT the cipro. Of course they do not understand this.

Self medicating and over medicating is rampant here.

I think over-medicating has become a problem in many places as some people just dont feel satisfied to leave a doctors office without the "comfort" of a prescription in hand ...no small wonder we have so many antibiotic-resistant strains with all the antibiotics being comsumed to treat viral illnesses.

Chip · Jan 22, 2008

As a parent I am concerned for the well being of my daughters and have been cognizant of the overuse of antibiotics since the beginning. That being said, young children seem to get sick quite often and what I typically do is when they have a consistent high fever of around 103-104 for at least two or even three days, we take them to the doctor where they always have prescribed antibiotics. Of course, this is even less than the doctors do here, if you take them to the doctor with any fever of 102 they will prescribe it just like that. The method I used was suggested by one of my best friends, who practices internal medecine in the States and has six children.

Ineveitably, it seems the girls are taking antibiotics 2 to 3 times a year. For me I seem to have to take them once every 2 to 3 years when I develop a severe sinus infection that won't go away on it's own or food poisoning, etc.

Lambada · Jan 22, 2008

Chip said:
Ineveitably, it seems the girls are taking antibiotics 2 to 3 times a year. For me I seem to have to take them once every 2 to 3 years when I develop a severe sinus infection that won't go away on it's own or food poisoning, etc.

I know you've got children & they can pick up things from school & their friends etc & bring them into the home, but for a youngish healthy adult to be needing to take antibiotics every 2-3 years seems a tad over frequent to me. In 15 years here I've needed to take metronidazole twice (same incident, took as prescribed but 10 days wasn't long enough to get rid of giardiasis so went back on it for a month

aranoid: that did the trick!). And that's been it for antibiotics for me. Everything else I either live through or take lime juice.

But the locals do ingest antibiotics as if they were sweeties and for all the wrong things like viruses. For those interested I found some interesting recent research here into how MRSA is learning to avoid neutrophils (white blood cells which normally destroy microbes)
Neutrophil Microbicides Induce a Pathogen Survival Response in Community-Associated Methicillin-Resistant Staphylococcus aureus -- Palazzolo-Ballance et al. 180 (1): 500 -- The Journal of Immunology

And on the soap-and-water front - don't forget the use of alcohol (isopropilico type not drinking type!). I know a doctor who uses it as an after shave - not a bad way to protect the self with all the cheek brushing skin contact here.

Chip · Jan 22, 2008

Lambada said:
I know you've got children & they can pick up things from school & their friends etc & bring them into the home, but for a youngish healthy adult to be needing to take antibiotics every 2-3 years seems a tad over frequent to me.

It was even more when we lived in the States, just about every time they got sick and had fever they were prescribed antibiotics - is it any wonder that there is a problem worldwide?

Worse was my wife's inability to understand that one needs to finish the antibiotic medicine instead of quit using it as soon as the fever goes away - I still have to battle for that one, but fortunately, the other half knows that when I put my foot down about the girls there is no point in even arguing.

Maybe kids are getting sicker more often nowadays, who knows? However I think most parents can vouch that anymore one is taking at least one of the kids to the doctor once every month or every other month. I want to do the best for our daughters of course, and I feel like a fever of around 104 degrees that won't go away after two to three days could be serious. Less than that and we will let it runs it's course.

Frank the Tank · Jan 23, 2008

JDJones said:
I got this strain on my back as a result of scratching an insect bite back in November.

Two days after the bite, I had to get emergency surgery to drain the abcess on my back that was the size of a baseball. The entire upper half of my back was black & blue.

I was required to take an incredible cocktail of antibiotics, and had to go to Clinica Abreu for treatments every morning for six weeks!

I still have a slowly closing hole in the middle of my back.

To add insult to injury, I got kidney stones at the same time.....

Good Lord!!

Chris · Jan 23, 2008

Chip said:
Maybe kids are getting sicker more often nowadays, who knows? However I think most parents can vouch that anymore one is taking at least one of the kids to the doctor once every month or every other month. I want to do the best for our daughters of course, and I feel like a fever of around 104 degrees that won't go away after two to three days could be serious. Less than that and we will let it runs it's course.

Chip, we certainly have a different experience. I have a granddaughter of almost 7 years .. she has not had antibiotics more than about three times in her whole lifetime ... and each time for an ear infection (bad swimming pool water down in the DR). Two or three times per year sounds an awful lot to me.

Again, we eat completely organic (not necessarily completely vegetarian or vegan, but if we eat a chicken, it sure is an organic chicken :laugh: ) ... So, perhaps tomorrow I get run over by a bus or something crazy, but it is possible to live healthy in the DR.

Chip · Jan 24, 2008

Chris said:
Chip, we certainly have a different experience. I have a granddaughter of almost 7 years .. she has not had antibiotics more than about three times in her whole lifetime ... and each time for an ear infection (bad swimming pool water down in the DR). Two or three times per year sounds an awful lot to me.

Again, we eat completely organic (not necessarily completely vegetarian or vegan, but if we eat a chicken, it sure is an organic chicken :laugh: ) ... So, perhaps tomorrow I get run over by a bus or something crazy, but it is possible to live healthy in the DR.

It appears your grandaughter is exceptionally healthy which is a very good thing. Unfortunately it appears mine get sick quite often from who knows what. Our middle girl had to have her tonsils taken out when she was just two in fact becasue of the frequent infections. All I can say is that I try to make the best informed decisions I can and try to accept the consequences but, nonetheless I thank modern medecine, in fact if it weren't for them I would have been pushing up daisies many moons ago....take care

Chirimoya · Jan 24, 2008

Chris said:
Chip, we certainly have a different experience. I have a granddaughter of almost 7 years .. she has not had antibiotics more than about three times in her whole lifetime ... and each time for an ear infection (bad swimming pool water down in the DR). Two or three times per year sounds an awful lot to me.

Again, we eat completely organic (not necessarily completely vegetarian or vegan, but if we eat a chicken, it sure is an organic chicken :laugh: ) ... So, perhaps tomorrow I get run over by a bus or something crazy, but it is possible to live healthy in the DR.

I could have written more or less the same thing about my seven-year old. My dad is a retired paediatrician who throughout his career went against the grain and would only prescribe antibiotics when absolutely necessary, which didn't go down too well with some of his patients (or their parents, to be precise). So, I have rarely taken antibiotics - and the same goes for my son + we eat a healthier than average diet (organic, mainly vegetarian, hardly any junk food). We hardly ever get sick - from time to time I get the initial symptoms of a cold/flu but they disappear within a day. He gets minor colds only. I am convinced we have sturdy immune systems as a result.

cobraboy · Jan 24, 2008

MRSA doesn't care what or how many antibiotics YOU have taken.

JDJones, I feel your pain. Did they put you on IV antibiotics, vancomycin? Or just oral?

Chirimoya · Jan 24, 2008

cobraboy said:
MRSA doesn't care what or how many antibiotics YOU have taken.

I'm aware of that. Our comments were off-topic but emphasised the benefits of avoiding antibiotic use generally.

More on MRSA....new study

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