By Kate Kelland
Reuters
Researchers have used DNA sequencing for the first time to identify, analyze and put a halt to an infectious disease outbreak in a hospital.

The success of the technique, which used fast genome sequencing technology to control an outbreak of the MRSA superbug on a baby ward, suggests it could be used to control hospital bugs, salmonella and E.coli infections and diseases like tuberculosis, scientists said.

"What we have glimpsed through this pioneering study is a future in which new sequencing methods will help us to identify, manage and stop hospital outbreaks," said Nick Brown, an infection control doctor at Addenbrooke's Hospital Cambridge, who co-led the study and presented the findings at a briefing.

MRSA, or methicillin-resistant staphylococcus aureus, is a drug-resistant bacterial infection, or superbug, and a serious public health problem. When outbreaks occur in hospitals it can lead to the closure of whole wards with many people infected.

The bug kills an estimated 19,000 people in the United States per year. Although rates of MRSA infection have come down significantly in Britain in recent years, it still presents a major threat with several hundred deaths a year and high hospital costs involved in managing infected patients.

Julian Parkhill from Britain's Sanger Institute, who also worked on the study, said there is a "real health and cost burden from hospital outbreaks" which could be significantly reduced or eliminated if they were contained swiftly.

In the study, staff at Addenbrooke's hospital using routine screening over a six month period found 12 patients carrying MRSA. Because they were only using standard tests, which provide limited information, the infection control team was not able to tell if the 12 were part of an outbreak, or were unconnected cases that did not present a threat.

MRSA is a bug present in around one percent of the population at any time, and does not always cause infection.

Parkhill and Brown's team analyzed MRSA samples from the 12 patients with DNA sequencing technology and found that all the MRSA bacteria were closely related, confirming an outbreak.

By tracing relatives and other people who had recent links to the hospital, they also found the outbreak was more extensive than previously thought, with twice as many people carrying or infected with the MRSA strain.

While this sequencing study was underway, the hospital's infection control team found a MRSA case in the special care baby unit - 64 days after the last MRSA patient had left.

The team used advanced DNA sequencing to show in real time that this strain was also part of the same outbreak, raising the possibility that a staff member was unknowingly carrying and transmitting the MRSA strain.

After screening 154 staff they found one carrying MRSA and, using DNA sequencing, confirmed it was the strain linked to the outbreak. The worker was quickly treated to eradicate the bug, and any further spread was stopped.

The researchers, whose findings were published in the Lancet Infectious Diseases journal, say this kind of fast genome sequencing could eventually form the basis for regional or national infection surveillance program designed to nip infectious disease outbreaks in the bud.

"This technology holds great promise for the quick and accurate identification of bacterial transmissions in our hospitals and could lead to a paradigm shift in how we manage infection control and practice," said Parkhill. 

It could also be used for outbreaks of food-borne infections like salmonella or E.coli. Genome sequencing was used in an E.coli outbreak in Europe in 2011, but only in the latter stages to help identify the source.

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A shortage of properly packaged drugs could be putting patients at risk, federal health officials said on Thursday.  They warned about clinics giving injections to more than one patient from vials designed for use for just one patient.

Ten patients in Arizona and Delaware were hospitalized with serious infections they got when clinic staff injected them with drugs taken from vials meant for one-time use in recent months, the Centers for Disease Control and Prevention said. Another patient was found dead at home after getting one of the injections, although it couldn’t be proven the infection killed the patient. Last April, staff at one clinic in Delaware managed to infect nine patients with bacteria from their own bodies.  

The CDC said the cases illustrate a growing problem -- there have been 20 such incidents since 2007.

Staff at both clinics said they had trouble getting specially designed vials for multiple uses, the CDC said. There have been nationwide shortages of some of the drugs because of manufacturing problems.  So staff diluted single-dose packages and used them in several patients, spreading infection. “Medications labeled as ‘single dose’ or ‘single use’ typically are preservative-free and should be dedicated for single-patient use to protect patients from infection risks,” the team of investigators wrote in the CDC’s weekly report on death and disease.

At one clinic in Arizona, staffers diluted a vial of contrast agent, used to help make x-rays clearer when preparing patients for injections of strong pain medications.  They injected 10 patients from this one diluted vial. Three patients were infected with methicillin-resistant Staphylococcus aureus, also known as MRSA, a serious and hard-to-treat bacterial infection.

All had to be hospitalized with meningitis, blood infections or abcesses – one for 41 days. “The fourth recipient of diluted contrast from the afternoon vial was found deceased at home, six days after treatment at the clinic. The cause of death was reported as multiple-drug over­dose; however, invasive MRSA infection could not be ruled out,” the health officials wrote.

In Delaware, seven patients ended up in the hospital for three to eight days after getting injections for joint pain from the same orthopedic clinic last March. “When a national drug shortage disrupted the supply of 10 mL single dose vials, office staff members began using 30 mL single dose vials of bupivacaine for multiple patients,” the investigators wrote.

CDC experts tested the patients and they all were infected with an identical strain of S. aureus – and it matched a strain found living in two of the clinic workers. The workers were colonized – meaning the bacteria lived in their noses or on their skin but didn’t make them sick.

“This report reminds health-care providers of the serious consequences of multipatient use of single-dose vials that can occur even when health-care workers believe they are being careful,” the report reads. There are ways to safely use smaller vials for multiple patients, but the CDC and state health officials in Arizona and Delaware said clinic staff need special training.

How can patients protect themselves? Infection control experts say it's best to be a squeaky wheel -- always ask doctors, nurses and other clinic staff if they have washed their hands before touching you. Patients receiving injections should ask if the equipment is sterile and if it has been prepared according to procedure. And anyone who has been to a clinic or hospital recently should immediately check with a doctor if they develop a fever, rash or cough.

By Susan E. Matthews
MyHealthNewsDaily

Infections with the bacteria methicillin-resistant Staphylococcus aureus (MRSA) have declined in recent years, according to a new huge study.

The bacteria are perhaps best known for spreading among hospital patients, but people have also contracted infections from elsewhere in their communities; the data show that the rates of both types of infections dropped between 2005 and 2010.

In 2005, community-onset MRSA infections affected 1.7 per 100,000 people, on average, but by 2010, the number had fallen to 1.2 infections per 100,000 people. Hospital-onset infections dropped from 0.7 infections per 100,000 people to 0.4 infections per 100,000 people between 2005 and 2010.

The findings are based on data collected by the Department of Defense on more than 9 million active and nonactive military personnel.

The decreases mean that MRSA infections “still represent a large burden of disease, but at least there are some encouraging results,” said study author Dr. Clinton Murray, chief of the Infectious Disease Service at the Brooke Army Medical Center in San Antonio.

Murray said that he found the decrease in the rate of community-onset infections surprising. Prior to 2005, the rate had been rapidly increasing.

About 19,000 people die yearly from MRSA infections, according to the Centers for Disease Control and Prevention (CDC). About one in five of those who develop invasive MRSA infections, which take hold in the blood and spread throughout the body, die from the bacteria. People with open wounds, particularly those in hospitals, as well as people with weakened immune systems, are more likely to die from MRSA.

Community-onset MRSA infections often spread through locker rooms or other close-contact situations.

The study's results are promising, and confirm a previous report by the CDC suggesting similar decreasing trends, said Dr. Michael David, who researches MRSA at the University of Chicago and was not involved in the study.

While the exact reasons for the decreases are unknown, researchers think that improved hospital practices, such as better cleaning practices and increasing attention to the importance of sterile treatments for open wounds, have played a role, David said.

The research also showed that the percentage of MRSA infections that developed outside of hospitals may have peaked in 2006, at 62 percent of infections, before decreasing to 52 percent in 2010.

David said that while these numbers are a positive sign, rates of community-onset infections are still much higher than in previous decades.

"If a doctor left the States in 1999, and came back in 2010, [he or she] would be shocked," David said.  Community-onset MRSA went from “never causing infection, to being the No. 1 cause," he said, and scientists are still trying to understand exactly why this happened.

More common in men
The researchers searched the health records of the 9 million military personnel, of which 82 percent were nonactive, and 52 percent were male.

Over the six years, the records showed 80,281 MRSA infections  of the skin or soft tissue, and 2,643 cases of infections in the blood. The infection was more common in men and people over age 65.

The data used in the study did not include people's risk factors for developing MRSA infections, which is unfortunate, David said, because tracking such factors may have yielded clues as to which improvements in health care practices are having the biggest impact.

While the study was large, it was limited in that the people included represent a subset of the general population, and because all participants had certain levels of income and access to health care.

Additionally, the researchers noted they used data collected only by military hospitals; people with military insurance can choose to see private physicians, so some cases of MRSA may have not been accounted for. While this should not affect the decrease found in the study, it may mean that actual incidence of MRSA is higher than was found here, the researchers said.

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Two of the three members of a Maryland family who died of flu complications last month also had been infected with the drug-resistant bacteria commonly known as MRSA, according to a report released today (April 26).

All three family members who died were infected with the influenza A virus, and two were also infected with methicillin-resistant Staphylococcus aureus (MRSA), the report from researchers at the Centers for Disease Control and Prevention said. 

The cases serve "as a reminder that influenza can cause very severe illness and can result in death," the CDC researchers wrote.

News reports have identified the family members as Lou Ruth Blake, 81, and her children Lowell Blake, 58, and Vanessa Blake, 56, of Calvert County, Md. Three additional family members were infected with the flu and two needed to be hospitalized, but neither was infected with MRSA and both recovered, the report said.

People infected with both the flu and MRSA have a higher mortality rate than people infected with only the flu, according to the report.

Signs that a person is infected with both include a rapid worsening of symptoms, and signs of pneumonia.

Two of the three family members who died had been vaccinated against flu, according to the report. Although the influenza vaccine does not prevent all cases of flu, it remains the best method for preventing complications from influenza, the CDC said. The agency recommends that all people over 6 months of age be vaccinated against the flu. Hand washing and covering coughs and sneezes can also prevent the flu from spreading, according to the CDC.

People with severe respiratory illness should be treated with antiviral medications, the report said. In addition, when there's a high suspicion that a bacterial infection exists, treatment with antibiotics should be considered.

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