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rem1536
10-17-2007, 10:17
Everyone in my group got MRSA Staph infections after our A.T. trip. I tried to stay as sanitary as possible, and I still got it.

Has anyone else experienced this? I was on the Georgia/Southern N.C. section in July.

rem1536
10-17-2007, 10:21
Google MRSA and do a little research. It's some scary stuff.

Here's an article from cnn.com about it.
http://www.cnn.com/2007/HEALTH/conditions/10/16/mrsa.cdc.ap/index.html

shelterbuilder
10-17-2007, 10:22
Everyone in my group got MRSA Staph infections after our A.T. trip. I tried to stay as sanitary as possible, and I still got it.

Has anyone else experienced this? I was on the Georgia/Southern N.C. section in July.

I'm no expert, but I would suspect that someone in your group had already been exposed to it immediately before the trip.

Appalachian Tater
10-17-2007, 10:39
MRSA is serious and hospitals have had to close units but there are tons of healthy people walking around carrying it. However, this is the first time I have heard about it being a problem on the A.T. A phrase like "MRSA Running rampant on A.T. -- Hikers Beware!!" is overdramatic. It's pretty much running rampant everywhere and recent information indicates that the problem has been underestimated. The common cold is running rampant on the A.T. as well.

Certainly tick-borne diseases pose a more frequent and serious threat to the average hiker and it is a problem that does not seem to be taken very seriously by very many.

Your point about good hygiene is well-taken. Children used to learn hygiene and physical health in school, I have seen the textbooks, but I don't think they do anymore. In 2006 there was at least one hiker who was hiking the ENTIRE trail without bathing. That is asking for trouble.

fitz
10-17-2007, 10:46
I don't usually post, I am an avid reader and lurker. I am a nurse who works in a jail setting. Staph is not new and neither is MRSA. staph is on you all the time. A local skin infection needs to be watched, kept clean and dry, and most important keep your hands off. If it gets larger than a dime see a MD. Most staph infections are moved around the body and from people to people by poor hand washing. Yes it can be scary when the media jumps on the band wagon hyping the situation. MRSA is not new and there are ways of treating most infections. So wash your hands, don't share clothes or sleeping bags. Clean your equipment on a regular basis. just my 2 cents worth.

fitz

the goat
10-17-2007, 12:13
from the washington post today:

http://www.washingtonpost.com/wp-dyn/content/article/2007/10/16/AR2007101601392_pf.html

Fahrenheit
10-17-2007, 18:40
MRSA may not be new but in recent years the amount of community acquired MRSA has sky-rocketed. It is something that the health community is only just starting to realize the scope of. On the other hand that Washington Post article strikes me as a bit over-dramatic. MRSA can be quite nasty but the worst cases we see are hospital acquired in already sick people . Community acquired MRSA, which is what the OP's group likely had, is no fun but usually much easier to treat. Its definately important to get it treated though as you can get quite sick.

Appalachian Tater
10-17-2007, 19:24
I don't usually post, I am an avid reader and lurker. I am a nurse who works in a jail setting. Staph is not new and neither is MRSA. staph is on you all the time. A local skin infection needs to be watched, kept clean and dry, and most important keep your hands off. If it gets larger than a dime see a MD. Most staph infections are moved around the body and from people to people by poor hand washing. Yes it can be scary when the media jumps on the band wagon hyping the situation. MRSA is not new and there are ways of treating most infections. So wash your hands, don't share clothes or sleeping bags. Clean your equipment on a regular basis. just my 2 cents worth.

fitz

Do you work in a jail or prison? Have you had a problem with MRSA? Drug-resistant TB with HIV+ prisoners? I'm just curious as to what changes or trends you've seen in the last few years.

handlebar
10-17-2007, 20:44
Everyone in my group got MRSA Staph infections after our A.T. trip. I tried to stay as sanitary as possible, and I still got it.

Has anyone else experienced this? I was on the Georgia/Southern N.C. section in July.

My hiking buddy Veto, who had been an intensive care nurse, got a boil on his knee and then got an infection on his foot that took him off the trail for 3 weeks. Turned out to MRSA.

I had a boil where my pack rubbed against a vertebre. It was resistant to some of the antibiotics, but healed promptly when drained at Millinocket and treated with a broad spectrum antibiotic.

What someone posted about hygiene is important. It's also important do deal with infections promptly.

Appalachian Tater
10-17-2007, 21:04
A lot of hospital employees, especially in the ICU, test positive for MRSA and that's method of transmission.

Lone Wolf
10-17-2007, 21:06
stay out of all hostels and shelters and y'all will be fine

Uncle Silly
10-17-2007, 21:33
However, this is the first time I have heard about it being a problem on the A.T. A phrase like "MRSA Running rampant on A.T. -- Hikers Beware!!" is overdramatic.

I saw at least two thru-hikers who had staph or MRSA infections in the VT/NH/ME region. There were reports of several others with the same issue. Considering I'd never heard of staph infections on the trail before this season, I don't think this is terribly overdramatic.

I'm curious, rem1536, you said your whole group got infections... how many folks is that?

Now the news programs on Charlotte's local CBS affiliate that run "investigative" reports on how much "bacteria that can make you sick" exists on (bathroom sink faucets, high school drinking fountains, or whatever surface strikes their fancy) ... now that's overdramatic.

modiyooch
10-17-2007, 21:36
I don't know much about mrsa, but I had staph when I was 10 yrs old from an infected mosquito bite. Spent a week in the hospital.

Smile
10-17-2007, 23:38
Interesting first and second posts by this user :)

Appalachian Tater
10-17-2007, 23:56
Staph. aureus is a common bacteria on the skin and in the nose. MRSA is the same bacteria, it has just changed genetically to be resistant to methicillin. A hundred years ago people died from infected mosquito bites and pimples and boils all the time. As organisms become resistant and the pace of discovering new antibiotics slows, you will see more people dying from infections.

MRSA contaminates surfaces and is transmitted that way as well as person-to-person.

Many MRSA infections in otherwise healthy people start out looking like a bug bite and develop into a boil. Another common form is an infection of the hair follicles in a rash. Anything unusual like this and you should seek medical attention.

MRSA is nothing new and there has not been some horrible increase in the number of cases over a short period of time. What's new is the media attention. If a group on the A.T. got it, it's no different from a group getting diarrhea at the same time or sharing a cold. There is no need to spread panic or create drama. The situation today is no different than it was a month ago nor is it different than it will be a month from now. When seeking information on it from the internet, look for reliable sources like the CDC, physician organizations, etc, and not the news bites on the 11 o'clock news. They are no more reliable at reporting on MRSA than they are on bear "attacks".

Frolicking Dinosaurs
10-18-2007, 06:26
He-Dino got MRSA when he has the surgery for the table saw accident in July 2006. Papaw Dino got it in an injury to his leg incurred during yard maintenance (the community acquired variety). Both were nasty stuff and hard to treat. Both ended up being successfully treated with a very old class of antibiotics that is rarely used anymore - the sulfur-based antibiotics. Seems MRSA has genetically forgotten about those drugs.

nitewalker
10-18-2007, 07:12
a good sign of this; is a wound that is sensitive to touch, gets more red, fills with more puss than usual, increases in size ....theses are a few symptoms to look for.....peace out, nitewalker

nitewalker
10-18-2007, 07:17
maybe the world needs to burn itself clean of all these viruses. natures way of cleaning up all the scum!!!.. how do you think they got rid of all the rats in chicago, fire or was that in boston..im not sure but there was some big city back around the turn of the century that was having a disease problem being spread by rats then they had the great fire which in a sense got rid of the rats and the disease went with them....fire, how about a little fire scarecrow!!!!!! peace out, nitewalker

shelterbuilder
10-18-2007, 08:45
....fire, how about a little fire scarecrow!!!!!! peace out, nitewalker

I'd just prefer NOT to be the scarecrow, thank you!:eek:

fitz
10-18-2007, 08:52
I work in a county jail which at my building houses over 200 inmates. Yes skin infections are on the rise. Most of my inmates claim they are spider bites. We have to educate them on spider behavior. Most spiders don't go out of there way to bite a human. Never had a real spider bite here but we do have a good amount of staph infections. Our HIV population is non-existant. We may get one person a yr in with HIV. I have been here 6 yrs and never had a case of active TB. Inmates and skin problems go hand in hand d/t they have nothing but time to scratch and pick at themselves.

fitz

rem1536
10-18-2007, 11:01
I saw at least two thru-hikers who had staph or MRSA infections in the VT/NH/ME region. There were reports of several others with the same issue. Considering I'd never heard of staph infections on the trail before this season, I don't think this is terribly overdramatic.

I'm curious, rem1536, you said your whole group got infections... how many folks is that?

Now the news programs on Charlotte's local CBS affiliate that run "investigative" reports on how much "bacteria that can make you sick" exists on (bathroom sink faucets, high school drinking fountains, or whatever surface strikes their fancy) ... now that's overdramatic.

There were 3 of us.

rem1536
10-18-2007, 11:04
Interesting first and second posts by this user :)


Yeah, I was an avid trailplace user, and posted on there quite a bit before/after my hike.
I just wanted to bring it to everyone's attention, because if a thru-hiker gets out there and gets an abscess and doesn't get it seen about the results can be quite devastating.

I agree with the statement about staying away from hostels, shelters and privies, but without them it can make the trail pretty miserable.

Don't use my number of posts as a sign that I don't keep up on the A.T. I just wanted to do a little public service.

Newb
10-18-2007, 17:12
MRSA is all over the school systems here in the DC area right now. THey just said on the news that it showed up now at the fire academy in DC. It's rampant.

Appalachian Tater
10-18-2007, 19:25
Inmates and skin problems go hand in hand d/t they have nothing but time to scratch and pick at themselves.

fitz

That is funny in a sad way. I wouldn't have thought of that but it makes a lot of sense. I knew a patient who lost a leg to necrotizing fasciitis, I think it was a Strep. and it started where he had a small bruise, no abrasion or cut. The skin is the largest body organ and in many ways very amazing with all the things it does and all it endures.

WILLIAM HAYES
10-18-2007, 23:10
I have worked in a hospital for 25 years and community acquired MRSA has become an increasing issue.My infectious disease docs tell me your best protection is to make sure you wash your hands frequently .Also
stay from folks with hacking coughs, treat open sores quickly especially blisters and in particular on the trail don't shake hands with people-you don't know how clean their hands are ,dont share food out of the same zip lock -actually you are a much safer situation on the trail than probably any place else.
Hillbilly

Appalachian Tater
10-19-2007, 00:00
IMy infectious disease docs tell me your best protection is to make sure you wash your hands frequently.
Which is exactly what nurses have been trying to convince physicians to do since the 1840s.


in particular on the trail don't shake hands with people-you don't know how clean their hands are Probably safe to assume that they are filthy. Maybe not with MRSA but with some nasty stuff nonetheless.


Probably a safe bet actually you are a much safer situation on the trail than probably any place else. Especially if your suggestions are followed.

In addition, people who get sick on the trail need to be scrupulous about not infecting others. I have seen someone drink out of a glass in a hostel and set it back down in the dishrack without washing it.

Uncle Silly
10-19-2007, 00:42
dont share food out of the same zip lock

Here's a great tip, can't remember where I first ran across it, but get yourself into this habit on the trail: If someone offers you some [gorp, crackers, other tasty snack from a ziplock], don't reach in to grab some. Instead, pour some out (or have them pour some out) into your hand. If you're the one offering, politely insist that anyone taking you up on the snack accept it poured into their hands.

This keeps the bag's contents from being cross-contaminated by all those hands but still allows you to share with your friends.

Appalachian Tater
10-19-2007, 00:46
Here's a great tip, can't remember where I first ran across it, but get yourself into this habit on the trail: If someone offers you some [gorp, crackers, other tasty snack from a ziplock], don't reach in to grab some. Instead, pour some out (or have them pour some out) into your hand. If you're the one offering, politely insist that anyone taking you up on the snack accept it poured into their hands.

This keeps the bag's contents from being cross-contaminated by all those hands but still allows you to share with your friends.

That's polite manners in general, even off the trail. Don't serve yourself from a common dish with your own utensils or with your hands unless you are taking a single serving of say, bread, in a way that doesn't cause you to touch anything else in the serving dish.

rem1536
10-19-2007, 08:19
-actually you are a much safer situation on the trail than probably any place else.
Hillbilly

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.

Doctari
10-19-2007, 13:39
I'm in the health field, most of us (right or wrong) think we already have it. Nasty stuff, especially if your immune system isn't "Up to speed" so to speak.

I agree that someone in your group may already have had it, then a little shared food (usually everyones hands into same food bag, like GORP or whatever) & presto MRSA for everyone.

Appalachian Tater
10-19-2007, 20:14
Sanitation is at its worst on the trail.
Speak for yourself! With soap and water &/or baby butt wipes soaked with a little alcohol &/or alcohol gel and a little common sense you can maintain an acceptable level of sanitation and avoid disease. Just because you aren't squeeky clean doesn't mean your face and private parts can't be cleaned daily and your hands can't be cleaned after you go to the bathroom and before you handle food.


That's why a greater percent of people that hike the trail come away with it.Huh? Where did you get your statistics or even an impression that this statement is true? Greater percent than what anyway?? How many cases have been reported? Over what period of time? You should worry more about tick-borne disease on the trail as it occurs frequently, is much harder to diagnose, and can be permanently disabling.


You are more likely to get MRSA on the trail than if you live a normal existence.How so? You get MRSA from other people either directly, or indirectly from things they have touched. Use a little common sense, the same sanitary precautions you should take all the time to avoid disease, and seek medical attention quickly for any infection.

You're probably safer on the trail because you're not touching doorknobs, light switches, copier buttons, etc. that everyone else touches. There are fewer people in general, and fewer sick people. The place you would most expect to get MRSA is in a hospital.

Start here and read some of the linked pages: http://www.nlm.nih.gov/medlineplus/mrsa.html

rumbler
10-19-2007, 21:54
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.

There is a big difference between being stinky and being sanitary.

I always hike with alcohol wet-wipes. Probably more diligent about washing my hands prior to eating than when I am not hiking, simply because I know that I am dirty and sweaty.

I don't think one needs to be a pig to qualify as being a hiker.

Fiddleback
10-20-2007, 11:20
I don't think one needs to be a pig to qualify as being a hiker.

I agree but behavior by some make you wonder...

I've seen posts on bp forums by folks who stop just short of bragging that they don't care or bother about 'washing up.' There's even been posts about not washing hands before inserting contacts.:eek:

In the end, it is a matter of drawing lines...some wash their hands 'all the time', some only after toileting, some never. But if you want to stay healthy, you must start by staying clean. The second step should be to stay away from those who don't. IMO.

FB

Frolicking Dinosaurs
10-20-2007, 11:38
Since Methicillin-Resistant Staph aureus (MRSA) is killed by the UV rays in sunlight, I would imagine that being infected on the trail is far less of a threat than being infected in a normal community setting - especially if one avoids shelters and hostels, uses clean methods to share food and does not accept food from others, and avoids touching other hikers.

icemanat95
10-20-2007, 11:45
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.


Doesn't make sense.

MRSA is a resistant staph infection, not just a plain old staph infection. It became resistant because it was exposed to common antibiotics in humans and the stuff that became MRSA was able to survive it, either because the antibiotics were not dosed properly or treatment was not followed through completely, or just because the infection strain evolved into a tougher form. The critical element in its evolution into MRSA was the presence of lots of people AND ineffective treatment with antibiotics, thus MRSA is most common in hospitals schools, prisons, etc. where close communities of people (even transient communities) combine with medical treatment/antibiotics and detergents. in the absence of these factors it will not be present.

On the AT the bacteria have only the one element...people. Thus it is FAR more likely that your group developed MRSA infections from contact with an infected person in your group or close to your group who caught the infection in a hospital, prison, jail, school etc. rather than encountering it randomly in the woods...its just not native to the trail environment.

I'm assuming that it is actually MRSA, properly diagnosed by medical personnel who took a culture? Staph infections are otherwise pretty common.

Now getting an infection that runs rampant on YOU in the woods or on trail isn't surprising, you are right about that. From filthy boots to filthy skin, hikers don't tend to be terribly clean folks, so any infection we do get tends to get bad.

SawnieRobertson
10-20-2007, 13:22
On the trail I carried betadine wipes, Dr. Bonner's peppermint soap, treated water, and doxicycline. I seldom (only in the event that there was an available spot) stayed in shelters and that only when a big storm was about. I hate privies and groan inwardly when I realize that one is available and that I, therefore, will be expected to use it. I also have opted not to stay at hostels, preferring in the days when I had more income, to stay at motels.

Every evening on the trail, I would duck into my tent before dark. There I would give myself a good wash down with Dr, Bonner's soap and treated water, I would wash out my underwear and hang them to dry within the tent. Usually the were dry by morning, being made of synthetics.

Any break of the skin got my full and immediate attention with the betadine wipe and then with neosporin if necessary. I'd give it as much air as I could and would repeat the treatment that night, in the morning, etc. until there was clearly no problem.

Only once did I think something was getting out of hand. One doxicycline pill, and the next day it was totally healed.

More than once I was amazed at how any break in the skin would heal overnight or in two days without any antibiotic taken orally or applied topically. My conclusion was that I became so healthy out there that my body benefitted in untold ways and that this is the way we are s'piosed to live.

I disagree that the trail is a medical trap of any kind.--Kinnickinic

mudhead
10-20-2007, 15:48
I would enjoy a medical opinion on the merit of sulfa-powders. I have used these on animals and was told they were state of the art way back when. Course it was a cow doctor...

Not sure about taking one doxy. Is that a normal run?

Maybe Bag Balm! That'll fix it!

icemanat95
10-20-2007, 16:45
Sulfa Drugs tend to make one more sensitive to sunlight. I'm not sure what the impact of sulfa powders would be. They were standard battlefield sterilization/antibiotics during WWII providing a significant benefit. Penicillin was a major Allied advantage at the time...the Axis powers didn't have it, making wounds a more difficult situation on their side.

WILLIAM HAYES
10-20-2007, 18:55
Rem has just demonstrated his own ignorance on the subject

shelterbuilder
10-20-2007, 18:58
Not sure about taking one doxy. Is that a normal run?


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!:eek: 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.

Uncle Silly
10-20-2007, 19:44
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!:eek: 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
10-20-2007, 19:54
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.:D

Appalachian Tater
10-20-2007, 19:58
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/journal/issues/v31nS1/000342/000342.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
10-20-2007, 19:59
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.:D

EXACTLY!!!

greengoat
10-20-2007, 21:34
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
10-31-2007, 11:57
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/ar/CAMRSA_ExpMtgStrategies.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
10-31-2007, 12:28
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
10-31-2007, 13:59
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
10-31-2007, 16:09
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
10-31-2007, 16:15
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
10-31-2007, 16:20
I hear if you filter your water you are immune.

saimyoji
10-31-2007, 19:19
Yeah but you have to carry hiking poles and sleep in a shelter at least 2x a week.

Uncle Silly
10-31-2007, 19:41
I heard you can get MRSA from trees, even if you filter your water! :eek:

shelterbuilder
10-31-2007, 21:54
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?:D )

take-a-knee
10-31-2007, 22:10
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
10-31-2007, 22:16
Where does one get Doxycyckine?

rafe
10-31-2007, 22:23
Where does one get Doxycyckine?

Ask your doctor for it. Worked for me.

shelterbuilder
10-31-2007, 22:26
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
10-31-2007, 22:28
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
10-31-2007, 22:31
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.

take-a-knee
10-31-2007, 22:46
ShelterBuilder, you keep saying infection, there is no infection yet when you get a tick on you. When you are exposed to a pathogen, your tissues are colonized at first (no symptoms) then if your immune system is unable to kill the invader initially you will experience an infection ( lots of symptoms). A couple of hours after you get a tick on you the colony count in your skin is miniscule and it is in a highly vascular area where the doxy can do its thing... think troops in the open and white phosphorous.

What makes Lyme and the other ricketsial bacteria (Rocky Mountain Spotted Fever, syphillis) a real bitch is their affinity for colonizing areas of the body with poor blood flow like joint capsules. That is why early treatment is best for this or any other bacteria.

The earlier post about Ranger students getting staph from untreated wounds is so true, TREAT ALL WOUNDS, HOWEVER MINOR THEY APPEAR.

shelterbuilder
11-01-2007, 07:36
ShelterBuilder, you keep saying infection, there is no infection yet when you get a tick on you. When you are exposed to a pathogen, your tissues are colonized at first (no symptoms) then if your immune system is unable to kill the invader initially you will experience an infection ( lots of symptoms). A couple of hours after you get a tick on you the colony count in your skin is miniscule and it is in a highly vascular area where the doxy can do its thing... think troops in the open and white phosphorous....

The "colonization" phase to which you are refering is the initial part of the "infection" - you make the distinction, I do not.

But I'd still prefer to see the science behind the practice before I'd commit to it.


Let's get back on topic.

Newb
11-01-2007, 09:12
MRSA has now been identified in the building in which I work here in Virginia. A worker here manifested it this week and they closed our cafeteria for scrubbing. egads.

Uncle Silly
11-01-2007, 11:06
The "colonization" phase to which you are refering is the initial part of the "infection" - you make the distinction, I do not.

This might seem semantic, but I think this is an important distinction. From the viewpoint of a healthy person, you aren't "sick" until you're experiencing the symptoms of a full-blown infection. SB, you're right that your body is "infected" by the pathogen as soon as it's introduced -- that's one use of the term "infection", the use that's synonymous with the term "invasion". But I think take-a-knee's distinction is more medically accurate -- or seems so to this layperson: You don't have a medically-significant "infection" until the pathogen has survived your immune system long enough to colonize part of your body.

take-a-knee, thanks for your explanation of the stages of infection, it does explain why the 1-doxy-pill tickbite remedy might work.

take-a-knee
11-01-2007, 12:42
This might seem semantic, but I think this is an important distinction. From the viewpoint of a healthy person, you aren't "sick" until you're experiencing the symptoms of a full-blown infection. SB, you're right that your body is "infected" by the pathogen as soon as it's introduced -- that's one use of the term "infection", the use that's synonymous with the term "invasion". But I think take-a-knee's distinction is more medically accurate -- or seems so to this layperson: You don't have a medically-significant "infection" until the pathogen has survived your immune system long enough to colonize part of your body.

take-a-knee, thanks for your explanation of the stages of infection, it does explain why the 1-doxy-pill tickbite remedy might work.

I've read the scientific studies on this, healthy people were subjected to attached ticks that were known carriers of Lyme (Borriela Burgdorfi). All were given ONE dose of doxy and there were no infections. If you remain unconvinced, Google till your hearts content.

The difference between a bacterial colony (like 20 feet of intestine) and an infection is untoward(undesireable) effects, like when that 20ft of intestine gets invaded by cholera. You can't digest your food without those bacterial colonies (normal flora). You also can't live if this balance is not maintained.

Appalachian Tater
11-01-2007, 13:02
All were given ONE dose of doxy and there were no infections.

That is not the results of the one study that your statements are based on. It was 87% and the 95% confidence level was 25% to 98%. You also need to look at the other attributes of the subjects in the study.

Prophylaxis of any any sort based solely on a tick bite is still NOT recommended.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=11450675&dopt=AbstractPlus

Uncle Silly
11-01-2007, 13:28
Prophylaxis of any any sort based solely on a tick bite is still NOT recommended.

Strictly speaking, western medicine isn't geared towards prevention (prophylaxis). The whole science is founded on treatment of symptoms, which you don't have when trying to prevent something. Of course it's not recommended -- they don't know there's anything there to treat! Doesn't mean it doesn't work.

Appalachian Tater
11-01-2007, 13:36
Strictly speaking, western medicine isn't geared towards prevention (prophylaxis). The whole science is founded on treatment of symptoms, which you don't have when trying to prevent something. Of course it's not recommended -- they don't know there's anything there to treat! Doesn't mean it doesn't work.

Um, taking a dose of doxycycline IS scientific-based medicine. And scientific medicine uses prophylaxis all the time, such as perioperative antibiotics and most of the chronic medications people take to lower cholesterol, etc. But you're right, we still have a long way to go to promoting wellness rather than just treating disease.

True prevention for Lyme is using tick repellant, wearing long pants, checking yourself for ticks, etc.

You can also take drugs for prevention of AIDS after being exposed to the HIV virus. But that's not the best method of prophylaxis for AIDS, and it's not the best method of prophylaxis for Lyme.

It's a real shame that the vaccine wasn't financially successful. It was pretty darn effective and I really wish it hadn't been withdrawn from the market. Maybe as Lyme disease spreads some smaller manufacture will reissue it.

take-a-knee
11-01-2007, 14:01
Okay Tater, I was wrong about the %100, %87 is still good enough for me, and it is on par with what is considered a highly successful treatment rate for a full course of antibiotics for the overwhelming majority of infections. The interesting part of that study is the sooner you get the tick removed, the lower your chances are of contracting the disease. I found the last sentence particularly interesting.

The Weasel
11-01-2007, 14:16
All those nim-nuks who say, "Save the weight, don't bring soap for dishes or hands" are wrong. Wash dishes. Wash hands. Wash face. Stay healthy.

TW

dessertrat
11-01-2007, 17:38
That is not the results of the one study that your statements are based on. It was 87% and the 95% confidence level was 25% to 98%. You also need to look at the other attributes of the subjects in the study.

Prophylaxis of any any sort based solely on a tick bite is still NOT recommended.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=11450675&dopt=AbstractPlus

That's what they say. Having seen the effects of Lyme disease on people, I would find a doctor to give me doxy as a precaution if I knew I had a tick bite, no matter what NIH says.

Appalachian Tater
11-01-2007, 17:51
That's what they say. Having seen the effects of Lyme disease on people, I would find a doctor to give me doxy as a precaution if I knew I had a tick bite, no matter what NIH says.

If I found a tick that had been on more than 24 hours I would try to convince my physician to give me a full ten day course, not one dose. Fortunately when I had Lyme, there was the typical rash so I didn't have to convince him. I did try to get him to give me fourteen days' worth and, being an excellent ID specialist as well as an internist, he refused. He has treated a good deal of Lyme.

On the other hand, when I was picking 5 to 25 ticks off every fifteen minutes this summer, I didn't worry about getting Lyme.

Just so anyone planning to take doxycycline knows, it is important to talk to your physician about what you should do if you vomit it, whether you should take it with food and/or replace the dose. I have a cast-iron stomach but it made me puke.

mambo_tango
11-01-2007, 18:18
my friend had to get off in Gorham because he had mrsa in his foot.