The effect of fluoroquinolones?

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The effect of fluoroquinolones?

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Deadly Bacteria Found to Be More Common

NEW YORK TIMES - October 16, 2007

ATLANTA, Oct. 16 — Nearly 19,000 people died in the United States in
2005 after being infected with virulent drug-resistant bacteria that
have spread rampantly through hospitals and nursing homes, according to
the most thorough study of the disease’s prevalence ever conducted.

The government study, which is being published Wednesday in The Journal
of the American Medical Association, suggests that such infections may
be twice as common as previously thought, according to its lead author,
Dr. R. Monina Klevens.

If the mortality estimates are correct, the number of deaths associated
with the germ, methicillin-resistant Staphylococcus aureus, or MRSA,
would exceed those attributed to H.I.V.-AIDS, Parkinson’s disease,
emphysema or homicide each year.

By extrapolating data collected in nine places, the researchers
estimated that 94,360 patients developed an invasive infection from the
pathogen in 2005 and that nearly one of every five, or 18,650 of them,
died. The study points out that it is not always possible to determine
whether a death is caused by MRSA or merely accelerated by it.

The authors, who work for the Centers for Disease Control and
Prevention, cautioned that their methodology differed significantly from
previous studies and that direct comparisons were therefore risky. But
they said they were surprised by the prevalence of serious infections,
which they calculated as 32 cases per 100,000 people.

In an accompanying editorial in the medical journal, Dr. Elizabeth A.
Bancroft, an epidemiologist with the Los Angeles County Department of
Public Health, characterized that finding as “astounding.”

The prevalence of invasive MRSA — when the bacteria has not merely
colonized on the skin, but has attacked a normally sterile part of the
body, like the organs — is greater, Dr. Bancroft wrote, than the
combined rates for other conditions caused by invasive bacteria,
including bloodstream infections, meningitis and flesh-eating disease.

The study also concluded that 85 percent of invasive MRSA infections are
associated with health care treatment. Previous research had indicated
that many hospitals and long-term care centers had become breeding
grounds for MRSA because bacteria could be transported from patient to
patient by doctors, nurses and unsterilized equipment.

“This confirms in a very rigorous way that this is a huge health
problem,” said Dr. John A. Jernigan, the deputy chief of prevention and
response in the division of healthcare quality promotion at the disease
control agency. “And it drives home that what we do in health care will
have a lot to do with how we control it.”

The findings are likely to stimulate further an already active debate
about whether hospitals and other medical centers should test all
patients for MRSA upon admission. Some hospitals have had notable
success in reducing their infection rates by isolating infected patients
and then taking extra precautions, like requiring workers to wear gloves
and gowns for every contact.

But other research has suggested that such techniques may be excessive,
and may have the unintended consequence of diminishing medical care for
quarantined patients. The disease control agency, in guidelines released
last year, recommended that hospitals try to reduce infection rates by
first improving hygiene and resort to screening high-risk patients only
if other methods fail.

Dr. Lance R. Peterson, an epidemiologist with Evanston Northwestern
Healthcare, said his hospital system in the Chicago area reduced its
rate of invasive MRSA infections by 60 percent after it began screening
all patients in 2005.

“This study puts more onus on organizations that don’t do active
surveillance to demonstrate that they’re reducing their MRSA
infections,” Dr. Peterson said. “Other things can work, but nothing else
has been demonstrated to have this kind of impact. MRSA is theoretically
a totally preventable disease.”

Numerous studies have shown that busy hospital workers disregard basic
standards of hand-washing more than half the time. This week, Consumers
Union, the nonprofit publisher of Consumer Reports, called for hospitals
to begin publishing their compliance rates for hand-washing.

Lisa A. McGiffert, manager of the “Stop Hospital Infections” campaign at
Consumers Union, said, “This study just accentuates that the hospital is
ground zero, that this is where dangerous infections are occurring that
are killing people every day.”

MRSA, which was first isolated in the United States in 1968, causes 10
percent to 20 percent of all infections acquired in health care
settings, according to the disease control agency. Resistant to a number
of front-line antibiotics, it can cause infections of surgical sites,
the urinary tract, the bloodstream and lungs. Treatment often involves
the intravenous delivery of other drugs, causing health officials to
worry that overuse will breed further resistance.

The bacteria can be brought unknowingly into hospitals and nursing homes
by patients who show no symptoms, and can be transmitted by contact as
casual as the brush of a doctor’s lab coat. Highly opportunistic, they
can enter the bloodstream through incisions and wounds and then quickly
overwhelm a weakened immune system.

On Monday, a Virginia teenager died after a week-long hospitalization
for an MRSA infection that spread quickly to his kidneys, liver, lungs
and the muscle around his heart. Local officials promptly closed 21
schools for a thorough cleaning.

A major difference between the new study and its predecessors is that it
compiled confirmed cases of MRSA infection, rather than relying on coded
patient records that sometimes lack precision. The study found higher
prevalence rates and death rates for the elderly, African-Americans and
men. The figures also varied by geography, with Baltimore’s incidence
rates far exceeding those of the eight other locations: Connecticut;
Atlanta; San Francisco; Denver; Portland, Ore.; Monroe County, N.Y.;
Davidson County, Tenn.; and Ramsey County, Minn.

Dr. Klevens said further research would be needed to understand the
racial and geographic disparities.

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