MRSA staph infection

[krakerjm]

I mentioned a couple months ago letting a friend stay with me cause he had to have artery bypass surgery.  Everything was fine till about a week and a half ago:  one of the bypasses sprung a leak so he had to have a second surgery to redo that one of three.  Now he has developed a MRSA staph infection and they are considering sending him home and have some one come to the house and give him his antibiotic IV drip daily, says it's not practical to keep him in the hospital since he's well enough to come home(guess they need the bed?). 
Well from what I am reading on the net about MRSA, it's not practical for him to be here exposing me to this infection.  I told him he needs to tell his doctor I am poz and I need to talk with his doctor;  I don't think it is wise for me to take this kind of risk when they can keep him there if need be until this think is cleared up, cured.  They have him in isolation at the hospital  and want to send him home?

[DCGuy511]

Definitely try to speak with his doctor or at least your own.  Do they need the bed or is his insurance (or the state) thinking that it is cheaper to have him at home with a visiting healthcare worker? 

[krakerjm]

He is at Shand's Jacksonville on a "city contract" he has no insurance; whether they need the bed or a money issue matters not if his coming here would put me at risk.  The hospital will just have to deal with it.  I have a call in to my doctor, but he is a busy man also.  From what I've read MRSA is a bit scarey, it can survive on inantimate objects...

[aztecan]

Don't mess with MRSA. Period.

It is a nasty infection that requires strong antibiotics to fight. Anyone with a compromised immune system must be doubly careful.

One person I dealt with developed MRSA on his hand/thumb when he shared a dirty needle during recreational drug use and developed an abscess. He nearly lost his hand. As it was, there were several weeks of daily IV antibiotics.

MRSA apparently can survive on surfaces for a long time, meaning anything this person touches should be sterilized, including bed linens, towels, table tops, etc.

For the hospital to send him home and then come by to give him his antibiotics is asking for trouble, in my opinion.

Definitely talk to your doctor.

HUGS,

Mark

[PDXRon31]

I feel deeply for your friend, and for you if you contract MRSA. I have had it attack my right leg in 6 spots over the last 3 years. Although nobody ever contracted it from me, nobody attending to my needs was immune compromised. My last bout with it was July of 2005. It is overwhelmingly painful. It ate holes in the flesh on my leg. I have one friend who has had AIDS now for over 2 years who cannot get rid of his MRSA. In fact it spread to his organs and will likely be what kills him. I would try to physically seperate yourself from your friend without making him feel like a leper, at least until the infection is cured. You sound like a good friend, and are no good to him if you get sick too. Best to you both.

- Ron

http://health.groups.yahoo.com/group/PMLSurvivors/

[JohnOso]

There has got to be a discharge planner at that particular hospital.  They should definitely be involved in planning for the needs of your friend. 

If he needs some type of care, then they will have to set something up, whether that involves a skilled nursing facility or just sending him home with home care. 

I would be extremely careful about this at your house.  I'm not even sure I would go visit him at his home. 

Take care,
John

[krakerjm]

I talked with his doctor for about 20 minutes last night; it's not the knid of staph that runs rampid in hospitals; it's a bacteria that is common on peoples skin and nasal pasages(not airborn) and many people are exposed to it(and I have most likely already been exposed.  It manifests ifself and causes an infection in an open wound and is difficult to treat cause it has become resistant to penicilin due of over treatment.  He insists good personal hygiene(which I should be aware of bing poz, protects me from many things) and not coming in contact with the infected area is suffiecient to protect me.  While he is isolated from other surgical patients, he is free to come and go from his room and have visitors.  Of course, I don't visit hospitals, there are sick people theer, LOL!  If he was at high risk to the hospital or anyone, why would they allow him to roam free?

[Teresa]

Well im glad its not the really really bad staph infection. I guess any staph infection is bad but you know what i mean.

I hate going to hospitals too..When hubby was there last month i had a bad cold 2 days after he got home. I know i caught it there!

Hugs Teresa

[JohnOso]

I guess my reply was couched in terms of levels of risk.  If you don't have to be exposed to something like that, why would you risk it?

If this is a case of "there's no other place for him to go," then that assessment might change.

I take care of MRSA and even VRE patients every day.  I had MRSA last year.  Would I prefer to do something different? 

Hell, yeah. 

But right now that's not feasible.  My job is safest at the hospital bedside unfortunately, and obviously I need my health insurance.

In any case, I'm glad that you were able to chat with the doctors and have a better feel for what you're up against.  And you're obviously a good friend to take on the responsibility!   

Take care,
John

[Oscar]

Jim, I am dealing with an MSRA infection right now. going through IV therapy at the hospital daily. I've had a very hard time finding an antibiotic that will kill it &  at the same time one that I am not allergic to. I have had to remove all hand towels from the bathrooms and can only use paper towels. Going through gallons of Purell hand sanitizer. I have to take 3 showers a day with Heppacleanse and change the bandages on the cyst sites on my body each time. It started out as one on my butt but now I have two others one on my leg and another on my chest. They are painful & itchy. I'm taking strong pain killers. This is highly contagious & you definantly don't want to have to deal with this. He needs to stay where he is.

Dan

[allopathicholistic]

friend sent this to me (sorta interesting)

======

Superbugs Killed By Soil Antibiotic

Soil bacteria from South Africa have yielded an antibiotic that kills usually immune bacteria.
Platensimycin, derived from the soil bacterium Streptomyces platensis, is the first antibiotic to kill bacteria by preventing them from making vital fatty acids. Mice that were infected with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci - two of the most common hospital superbugs - were cured without apparent side effects. (Nature, vol 441, p 358)

This is a great opportunity for the development of critically needed antibiotics, says Jun Wang, who discovered the substance at Merck Research Labs in Rahway, New Jersey.

[JohnOso]

That is interesting and hopeful news, AH.


Pretty fascinating.


Take care,
John

[krakerjm]

He is doing fine, getting at home care, does his own IVs twice a day(has a surgical IV implant in his arm) we have NO personal contact and he says if I don't guit spraying every thing with bleach and antibacterial Lysol, he's going nuts.  Better him than me.  Another couple of weeks and he will be supposedly okay; his nurse is ove a couple times a week to check on an him and blood work once a week.  I am fine with it now since I layed the law down about him being isolated from me and he's doing good with that; hell, I'm paying the bills, he don't want me to be sick.

[JohnOso]

Glad you updated us on what happened with your friend. 

It sounds like he's doing well at home under the limited medical supervision that he requires, PLUS you don't have to worry about catching anything. 

A win-win situation in my book, and those sure as hell don't come around often.

Take care,
John

[bimazek]

what is connect between phage

http://en.wikipedia.org/wiki/Tbilisi_Institute

http://en.wikipedia.org/wiki/Phage_therapy

Absorption and activity of bacteriophages in the gastrointestinal tract, 2
4.    
Easy permeation of bacteriophages into the bloodstream and its outcomes, 3
5.    
Immune system response and elimination of bacteriophages, 4
6.    
Bacteriophages and eukaryotic cells, 5
7.    

Conclusions, 5
8.    

Acknowledgements, 5
 1. Summary   Go to:         GO   down   

Bacteriophages are viruses that infect bacteria. They are the most numerous life forms on earth. As antibiotic resistance is becoming an increasingly worldwide challenge, bacteriophages as potential antimicrobial agents are being more intensively explored. Some very important questions involve their ability to penetrate higher organisms, as this determines potential phage activity in antibacterial treatment. Higher organisms are widely exposed to bacteriophages, which penetrate them quite freely. Bacteriophage activity can be influenced by specific antibodies which, together with the nonspecific immune system, can contribute to their rapid clearance from the organism. Bacteriophages can also interact directly with mammalian cells and even play a role in the development of some nonbacterial diseases, although they are not able to multiply in these cells. All aspects of the interaction between phages and higher organism are of interest and importance for further medical and biochemical applications.
 2. Introduction   Go to:         GO   updown   

Bacteriophages are viruses that infect bacteria. Their general nature is similar to other viruses in that they consist of a piece of genetic information (nucleic acid) and a protein coat, some containing lipids in their coats or envelopes. They require a sensitive host with a specific receptor in order to replicate in the host cells. Over 5100 phages have been examined under electron microscopy since 1959. The groups of bacteriophages are varied, with DNA- and RNA-phages, phages of different morphology, size, etc. At least 4950 phages (96%) are tailed and constitute the order Caudovirales and the three families Siphoviridae, Myoviridae and Podoviridae. Polyhedral, filamentous and pleomorphic phages comprise <4% of bacterial viruses (Ackermann and Gershman 1992; Doskar et al. 2000; Ackermann 2001, 2003).

Bacteriophages are the most numerous life forms on earth. Estimates of phage frequency in aquatic habitats indicate their total number at approximately 1031 viral particles (Ashelford et al. 2000; Hendrix 2002). They can be found almost everywhere: from the ocean depths to hot springs, and can be isolated from the soil and water as well as from the human or animal body (e.g. saliva, faeces, skin) because they propagate on symbiotic or pathogenic bacteria in higher organisms. Bacteriophages are known to be very common in the gastrointestinal tract and, together with their bacterial hosts, are an important component of gut flora (Merril 1974; Ashelford et al. 2000; Gorski et al. 2003). All these facts reveal that mammalian organisms are very frequently exposed to interactions with bacteriophages and that this natural contact is not incidental, but rather constant and intensive.

A special importance of bacteriophages arose with the emergence of bacterial strains that are highly resistant to virtually all available antimicrobial agents. It has been emphasized that we may therefore be returning to a pre-antibiotic era (Gilmore and Hoch 1999; Smith et al. 1999; Clarke 2003). Most bacteriophages are able to destroy bacteria. Thus, bacteriophage therapy represents a potentially viable alternative to antibiotics (Pirisi 2000; Das 2001). There have been many attempts to apply bacteriophages in the treatment of bacterial infections; however, the discovery, widespread, and success of antibiotics significantly delayed investigations on the potentials of phage therapy. Only a few scientific centres explored this area during last decades. Their results are very promising, but bacteriophages are still considered controversial (Stone 2002; Merril et al. 2003; http://surfer.iitd.pan.wroc.pl/phages/phages.html.). Poor understanding of phage therapy kinetics remains a major problem. Some new efforts have been made to provide more data in this field. The kinetics of active phage therapy concerns the population dynamics of ecological predator–prey models and epidemiological host–parasite models. Phages, as self-replicating 'pharmaceuticals', substantially differ from other pharmacological agents. Very important studies of phage therapy kinetics were presented by Payne and Jansen (2003). Some very important questions still involve bacteriophage ability to penetrate higher organisms, as this determines the potential phage activity in antibacterial treatment. In this work we intend to present current knowledge in this area and point out the main possibilities that are the outcomes of bacteriophage treatment.
 3. Absorption and activity of bacteriophages in the gastrointestinal tract   Go to:         GO   updown   

Oral administration of bacteriophages is very effective in the treatment of alimentary tract infections, e.g. in calves, lambs and piglets. Animals were protected by phages from diarrhoea and death, even colostrum-deprived individuals, in which colostral immunoglobulins could not protect the animals. Bacteriophages multiplied rapidly and abundantly in Escherichia coli infected small intestine. During the first 24 h after treatment, high phage counts were found in the faeces of the calves and declined with the number of bacteria (Smith and Huggins 1983; Smith et al. 1987a). Interestingly, diarrhoea was also prevented by only 102 phage particles sprayed on the litter in the calf rooms. Moreover, protection was also achieved by keeping calves in the uncleaned rooms that had previously been occupied by animals treated with phages (Smith et al. 1987b).

Some reports stated that no phage particles were detected in mouse and guinea-pig circulation after oral administrations (Keller and Engley 1958; Merril et al. 1996). However, other works revealed the presence of orally applied bacteriophages in the blood and urinary tract of humans (Weber-Dabrowska et al. 1987) and mice (Keller and Engley 1958; Hoffmann 1965). Both the feeding and gastric lavage of animals with bacteriophages resulted in irregular but consistent recovery of bacteriophages from the blood (Keller and Engley 1958). The titre was generally highest at only 15 min but the individual values can deviate from one another within a wide range. Animals could differ in their reaction to the oral phage administration by about two orders of magnitude. (Hoffmann 1965). In rabbits and mice, bacteriophages were detected in the circulation only few minutes after introduction into the rectum (Hoffmann 1965; Sechter et al. 1989). In fact, the time of intestinal wall penetration can be extraordinarily short. In some mice, phages were already found in tail-tip blood 10 s after applications. The blood phage level (5 min after the rectal phage administration) was reported to be about two orders of magnitude higher than by oral feeding (Hoffmann 1965). Hildebrand and Wolochow (1962) postulated that only small numbers of phage particles could penetrate directly into portal blood, and translocation to the blood occurred via the regional lymphatic system. However, the early research of Keller and Engley (1958) revealed that phages could be detected in the blood within 5 min of gastric delivery in mice. This suggests that significant numbers of phages can enter the circulation by diffusion rather than via the lymphatic system.

Oral administration of bacteriophages was effective in the therapy of septicaemia and other bacterial infections in humans (Weber-Dabrowska et al. 2000, 2003). Interestingly, bacteriophages were also detected in commercial sera. A group of bacteriophages that were active on E. coli was found in calf, bovine, lamb and horse sera. The source of phages in sera is rather endogenous, and probably reflects physiologic viraemia (phagaemia) rather than contamination during sera procurement (Merril et al. 1972; Trefouel 1974). These observations correspond to the presence of bacteriophages in live virus vaccines (Moody et al. 1975).

Undoubtedly, the neutralization of stomach acid (e.g. by giving calcium carbonate to animals in the feed or by administering neutralizing medications to human patients, e.g. aluminium/magnesium hydroxide, calcium/magnesium carbonate) before bacteriophage administration is an important factor for bacteriophage viability. Many phages are sensitive to an acidic environment (Smith et al. 1987a). Bacteriophages were demonstrated to penetrate to the blood much less effectively from the stomach than from other sections of the gastrointestinal tract. They can rather be absorbed in the higher or deeper sections of the intestine (Hoffmann 1965). It was demonstrated that phages did not survive an exposure to pH 2·0, and a decrease in the number of phages was observed at pH ranging from 3·0 to 7·0. Nevertheless, the sensitivity to low pH values depends on the species of bacteriophage. Some bacteriophages were shown to be relatively acid resistant in vitro and in vivo, but for others the neutralization of gastric acid might be essential for their survival (Smith et al. 1987a; Vijayashree et al. 1999).

Schubbert et al. investigated the fate of orally ingested foreign DNA in mice, using phage M13 DNA and plasmid DNA. This DNA (without homology to the mouse genome) was able to persist in fragmented form in the gastrointestinal tract, penetrate the intestinal wall and reach the nuclei of various cells. Nevertheless, these DNA fragments were detected only until 24 h after feeding. After oral administration to pregnant mice it was discovered in various organs of foetuses and newly born animals. Nevertheless, this effect does not seem to be characteristic of phage DNA only, as results obtained with plasmid DNA and phage DNA were similar (Schubbert et al. 1997, 1998).
 4. Easy permeation of bacteriophages into the bloodstream and its outcomes   Go to:         GO   updown   

Intravenous (i.v.) injection of bacteriophages enables a fast and direct introduction of bacteriophages into the blood circulation and their spread throughout the system (Bogozova et al. 1991). However, other ways of administration have proved to result in an equally effective penetration of bacteriophages into the blood. Intraperitoneal (i.p.) injections are very efficient in introducing phages into the circulatory system. In this case, bacteriophage titres usually reflect the initial dose and relative attenuation of the phage titre in the animal body. Therefore, the peritoneum-blood penetration appears to be very fast and facile (Bogozova et al. 1991; Merril et al. 1996). Indirect but important evidence of bacteriophage penetration to the blood is their ability to cure septicaemia in animals after i.p. injection (Merril et al. 1996). Similarly, intramuscular injections can also protect animals from lethal bacterial infections (Dubos et al. 1943; Smith and Huggins 1982; Barrow et al. 1998). Intranasal administration of bacteriophages to mice resulted in their presence in the blood and internal organs within 24 h, even in the central nervous system (Bogozova et al. 1991; Frenkel and Solomon 2002; Carrera et al. 2004). This was also followed by an immune response to bacteriophage antigens (Delmastro et al. 1997). It was demonstrated in mice that intravaginal and intrauterine application of bacteriophages resulted in the presence of phage particles in the blood (Georgakopoulos 1968). There is also a suggestion that bacteriophages can penetrate into fish body, piercing the skin and probably gills. This suggestion results from the observation of phage particles in the kidneys after submerging fish in bacteriophage solution (Nakai and Park 2002). Bacteriophage aerosol spray was shown to be effective in the treatment of E. coli respiratory infections in chickens (Huff et al. 2002) and bacteriophage particles were detected in the blood and internal organs after tracheal administration in mice (Hoffmann 1965). These data exemplify the great infiltration potential of bacteriophages, which are able to penetrate and spread throughout a higher organism over virtually all standard administration routes.

Rapid permeation to the blood is followed by relatively rapid arrival at the animal's internal organs. The highest bacteriophage titre is usually observed in mice within 24 h after inoculation, but it was also reported within only few minutes (Keller and Engley 1958; Hoffmann 1965; Bogozova et al. 1991). Other administration routes almost reflect i.v. administration, which results in very fast arrival to the internal organs through the blood stream (Bogozova et al. 1991). Bacteriophage titres in lung, kidney, spleen, liver and brain were appreciable 3 h after phage administration, although it was approximately 100 times lower than that of the blood (Keller and Engley 1958; Bogozova et al. 1991). The detection of bacteriophages in animal brains is of special significance. Bacteriophages applied through the murine peritoneum can be detected in the brain as early as 1 h after injection and reach their maximum titre within 2 h. Additionally, intramuscular injections of an appropriate phage were very effective in the treatment of mice (Dubos et al. 1943; Smith and Huggins 1982) and chickens (Barrow et al. 1998) with an experimental bacterial encephalitis or meningitis. In these animals, more phage particles were noted in the brain than at other sites. The maximum titre was reached in 12–18 h, and its level was much higher than the injected phage amount (Dubos et al. 1943). These observations indicate that bacteriophages are able to cross the blood–brain barrier.

Bacteriophages administered i.p. were reported to be able to penetrate even into the urinary tract and into the intestine. In murine urine samples, bacteriophage were detected as early as 30 min after i.p. administration (Keller and Engley 1958). They were recovered in samples of faeces or directly from the intestine of mice and fish as early as 3 h after injection. Recovery ended within approximately 12 h in mice and 10 h in fish (Keller and Engley 1958; Nakai and Park 2002).

The time of bacteriophage persistence in an animal's body and their concentration in a particular organ strongly depends on the absence or presence of susceptible bacteria. Phages were observed in the intestine of noninfected fish no later than 10 h after i.p. injection and in the spleen for up to 24 h. Simultaneous administration of sensitive bacteria resulted in the presence of bacteriophages in the intestine 24 h and in the spleen 5 days after i.p. administration (Nakai and Park 2002). The number of bacteriophages in murine brain was considerably higher in the animals that were intracerebrally infected with sensitive bacteria (Dubos et al. 1943; Smith and Huggins 1982; Barrow et al. 1998). This may be explained by in vivo multiplication of bacteriophages.
 5. Immune system response and elimination of bacteriophages   Go to:         GO   updown   

Bacteriophages consist of tightly packed DNA or RNA and a protein (or lipido-protein) coat. The coat consists of a relatively large number of proteins (usually several hundred molecules). It appears obvious that neutralizing antibodies should be produced in individuals subjected to phage therapy or exposed to naturally occurring bacteriophages. In fact, naturally occurring bacteriophages are able to induce humoral immunity: phage-neutralizing antibodies that were not stimulated by phage treatment were detected in the sera of different species (e.g. human) and in bovine colostrum. Nevertheless, the results for particular bacteriophages differed strongly: for some phages no antibodies were revealed, but for others the occurrence of anti-phage antibodies was very frequent (Smith et al. 1987a). These results probably reflect the frequency of natural contact of animals/humans with various phage species. The contact with bacteriophages may be related to prior infection with host-strains of bacteria, for example, in patients with acute staphylococcal infection, anti-phage antibody titre was reported to arise very strongly. The titres were particularly elevated during infections: a fourfold rise was observed within 6–14 days of acute staphylococcal infections, whereas a fall in the titre correlated with treatment and was usually slow and followed the clinical regression of the infection (Hedström and Kamme 1973; Kamme 1973).

The immunogenic effect of bacteriophages (oral administration) was also observed in patients subjected to phage therapy of bacterial infections caused by Staphylococci, Klebsiella, Escherichia, Proteus and Pseudomonas. Before treatment, anti-phage antibodies were detected in 23% patients and on the 10th day of therapy in 54% patients. Total concentrations of anti-phage antibodies were significantly higher after phage therapy than before it (Kucharewicz-Krukowska and Slopek 1987). Furthermore, in vivo humoral responses to phage FX174 have been used for more than 30 years in clinical immunology as a measure of T helper cell-dependent antibody production (Fogelman et al. 2000; Rubinstein et al. 2000; Shearer et al. 2001). In addition, in calf serum anti-phage antibodies appeared after an oral administration of bacteriophages (Smith et al. 1987a). In mice, antibacterial treatment was ineffective after prior immunization (intramuscular injection) with an appropriate phage (Smith et al. 1987a). However, in fish, no anti-phage antibodies were detected after oral treatment with bacteriophages and after intramuscular injections (Nakai and Park 2002).

[allopathicholistic]

bimazek: thanks. lots of info, wow

johnoso: glad to share. i get forwarded a lot of varioius hiv aids bulletins

mrsa sounds dreadful. it's good to learn about it just in case

[poet]

You can also read about MRSA as it applies to (male) wrestlers in Michigan (not that you guys would be interested in them, of course .  Wrestlers have skin on skin contact with each other which is why it has become such a problem, along with all the other skin to skin contact infections possible.

Going back to where things started in this thread, given what you said, it would be the lack of insurance which would have pushed the hospital into moving a patient from its site to a home.  For anyone reading this thread, if something like this came your way, please do think about your own concerns, your valid health concerns, and make a decision to be safe over being passively agreeable?  By running this through the friend's physician, 'your' personal concerns get put in a second position.  And even if certain fears might be deemed by some to be unreasonable, better to not take a chance.  Win

[Eldon]

A conversation is defintely in order with the Doctor in order to eliminate the possibility of you becoming infected. This is  a wise move on you part. I am sending my best wishes that your friend gets well and recover.

"What Can I do today to make a better Tommorrow?"