MRSA and jails and public reaction

I have a GoogleNews Alert set to crawl for any new posts that mention MRSA. The Google crawler goes pretty deep and often finds things that I would not have known to look for; this week, it has produced a letter to the editor about conditions in a women's jail in South Florida.

The letter itself is interesting, but the public reaction to it, in the form of comments on the website where it was reproduced, is breathtaking.

Here's a quick recap: A woman named Susan M. Woods writes in the letters to the editor on TCPalm.com (which appears, after some drilling, to be a joint site for the Stuart, Fla. Treasure Coast News/Press-Tribune, the Vero Beach Press Journal, the Jupiter Courier, and the Sebastian Sun) about conditions at the Indian River County Jail, where she has been an inmate:

The absolute squalor women are forced to live in is similar to a Third World country. Backed-up toilets, black mold, roaches all around, and nothing to clean the common areas except diluted Windex — it’s frightening. It should be no surprise to hear that at least seven women have gotten MRSA — a staph infection — in as many months.

It will not surprise any of you who follow news about MRSA that jails and prisons are particularly vulnerable to outbreaks; the Los Angeles County Jail epidemic (first described in this MMWR article and further described in this one and covered in this book, which was written by, umm, me) has been going on for half a decade at this point and has affected thousands of prisoners. That there is an outbreak in a jail in Florida is exasperating and sad.

But that people in Indian River County think prisoners somehow deserve staph is just astounding. In the comments on Woods' letter, they say:

In my opinion, someone with Susan's alleged criminal record deserves far worse conditions in her cell than what she is describing in her letters.

You are supposed to not want to be there you idiot. That's why its like living in a third world county.

The conditions in jail are horrendous but people keep coming back. What should the taxpayers do then? Take money away from roads, schools, emergency services to make sure the jails are clean, bright and cheery? Or hope that the bad conditions convince just one moron to obey the law.

If I understand the trolls commenters correctly, they believe that prisoners forgo human rights to such an extent that it is an appropriate part of their punishment to subject them to infectious diseases. So, OK: If they are unmoved to care for their fellow humans, we will leave them to their karma.

But really: Don't they want to take care of themselves? It is well-established by now that MRSA in jails does not stay in jails: It moves out into the community when inmates who acquire it in jail are released and return to the outside. So unless you're going to argue that people in jail should remain there indefinitely — which seems impractical given the rate at which we put people away — to be concerned about MRSA in jails is self-protection if nothing else.

Final report from ICAAC-IDSA 08 (news from ICAAC, 3)

The ICAAC-IDSA (48th Interscience Conference on Antimicrobial Agents and Chemotherapy and 46th annual meeting of the Infectious Diseases Society of America) meeting ended a week ago, and I'm still thrashing my way through the thousands of abstracts.

Here's my final, highly unscientific selection of papers that caught my eye:

* Evidence that the community-strain clone USA300 is a formidable pathogen: It first appeared in the San Francisco jail in 2001. By last year, it had become the sole MRSA strain found in the jail — it crowded out all others. (P. Tattevin, abstract C2-225)
* Another paper from the same UCSF research group finds that the emergence of USA300 has caused a dramatic increase in bloodstream infections, most of which are diagnosed in the ER, not after patients are admitted to the hospital. (B. Diep, abstract C2-226)
* And the CDC finds that USA300 is picking up additional resistance factors, to clindamycin, tetracycline and mupirocin, the active ingredient in the decolonization ointment Bactroban. (L. McDougal, abstract C1-166)
* An example of the complexity of "search and destroy," the active surveillance and testing program that seeks to identify colonized patients before they transmit the bug to others in a health care institution: Patients spread the bug within hours, often before test results judging them positive have been returned from the lab. (S. Chang, abstract K-3379b)
* In addition to the report from Spain I posted on during the meeting, there is a report of emerging linezolid resistance in France. (F. Doucet-Populaire, abstract C1-188)
* And in addition to the abundant new news about MRSA in pork, and "pork-MRSA" or ST 398, in humans, over the past few days, there were reports of MRSA in milk in Brazil (W. Gebreyes, abstract C2-1829) and Turkey (S. Turkyilmaz, abstract C2-1832), and beef and chicken in Korea (YJ Kim, abstract C2-1831), as well as ST 398 itself acquiring resistance to additional drugs. (Kehrenberg, abstract C1-171)
* Echoing many earlier findings that MRSA seems most common among the poor, the poorly housed and the incarcerated, BR Makos of the University of Texas found that children are more likely to be diagnosed with the bug if they are indigent, or from the South (which I imagine is a proxy for lower socio-economic status, since the South is a more rural, more poor region). (abstract G2-1314)
* And finally, to the long list of objects (ER curtains, stethoscopes) that harbor MRSA, here are more: The ultrasound probes in emergency rooms (B. Wessman, abstract K-3377). Also: Dentures. (Ick.) (D. Ready, abstract K-3354)

Breaking MRSA news from the ICAAC meeting 1

There are 15,000+ people at the 48th Interscience Conference on Antimicrobial Agents and Chemistry (known as ICAAC - yes, "Ick-ack") and 46th Infectious Diseases Society of America Annual Meeting, and at least half of them seem interested in MRSA. At the keynote address last night, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, referred to MRSA as a "global pandemic."

Here are some highlights — a few of very, very many — from the first two days:

• MRSA is truly a global phenomenon: Researchers here are reporting on local epidemics in Argentina, Australia, Botswana, Canada, Colombia, Ecuador, Greece, Japan, Nigeria, Peru, South Korea, Sweden and Taiwan.
• In the United States, USA300 — the virulent community strain that is crowding out all other community strains — continues its dominance. It first appeared in the San Francisco jail in 2001 and now is the only cause of community MRSA infections there. (Tattevin, P. et al. "What Happened After the Introduction of USA300 in Correctional Facilities?" Poster C2-225.)
• And MRSA continues to demonstrate its protean ability to cause unexpected forms of illness: The number of cases of sinusitis caused by MRSA seen at Georgetown University tripled between 2001-03 and 2004-06. (I. Brook and J. Hausfeld. "Increase in the Frequency of Recovery of Methicillin-Resistant Staphylococcus aureus in Acute and Chronic Maxillary Sinusitis." Poster C2-228.)
• Meanwhile, treatment options are shrinking. Hospitalization for vancomycin-resistant pathogens (that is, resistant to vancomycin, the drug of last resort for MRSA) doubled between 2003 and 2005 according to national healthcare utilization databases. (A.M. Ramsey et al. "The Growing Burden of Vancomycin Resistance in US Hospitals, 2000-2005." Poster K-560.)
• But, new drugs are beginning to emerge from the pipeline. Early results from a privately held company called Paratek Pharmaceuticals (co-founded by resistance guru Dr. Stuart Levy) showed that their new tetracycline relative PTK 0796 scored as well or slightly better than linezolid (Zyvox) in safety, tolerability and adverse events, and is advancing to a full Phase 3 trial. (R.D. Arbeit et al. "Safety and Efficacy of PTK 0796." Poster L-1515.)
  

More as the meeting goes on.

As promised last month

Not MRSA but worth reading, I hope: My big project on post-Katrina New Orleans, a narrative profile of the leader of the city's "mental health SWAT team," has been published by MORE Magazine.

Read "After the Deluge" here, and then please take a moment to think what you might do to help the recovery of a fabled and shamefully abandoned city. New Orleans is not even close to being over Katrina. It needs all the help it can get.

7-fold increase CA-MRSA in parts of Chicago

Via the Archives of Internal Medicine, a new study from Cook County Hospital and Rush University Medical Center in Chicago. Betwen 2000 and 2005, the incidence of CA-MRSA at the hospital and its neighborhood clinics increased 6.84 times. Notably, meth-sensitive staph (MSSA) did not decrease - this was a true addition, not a substitution of one strain for another. And 79% of the strains identified were USA300. Important clues to the rapid spread of the bug: Those infected were more likely to have been incarcerated more than once (carrying the bug from the known epicenters of jails and prisons back out into the community) or to live in public housing (possibly because of overcrowding as Chicago demolishes its old-style projects and moves the people who live there into its remaining public housing). The paper raises but can't answer the question of a synergy between those factors: People coming out of jail may be returning to households in public housing creating a bridge between a known epicenter and a population whose living conditions put them at greater risk.

Find the paper here.