MRSA Running rampant on A.T. -- Hikers Beware!!

[Uncle Silly]

I'm not a doctor, but I would think that taking ONE doxy (or one of any antibiotic) would be a waste of a good antibiotic, unless, of course, you were trying to create a superbug that was immune to that antibiotic! Antibiotics are generally prescribed as a course that runs 7 to 10 days, so that all of the offending bug that's in your system is killed off. I have my doubts that one dose would be enough to do this.

Actually I attended the medical discussion at the Gathering (Dr Gwinn presiding) and if I recall correctly he said he carries doxy on his as a Lyme's prevention. He recommended 1-2 pills (immediately or within a week or so) after getting a tick bite. The theory being that this would be enough to kill any Lyme bug during its incubation period and prevent it from becoming full-blown Lyme's. (Don't take this as gospel -- this is from memory which could be fuzzy.)

I kinda wish I'd thought to bring up MRSA at the discussion.

[shelterbuilder]

Actually I attended the medical discussion at the Gathering (Dr Gwinn presiding) and if I recall correctly he said he carries doxy on his as a Lyme's prevention. He recommended 1-2 pills (immediately or within a week or so) after getting a tick bite. The theory being that this would be enough to kill any Lyme bug during its incubation period and prevent it from becoming full-blown Lyme's. (Don't take this as gospel -- this is from memory which could be fuzzy.)

I kinda wish I'd thought to bring up MRSA at the discussion.

As I said, I'm no doctor...the last time I was diagnosed with Lyme, my doc prescribed a 3 week doxy course (this was 6 - 7 years ago). One or two pills strikes me as kind of "living on the edge".

From what I'm reading, MRSA's been around for a while, but it's only recently that it's getting it's "fifteen minutes of fame" in the media. I guess that the media needs to take some of the spotlight off of global warming, with the presidential elections coming next year.

[Appalachian Tater]

Actually I attended the medical discussion at the Gathering (Dr Gwinn presiding) and if I recall correctly he said he carries doxy on his as a Lyme's prevention. He recommended 1-2 pills (immediately or within a week or so) after getting a tick bite. The theory being that this would be enough to kill any Lyme bug during its incubation period and prevent it from becoming full-blown Lyme's. (Don't take this as gospel -- this is from memory which could be fuzzy.)

I kinda wish I'd thought to bring up MRSA at the discussion.

I hope your memory is fuzzy because that is very poor advice and that physician should be ashamed if he actually said something like that. Prophylaxis is not recommended at all for tick bites and if you have early Lyme disease, you need ten days of doxy, not one or two doses.

http://www.journals.uchicago.edu/CID...000342.web.pdf

MRSA and Lyme are serious medical problems. The medical and other health care professions at least make a pretense of adhering to scientific principles. It is very easy to Google and find reliable resources and information.

For the most part, there is little room for speculation and opinion because there is scientific evidence to support practices involved in the prevention, diagnosis, and treatment of disease. Spreading sensational headlines or inaccurate information like "MRSA is running rampant on the A.T." or other inaccurate information about such issues is extremely irresponsible.

[Appalachian Tater]

As I said, I'm no doctor...the last time I was diagnosed with Lyme, my doc prescribed a 3 week doxy course (this was 6 - 7 years ago). One or two pills strikes me as kind of "living on the edge".

From what I'm reading, MRSA's been around for a while, but it's only recently that it's getting it's "fifteen minutes of fame" in the media. I guess that the media needs to take some of the spotlight off of global warming, with the presidential elections coming next year.

EXACTLY!!!

[greengoat]

Many of my peers at Ranger School contracted staff. I remember cuts and abrasions oozing with puss. Those of us who treated our abrasions and cuts with Hydrogen Peroxide and neosporin, from the beginning, on a daily basis did not contract staff. Hygeine works even on the AT! Wet Ones work great for a makeshift sponge bath before racking out. Plus it helps cut down the stink. Loose the underwear except for microlight merino wool in cold weather and you'll be fine.

Vty
Green Goat

[Appalachian Tater]

Subject: DOHMH Alert # 33 - Methicillin resistant Staphylococcus aureus infections in school aged children
Date: October 31, 2007 11:48:29 AM EDT

Dear HAN Subscriber:

We have just released a DOHMH Alert concerning Methicillin resistant
Staphylococcus aureus infections in school aged children.

2007 Alert 33:
Methicillin resistant Staphylococcus aureus infections in school aged
children

Community-acquired methicillin-resistant Staphylococcus aureus (MRSA)
skin infections in children are common. Serious illness and deaths are
extremely rare.
Single cases of MRSA are not reportable. Please report clusters or
cases in which an increased risk of person-to-person transmission exists
(see text for details).

Please Distribute to All Clinical Staff in Internal Medicine, Surgery,
Pediatrics, Infectious Diseases, Emergency Medicine, Family Medicine,
Dermatology, Laboratory Medicine and Infection Control Staff. Please
also share with your non-hospital based primary care colleagues.

October 31, 2007

Dear Colleagues,

The recent death of a12-year-old child in Brooklyn has raised community
concern over methicillin-resistant Staphylococcus aureus (MRSA)
infections occurring in school aged children. Although the Medical
Examiner is still investigating the exact cause of death, a blood
culture obtained 24 hours postmortem grew MRSA. The child was known to
have had a recent skin infection. There have been no secondary MRSA
infections associated with this case. The purpose of this alert is to
inform primary and acute care practitioners about community-acquired
MRSA infections, offer guidance in diagnosing and treating MRSA
infections, and to clarify reporting requirements to the NYC Department
of Health and Mental Hygiene (DOHMH).

Skin and soft tissue infections (SSTIs) in children are common and
approximately half are due to Staphylococcus aureus. A study published
this month reported data from nine sentinel active surveillance sites
(Klevens et al. Invasive methicillin-resistant Staphylococcus aureus
infections in the US. JAMA 2007; 298:1763-71). The study was limited to
bloodstream and other sterile site MRSA infections and therefore does
not include uncomplicated SSTIs. The authors estimated that 94,360
invasive MRSA cases occur in the US annually, more than were previously
believed to occur. MRSA is currently reportable in only a handful of
states and the true incidence of MRSA, inclusive of skin and soft tissue
infections, is unknown.

The recent media attention given to this common pediatric infection may
cause parents to bring children to their physician requesting
examination, screening and reassurance. DOHMH conducted a survey of
laboratories with high-volume pediatric hospital emergency departments
in NYC to estimate the number of MRSA SSTIs in children. We estimate
that there were at least 600 laboratory-confirmed MRSA cases in children
5- to 18-years old in NYC in 2006. During the same time period, no
deaths due to MRSA in previously well children were found on a
preliminary review of death certificates for NYC children less than 18
years of age. Clinicians should reassure parents that while skin and
soft tissue infections are common in children, serious illness is very
unusual. In the article by Klevens referenced above, the death rate
among children was reported as 0.1 per 100,000 population, and the rate
of invasive infection (positive culture from a sterile site) was 1.4 per
100,000 among 5- to 17-year-old children.
Transmission of MRSA is generally by direct person-to-person contact.
The role of fomites or contamination of the environment in community
transmission is believed to be minimal. We recommend that all exposed
wounds, especially those with draining exudate or pus, be securely
covered with a clean, dry bandage in public settings.

Management of MRSA Infections in School-aged Children
MRSA in school-aged children is common and covered wounds present little
or no risk of transmission. Children with MRSA should not be excluded
from school. MRSA outbreaks or clusters in classroom settings have not
been reported. However, outbreaks among members of sports teams,
especially those with a high degree of skin to skin contact, have been
reported.

Individuals involved in contact sports (e.g., football, basketball,
wrestling) should have skin and soft tissue injuries regularly viewed by
parents, coaches or trainers to assure the injuries are healing
normally. Any sign of infection should be promptly evaluated by a
medical provider. Because of the nature of the sport, wrestlers with
MRSA should not be allowed to participate until their wound has healed
and the patient has received medical clearance. Athletes diagnosed with
MRSA, other than wrestlers, should be evaluated on a case-by-case basis
and excluded from participation only if their wounds cannot be securely
covered to prevent leakage of drainage. Care should be taken to ensure
that any equipment, towels or clothing which may have contact with the
wound are not shared.
Please reinforce with your patients that frequent hand washing and
personal hygiene are fundamental to preventing MRSA infections.

Diagnosis and Treatment of SSTI
Incision and drainage (I&D) is the preferred treatment for abscesses
whenever possible. Practitioners who are not able to perform I&D in
their offices should assess the need for the procedure and refer the
patient to either a surgeon or an emergency department where the
procedure can be performed. Antibiotic treatment often is not necessary
and the patient should be educated on general wound care. However,
culture of the wound or abscess should be strongly considered,
particularly if antibiotic treatment is given, the initial regimen has
failed, or the infection appears to be severe. Antibiotic therapy should
be guided by culture and susceptibility results. As these tests take
several days, empiric therapy should consider that MRSA is increasingly
recognized in community settings; data from an ongoing DOHMH
investigation found that 39% of Staphylococcus aureus identified in
cultures submitted to a large commercial outpatient laboratory in 2006
were methicillin-resistant. The sample includes patients of all ages and
represents patients visiting private medical providers. The Table below
presents the susceptibility profile of these isolates to commonly used
antibiotics. A review article on the clinical approach to MRSA SSTI was
published this summer in the New England Journal of Medicine (Daum S.
Skin and soft tissue infections caused by methicillin-resistant
Staphylococcus aureus. N Engl J Med 2007; 357:380-390).

Colonization by Staphylococcus aureus may occur in 20-25% of healthy
people; fewer than 1% are colonized by MRSA. Treatment of colonization
is not generally recommended as carriage may be transient. Unless a
patient has recurrent MRSA infections there is no indication for routine
nasal screening. Consultation with an infectious disease specialist
before treating colonization is recommended.

MRSA pneumonia is a well-known and potentially fatal complication of
influenza infection, including in children. Consider influenza vaccine
for your patients at increased risk for influenza-related morbidity and
mortality. There is no shortage of vaccine this year. The following
pediatric groups should be targeted for influenza vaccination:
All children 6 months to 5 years.
All persons 6 months and older with chronic medical conditions,
including heart disease, pulmonary disorders (including asthma),
diabetes, kidney disease, hemoglobinopathies and compromised immune
systems (HIV or immunosuppressive therapy).

For more information on indications for influenza vaccine please visit:
http://www.nyc.gov/html/doh/html/imm/fluhome.shtml

Environmental Cleaning Considerations for MRSA
No special disinfection measures are recommended for schools or offices
to eliminate Staphylococcus aureus or MRSA from the environment. Humans
are the natural reservoir and the organism is ubiquitous. Proper skin
care and personal hygiene are the recommended measures to control MRSA
in non-healthcare settings. Specific guidance on EPA-registered
disinfectants effective against MRSA is available at:
http://www.epa.gov/oppad001/list_h_mrsa_vre.pdf

Reporting of MRSA
Please report clusters of MRSA (2 or more confirmed cases with a common
association) to DOHMH. Single confirmed cases of Staphylococcus aureus
and MRSA are not reportable except under the following high-risk
categories:
. Children and young adults involved in inter-scholastic,
inter-collegiate and competitive sports teams where either shared
equipment or use of locker room facilities exists.
. Children in daycare.
. Persons living in congregate settings (e.g., shelters).
. Any unusual circumstances in which wound drainage cannot be contained
or a risk of contamination to others exists.
. Any unusual manifestation of disease (e.g., death in a child).

The Department has proposed adding MRSA to the list of reportable
diseases. We are only asking that laboratories be required to report
MRSA through the New York State Electronic Clinical Laboratory Reporting
System. Medical providers are not being asked to report individual MRSA
cases except, as noted above, clusters or individual cases with high
risk for exposure to others. MRSA reporting will assist the Department
to quantify the burden of illness in NYC, track trends, perform
investigations to learn about risk factors and develop prevention
messages. A proposal was submitted to the Board of Health on October 24,
2007 and is presently open for public comment until November 28, 2007.

For more information or to comment on the proposal, please visit our
website at:
http://www.nyc.gov/html/doh/html/notice/notice.shtml


Table- Antibiotic susceptibility profile of community and
healthcare-associated MRSA from skin and soft tissue infections
diagnosed by a commercial outpatient laboratory, all ages, NYC, 2006
Antibiotic Percent Susceptible

Healthcare associated-MRSA (%)
(Healthcare exposure defined as hospitalization, surgery or dialysis in
the 3 months prior to onset of infection)
N=105 Community associated-MRSA (%)
(Patients without healthcare exposure)
N=567
Ciprofloxacin 21 30
Clindamycin1 43 62
Erythromycin 12 11
Tetracycline 90 82
Trimethoprim-Sulfamethoxazole 99 99
1 Clinicians should check with their laboratories to ensure that the
D-test to examine for inducible clindamycin resistance is performed


Additional information may be found at the Centers for Disease Control
and Prevention website:
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html

The CDC, American Medical Association, and Infectious Diseases Society
of America flyer on clinical management of skin and soft tissue
infections:
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_skin.html

Strategies for Clinical Management of MRSA in the Community, the summary
of an expert panel convened by CDC is available at:
http://www.cdc.gov/ncidod/dhqp/pdf/a...Strategies.pdf

CDC's Get Smart Campaign Promoting the Judicious Use of Antibiotics
http://www.cdc.gov/drugresistance/community/

To report a cluster or confirmed high-transmission risk MRSA case,
consult on infection control practices, or to obtain additional
information, please contact the Bureau of Communicable Disease at:

During business hours: 212-788-9830
After hours, contact the Poison Control Center: 212-764-7667 or
1-800-222-1222 and ask for the Doctor on Call

We appreciate your assistance in addressing the emerging problem of
community acquired MRSA in New York City.

Sincerely,

Don Weiss, MD, MPH
Director of Surveillance
Bureau of Communicable Disease

Melissa A. Marx, PhD
Director, Antibiotic Resistance Unit
Bureau of Communicable Disease


[Cuffs]

That is ignorant. Sanitation is at its worst on the trail. That's why a greater percent of people that hike the trail come away with it. You are more likely to get MRSA on the trail than if you live a normal existence.

OK, no name calling please. I will say that when I was teaching, I had every cold that came thru the classroom, so much for sanitation. I always got better and felt better when out hiking. I do keep a strict hygiene regiment on the trail.

Where are you rpercentages coming from? What database provided your statistics?

[kyerger]

I hiked that section then too. Went fron Ga./NC boarder to the smokies. i had no problems with MERSA. Any chance we ran into each other. I go by trail name turdle cause im slow.

[Blue Jay]

Spreading sensational headlines or inaccurate information like "MRSA is running rampant on the A.T." or other inaccurate information about such issues is extremely irresponsible.

Truer words have never been spoken on this forum. For some perverted reason many people love to spread fear. For them, I always say, please stay under your bed and do not type.

[Blue Jay]

You are more likely to get MRSA on the trail than if you live a normal existence.

This is possibly the biggest load of BS on this forum. There are fewer people on the trail than almost any place else in this country. Do you get MRSA from trees? Again stay under your bed and stop spreading fear.

[SGT Rock]

I hear if you filter your water you are immune.

[saimyoji]

Yeah but you have to carry hiking poles and sleep in a shelter at least 2x a week.

[Uncle Silly]

I heard you can get MRSA from trees, even if you filter your water!

[shelterbuilder]

Thank you, Tater, for that post - a little long-winded, but right on the mark for putting this issue to rest scientifically.

It seems to me that most of us have a better chance of coming down with Lyme than we do of contracting MRSA.

(So tell me, where's the "panic thread" for Lyme? )

[take-a-knee]

Uncle Silly is correct about a single 100mg tab of Doxycycline being preventative for Lyme disease. This is not a treatment for an infection, there is no infection...yet. You find tick, remove tick, take pill, all is well. If you wait a week, all bets are off.

You only take one pill per week to prevent malaria (unless you are using doxy, then you take one pill daily). If you get malaria, you must take lots and lots of pills.

[SGT Rock]

Where does one get Doxycyckine?

[rafe]

Where does one get Doxycyckine?

Ask your doctor for it. Worked for me.

[shelterbuilder]

Uncle Silly is correct about a single 100mg tab of Doxycycline being preventative for Lyme disease. This is not a treatment for an infection, there is no infection...yet. You find tick, remove tick, take pill, all is well. If you wait a week, all bets are off.

You only take one pill per week to prevent malaria (unless you are using doxy, then you take one pill daily). If you get malaria, you must take lots and lots of pills.

I still have problems with the concept of taking only one antibiotic pill at any stage of infection. To my way of thinking - and correct me if I'm wrong - low doses of antibiotics are how we create "superbugs" in the first place, by accustoming the bugs to low doses of the drugs we use to kill them.

SGT, doxycycline is a tetracycline analog, available by prescription only.

[SGT Rock]

Ask your doctor for it. Worked for me.

I still have problems with the concept of taking only one antibiotic pill at any stage of infection. To my way of thinking - and correct me if I'm wrong - low doses of antibiotics are how we create "superbugs" in the first place, by accustoming the bugs to low doses of the drugs we use to kill them.

SGT, doxycycline is a tetracycline analog, available by prescription only.

So this is a pill or two you carry in case you get a tick.

Of all the critters out there, the Lyme disease is the one I really am concerned about. Too bad the vaccine was a flop.

[take-a-knee]

Rock, you need a scrip for doxycycline. 100mg is the usual dose. It comes in tablets and capsules, the tablets store much better. When you get this stuff it needs to go in an airtight container with a little dry cotton and stored at room temp or below. Write the expiration date on it, and try to get some with the farthest out exp date. I have used penicillin based drugs that were years out of date with no problem. Don't even think about trying this with doxy or anything else in the tetracycline family as it decays into products that are really, really hard on your kidneys. When the drug expires, replace it and throw the old stuff in the trash.