Rational management of community-acquired methicillin-resistant Staphylococcus aureus can be challenging because the approaches used to evaluate and treat such infections remain quite variable nationwide.
American College Of Emergency Medicine
over 11 years ago
Todar's Online Textbook of Bacteriology chapters on bacteriology, microbes in the environment, cycles of elements, bacterial structure, bacterial nutrition, bacterial growth, bacterial metabolism, bacteria and archaea, normal flora, bacterial pathogens, bacterial toxins, endotoxin, antibiotics, antibiotic resistance, staphylococci and MRSA, streptococcus, pneumonia, anthrax, E. coli, cholera, Salmonella, Pseudomonas, Shigella, gonorrhea, meningococcal meningitis, botulism and tetanus hib meningitis, Listeria, whooping cough, B. cereus food poisoning, tuberculosis, diphtheria, Rocky Mountain spotted fever, Lyme disease, Vibrio vulnificus, Bacillus, lactic acid bacteria.
over 7 years ago
Is it policy in UK hospitals to screen for MRSA with random swabs for all new patients? If found, what is the treatment to clear colonisation? Does Treatment have a good success rate? Also, interesting thought, if a doctor is colonised, would they be prevented from working?
Dr David Zebedee
over 8 years ago
Thanks to those who read my last post. I was encouraged to hear from my colleagues at Med school that the post sounded very positive and hopefully. A few of them queried whether I had actually written it because there was a noticeable lack of sarcasm or criticism. So... the following posts may be a bit different. A little warning - some of what I post may be me playing "Devil's advocate" because I believe that everything should be questioned and sparking debate is a good way of making us all evaluate what we truly think on a subject. With no further a do, let's get on to the subject of today's post .... An Introduction to Clinical Medicine The previous year was my first as a clinical med student. Before we started I naively thought that we would be placed in helpful, encouraging environments that would support us in our learning, so that we were able to maximize our clinical experience. My hope was that there would be lots of enthusiastic doctors willing to teach, a well organised teaching schedule and admin staff that would be able to help us with any difficulties. I hoped these would all be in place so that WE medical students could be turned from a bunch of confused, under-grad science students into the best junior doctors we could possibly be. It seems that medical school and the NHS have a very different opinion of what clinical medical teaching should be like. What they seem to want us to do is 1) listen to the same old health and safety lecture at least twice a term, 2) re-learn how to wash our hands every 4 weeks, 3) Practicing signing our name on a register - even when this is completely pointless because there are no staff at the hospital anyway because the roads are shut with 10 inches of snow most of the time, 4) Master the art of filling in forms that no one will ever look at or use in anyway that is productive, 5) STAY OUT OF THE WAY OF THE BUSY STAFF because we are useless nuisances who spread MRSA and C.Dif where ever we go! How we all learn medicine and pass our exams is any ones guess! Undergraduate Co-Ordinators - Why won't you make life easier for us? While at my last placement I was elected as the 3rd year student representative for that hospital. While I was fulfilling that role it got me wondering what it is that Under-grad Co-Ordinators actually do? I thought this may be an interesting topic of debate. 1) Who are they and how qualified are they? 2) what is their job description and what are they supposed to be doing? 3) Are they a universal phenomena? or have they just evolved within the West Midlands? 4) Does anyone know an under-grad Co-Ordinator (UC - not ulcerative colitis) who has actually been more benefit than nuisance? 1) UC's as a species are generally female, middle aged, motherly types who like to colonize obscure offices in far flung corners of NHS training hospitals. They can normally be found in packs or as they are locally known "A Confusion of co-ordinators". How are they qualified? I have absolutely no idea, but I am guessing not degrees in Human Resource Development. 2)I am fairly certain what their job should involve: 1) be a friendly supportive face for the poor medical students; 2) organise a series of lectures; 3) organise the medical students into teaching firms with enthusiastic consultants who are happy to give them regular teaching; 4) ensure the students are taught clinical skills so that they can progress to being competent juniors; 5) be a point of contact for when any students are experiencing difficulties in their hospital and hopefully help them to rectify those problems to aid their learning. What do they actually do? It seems to be a mystery. I quite regularly receive emails that say that I wasn't in hospital on a certain day, when I was in fact at another hospital that they specifically sent me to on that day. I often receive emails saying that my lectures are cancelled just as I have driven for over an hour through rush hour traffic to attend. I sometimes receive emails saying that I, specifically, am the cause of the whole hospitals MRSA infection because I once wore a tie. I never receive emails saying that such and such a doctor is happy to teach me. I never receive emails with lecture slides attached to them so that I can revise said lectures in time for an exam. I NEVER receive any emails with anything useful in them that has been sent by a UC! Questions 3 and 4, I have no idea what the answers are but would be genuinely pleased to hear people's responses. The reason I have written this blog is that, these people have frustrated my colleagues and I all year. I am sure they are integral to our learning in some way and I am sure that they could be very useful to us, but at the moment I just cannot say that they are as useful as they should be. To any NHS manager/ medical educator out their I make this plea I am more than happy to give up 2 weeks of my life to shadow some UC to see what it is they do. In essence I want to audit what it is they do on a day to day basis and work out if they are a cost-effective use of the NHS budget? I want to investigate what it is they spend their time on and how many students they help during a day? I would like someone with a fresh pair of eyes to go into those obscure offices and see if they can find any way of improving the systems so that future generations of medical students do not have to relive the inefficiencies that we have lived through. I want the system to be improved for everyone's sake. OR if you won't let a medical student audit the process, could you manager's at least send your UC's to learn from other hospitals where things are done better! If we (potential future) doctors have to live by the rule of EVIDENCED BASED MEDICINE, why shouldn't the admin staff live by a similar rule of EVIDENCED BASED ADMINISTRATION? Share good ideas, learn from the best, always look for improvements rather than keep the same old inefficient, pointless systems year after year. My final point on the subject - at the end of every term we have to fill in long feedback forms on what we thought of the hospital and the teaching. I know for a fact that most of those forms contain huge amounts of criticism - a lot of which was written exactly the same the year before! So, they are collecting all of this feedback and yet nothing seems to change in some hospitals. It all just seems such a pointless waste. Take away thought for the day. By auditing and improving the efficiency, of the admin side of an undergraduate medical education, I would hope the system as a whole would be improved and hence better, more knowledgeable, less cynical, less bitter, less stressed junior doctors would be produced as a result. Surely, that is something that everyone involved in medical education should be aiming for. Who is watching (and assessing) the watchers!
about 9 years ago
Researchers funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have found that two common antibiotic treatments work equally...
about 7 years ago
Interesting and very useful post, Lauren. In Australia we generally use flucloxacillin or dicloxacillin as first line in cellulitis, as per our Antibiotic Guidelines, although it is recommended for 7-10 days. Do you use it in North America? It's got good strep and non-MRSA staph coverage and narrower spectrum than cephalexin, although the kids don't like the taste as much. We would typically use cephalexin as an alternative, and clindamycin if penicillin allergic or for MRSA. After reading your post I'll be encouraged to use shorter duration. Admittedly, I quite often use a 5 day course anyway due to the pack size of flucloxacillin, but at least now I've got some useful references to back me up!
about 7 years ago
Aimed at junior hospital doctors and general practitioners, the In Practice Series has been devised by RSM Press to present cutting-edge and clear-cut opinion leader advice and summary acts related to every day clinical practice.MRSA is an all too familiar acronym in use in most UK hospitals. MRSA was discovered in the 1960s however has not been a public cause for concern until the current pandemic started in the 1990s. It shows no signs of abating and the UK now has about the highest prevalence in Europe. It has captured the attention of the public and politicians but how important is it in clinical practice? How did it evolve, will it go away or get worse - will it really develop into the untreatable superbug? Is it more virulent than Staphylococcus aureus, what are its common clinical presentation and the best treatments? What are the best ways to control it if indeed we should bother? How much does it cost the NHS? Do we have any new strategies up our sleeves? These are just some of the intriguing questions that a distinguished panel of authors from around the world have tried to answer in this monograph.Some of the topics covered include:Historical perspectives - Ian Phillips (London)Immunology and pathogenesis of MRSA - Von Belkum (Rotterdam) Antibiotic resistance in MRSA - Giles Edwards (Glasgow)Evolution of MRSA - Mark Enright (London University)Epidemiology of MRSA - Vuopia-Varkila (Finland) Control of MRSA - Barry Cookson (London) Georgia Duckworth (London) & Hans Kolmos (Denmark) Treatment of MRSA - Ian Gould (Aberdeen)Decolonisation of MRSA patient - A Seaton (Glasgow)Laboratory aspects- developments in detection and AST - Donald Morrison (Glasgow) Alternative treatments - Tom Riley (Perth, Australia)MRSA in the home and on the farm - Vos + Vos (Nijmegen/Rotterdam)Mopping up MRSA - Stephanie Dancer (Glasgow)Guidance to control MRSA from the Royal College of Physicians of Edinburgh - D Baird (Glasgow)With its easily accessible approach, broken down into easy-to read chapters, the tips and useful advice of this text makes this a key text for all hospital practitioners. MRSA In Practice is a book that no health care professional can afford to be without.
about 7 years ago
It is estimated that up to 15-30% of the human population in developed countries are colonized by the community acquired strains of methicillin resistant staph aureus. The risk of developing a skin infection in the year following discovery of colonized status is approximately 1-in-4. Autoinfection rates are between 76-86% – thus most people that get MRSA infections get it from themselves.
over 6 years ago