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US Hospitals Increasingly Colonized by Drug-resistant Germs

Concern is rising in the US over increasing lack of hygiene in hospitals, resulting in a virtual invasion by the drug-resistant staph bacteria, also called the superbugs.

At least 30,000 U.S. hospital patients may be carrying in them the superbugs at any given time, according to a survey released Monday by the Association for Professionals in Infection Control and Epidemiology.

The estimate is about 10 times the rate that some health officials had previously estimated.

Called methicillin-resistant staphylococcus aureus, or MRSA, these staph germs can cause skin infections that in rare cases have led to pneumonia, bloodstream infections and a painful, flesh-destroying condition.

Actually, about 25% of people normally carry staph in the nose, mouth, genitals, and anal area. The foot is very prone to pick up bacteria from the floor. The infection often begins with a little cut, which gets infected with bacteria.

These staph infections range from a simple boil to antibiotic-resistant infections to flesh-eating infections. The difference between all these is how deep and how fast the infection spreads, and how treatable it is with antibiotics.

MRSA is hard to treat because the bacteria have developed resistance to the penicillin drug family.

The antibiotic-resistant infections are more common in North America, because of overuse of antibiotics.

Some federal health officials said they had not seen the APICE study and could not comment on its methodology or its prevalence. But they welcomed added attention to the problem.

"This is a welcome piece of information that emphasizes that this is a huge problem in health care facilities, and more needs to done to prevent it," said Dr. John Jernigan, an epidemiologist with the U.S. Centers for Disease Control and Prevention.

Past studies have looked at how common the superbug is in specific patient groups, such as emerge ncy-room patients with skin infections in 11 U.S. cities, dialysis patients or those admitted to intensive care units in a sample of a few hundred teaching hospitals.

It's difficult to compare prevalence estimates from the different studies, experts said, but the new study suggests the superbug is eight to 11 times more common than some other studies have concluded.

The new study was different in that it sampled a larger and more diverse set of health care facilities. It also was more recent than other studies, and it counted cases in which the bacterium was merely present in a patient and not necessarily causing disease.

The infection control professionals' association sent surveys to its more than 11,000 members and asked them to pick one day from Oct. 1 to Nov. 10, 2006, to count cases of the infection. They were to turn in the number of all the patients in their health care facilities who were identified through test results as infected or colonized with the superbug.

The final results represented 1,237 hospitals and nursing homes or roughly 21 percent of U.S. inpatient health care facilities, association officials said.

The researchers concluded that at least 46 out of every 1,000 patients had the bug.

There was a breakdown: About 34 per 1,000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1,000 were "colonized," meaning they had the bug but no illness.

Most of the patients were identified within 48 hours of hospital admission, which means, the researchers believe, that they didn't have time to become infected to the degree that a test would show it. For that reason, the researchers concluded that about 75 percent of patients walked into the hospitals and nursing homes already carrying the bug.

"They acquired it in a previous stay in health care facility, or out in the community," said Dr. William Jarvis , a consulting epidemiologist and former CDC officials who led the study.

Only a couple of weeks ago researchers had said the superbugs, first seen mainly in hospitals and nursing homes, was spreading to urban poor settlements. The strain had turned up recently among athletes, prisoners and people who get illegal tattoos, it was said. It had risen almost seven-fold in some Chicago neighborhoods.

The type of staph infection that involves skin is called cellulitis and affects the skin's deeper layers. It is treatable with antibiotics.

This type of infection is very common in the general population -- and more common and more severe in people with weak immune systems. People who have diabetes or weakened immunity are particularly prone to developing cellulitis.

Staph cellulitis usually begins as a small area of tenderness, swelling, and redness. Sometimes it begins with an open sore. Other times, there is no break in the skin at all -- and it's anyone's guess where the bacteria came from.

The signs of cellulitis are those of any inflammation -- redness, warmth, swelling, and pain. Any skin sore or ulcer that has these signs may be developing cellulitis. If the staph infection spreads, the person may develop a fever, sometimes with chills and sweats, as well as swelling in the area.

Antibiotics are used to treat these infections. But there's been a gradual change in how well these antibiotics are working. While most staph infections used to be treatable with penicillin, in the 1980s that changed and stronger antibiotics are now used.

In about 50% of cases, however, resistance is seen even to these stronger antibiotics. These cases are not just happening in hospitals -- as once was true -- but now are occurring in the general community. That's been a problem. Many doctors are accustomed to using certain antibiotics, but those then fail because of antibiotic resistance. There are several more po tent antibiotics now, but doctors need to know when to use them.

If the infection goes so deep that it involves muscles or fibers that enclose muscles, it needs to be surgically cleaned.

Dr. Susan Gerber of Chicago's Department of Public Health said it would be a mistake to assume the infection isn't also in affluent neighborhoods. "This is an equal opportunity bacteria," she said.

To prevent staph's spread, the U.S. Centers for Disease Control and Prevention recommends washing hands with soap and water or an alcohol-based sanitizer, keeping cuts clean and covered with a clean bandage until healed, avoiding contact with other people's wounds and bandages and avoiding shared personal items such as towels and razors.

Official figures published in the UK sometime showed Clostridium difficile infection caused 4,000 deaths a year and was still spreading despite all attempts to curb it. Clostridium difficile, a bacterium that causes diarrhea and more serious intestinal conditions such as colitis.

The Healthcare Commission had said it would carry out spot checks at 120 NHS trusts over the next year in its biggest ever programme of visits aimed at cutting rates of infection with MRSA and Clostridium difficile.


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