Staph superbug may be infecting patients
Mon, 25 Jun 2007 04:28:10 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - A dangerous, drug-resistant staph germ may be infecting as many as 5 percent of hospital and nursing home patients, according to a comprehensive study.
At least 30,000 U.S. hospital patients may have the superbug at any given time, according to a survey released Monday by the Association for Professionals in Infection Control and Epidemiology.
The estimate is about 10 times the rate that some health officials had previously estimated.
Some federal health officials said they had not seen the study and could not comment on its methodology or its prevalence. But they welcomed added attention to the problem.
"This is a welcome piece of information that emphasizes that this is a huge problem in health care facilities, and more needs to done to prevent it," said Dr. John Jernigan, an epidemiologist with the U.S. Centers for Disease Control and Prevention.
At issue is a superbug known as Methicillin-resistant Staphylococcus aureus, which cannot be tamed by certain common antibiotics. It is associated with sometimes-horrific skin infections, but it also causes blood infections, pneumonia and other illnesses.
The potentially fatal germ, which is spread by touch, typically thrives in health care settings where people have open wounds. But in recent years, "community-associated" outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels.
Past studies have looked at how common the superbug is in specific patient groups, such as emergency-room patients with skin infections in 11 U.S. cities, dialysis patients or those admitted to intensive care units in a sample of a few hundred teaching hospitals.
It's difficult to compare prevalence estimates from the different studies, experts said, but the new study suggests the superbug is eight to 11 times more common than some other studies have concluded.
The new study was different in that it sampled a larger and more diverse set of health care facilities. It also was more recent than other studies, and it counted cases in which the bacterium was merely present in a patient and not necessarily causing disease.
The infection control professionals' association sent surveys to its more than 11,000 members and asked them to pick one day from Oct. 1 to Nov. 10, 2006, to count cases of the infection. They were to turn in the number of all the patients in their health care facilities who were identified through test results as infected or colonized with the superbug.
The final results represented 1,237 hospitals and nursing homes — or roughly 21 percent of U.S. inpatient health care facilities, association officials said.
The researchers concluded that at least 46 out of every 1,000 patients had the bug.
There was a breakdown: About 34 per 1,000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1,000 were "colonized," meaning they had the bug but no illness.
Most of the patients were identified within 48 hours of hospital admission, which means, the researchers believe, that they didn't have time to become infected to the degree that a test would show it. For that reason, the researchers concluded that about 75 percent of patients walked into the hospitals and nursing homes already carrying the bug.
"They acquired it in a previous stay in health care facility, or out in the community," said Dr. William Jarvis, a consulting epidemiologist and former CDC officials who led the study.
The infection can be treated with other antibiotics. Health care workers can prevent spread of the bug through hand-washing and equipment decontamination, and by wearing gloves and gowns and by separating infected people from other patients.
The study is being presented this week at the association's annual meeting in San Jose, Calif., but has not been submitted for publication in a peer-reviewed medical journal.
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On the Net:
Association for Professionals in Infection Control & Epidemiology: http://www.apic.org
The CDC's Web page on MRSA: http://tinyurl.com/ysc87z
Wounded GI endures blindness paralysis
Sun, 24 Jun 2007 23:02:23 GMT
By MARILYNN MARCHIONE, AP Medical Writer
TAMPA, Fla. - He lies flat, unseeing eyes fixed on the ceiling, tubes and machines feeding him, breathing for him, keeping him alive. He cannot walk or talk, but he can grimace and cry. And he is fully aware of what has happened to him.
Four years ago almost to this day, Joseph Briseno Jr. was shot in the back of the head at point-blank range in a Baghdad marketplace. His spinal cord was shattered, and cardiac arrests stole his vision and damaged his brain.
He is one of the most severely injured soldiers — some think the most injured soldier — to survive.
"Three things you would not want to be: blind, head injury, and paralyzed from the neck down. That's tough," said Dr. Steven Scott, head of the Polytrauma Rehabilitation Center at the Tampa VA Medical Center, where Briseno has twice been hospitalized for extensive care. In recent days, Briseno was hospitalized yet again, this time at the Washington, D.C., VA Medical Center.
As a high schooler, Briseno liked the Discovery Channel and CSI, and wanted to be a forensic scientist or investigator. He was 20 years old, attending George Mason University, when he was called up from the reserves and sent to war.
After he was shot, he was flown to Kuwait and then to a military hospital in Landstuhl, Germany. His parents and two sisters rushed to his side.
"They told us, 'Prepare for his service.' That's how bad he was," said his father, Joseph Briseno Sr., a retired career Army man.
But he survived. From Germany, he went to Walter Reed Army Medical Center in Bethesda, Md., then to McGuire VA Medical Center in Richmond, Va. In December 2003, he went home, to Manassas Park, Va., where his parents, Joseph Sr. and Eva, quit their jobs to care for him.
"All our savings, all our money, was just emptied ... the 401s, everything," said Joseph Briseno, who took a new job a year and a half ago to make ends meet.
Various charities, especially Rebuilding Together, raised money to renovate their basement, supply a backup generator for the medical equipment, and install a lift so they can hoist "Jay," as they call him, into a chair and bathe him in a handicapped accessible bathroom.
"If you asked me this from the very beginning, if we can handle it, I wouldn't lie to you. I would say no, that there is no way. There's no way that we're going to learn all these things. But my wife and I, we learned everything. We are the respiratory technician, we are the physical therapists, occupational therapists, speech therapists ... his wound care nurse," Joseph Briseno said.
"It's a lot of work and it's hard, and some days are harder than the other days. But we don't take this as a burden for us because he's our son. We will do everything for him."
The family has help from VA-provided nurses, but not around the clock. Jay's mother and father often do overnight duty, making sure their son is turned every four hours so he does not develop bedsores, which can become infected and threaten his life. If they do not turn him and keep him on schedule, he does not sleep well and becomes agitated.
At the Tampa VA, a nurse taught Jay Briseno to swallow his saliva — a big step that allowed him to have some pureed foods instead of just tube-feeding. He has not been able to handle any solid food, though — his injuries are too profound.
More recently, the Tampa staff tried to wean him from the respirator. This involved painstaking therapy to strengthen his diaphragm by placing weights on his belly and gradually increasing the air pressure on the machine to try to create resistance and muscle strength. So far, it hasn't worked.
He has had other trials: surgeries, procedures and medications for bladder problems, high blood pressure, the opening for his breathing tube, dead tissue on his tongue — even an ingrown toenail. The latest is the bone disease, osteoporosis.
He can respond to questions by grunting or grimacing, and occasionally can say "mom" or "go," but not consistently. He often opens his mouth.
"We believe he is very frustrated because he wants to say something. Those are the hardest times for us, especially when he's sick or not feeling well. He just lays there. We don't know what's wrong with him," Joseph Briseno said.
They pray that he will continue to improve, not get worse. And they hope to move to Tampa, where they believe their son can get the best care.
"We always have hope. One day at a time — that's the way we live our lives," the elder Briseno said. "We're so lucky to have him. He was a very good son from the very beginning. God gave Jay to us and he's a blessing to us."
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On the Net:
Department of Veterans Affairs: http://www.va.gov/
Charitable group: http://www.rebuildingtogether.org/
American kids shaping up with trainers
Sun, 24 Jun 2007 20:19:29 GMT
By JAMIE STENGLE, Associated Press Writer
DALLAS - Nearly a million American youngsters, some as young as 6, rely on personal trainers to shape up, lose weight or improve in sports, according to figures from the nation's leading sports club association.
Many parents, worried about their children's weight and fitness, say working with a trainer motivates their kids and helps build confidence. So they are willing to spend the $40 to $60 an hour that trainers generally charge.
"We are seeing children that are out of shape where their parents realize the exercise program needs to be safe and effective," said Joe Moore, president of International Health, Racquet and Sportsclub Association. "A personal trainer is a good way to make sure that the criteria are met."
The Boston-based group's latest figures, from 2005, show that 824,000 children between the ages of 6 and 17 use trainers — a figure that accounts for about 13 percent of trainers' clients.
With many high school students not getting exercise at school unless they play a sport, more parents are turning to trainers to help their children stay fit, said Carla Sottovia, assistant fitness director at Dallas' Cooper Fitness Center.
More than one-third of American children are overweight and experts warn of future health problems ahead from diabetes to heart disease.
Kathleen Ballew decided her 7-year-old son, Jordan Sims, who will begin second grade in the fall, could benefit from some one-on-one time with a fitness professional. She had noticed he needed help with balance and coordination in soccer and karate. She'd also observed he was reluctant to do things kids normally do, like climbing on park equipment.
"I also just want to get him in the habit of making exercise part of daily routine," said Ballew, who described her son as just a little overweight. She fears it's something he'll have to struggle with as he grows up.
Since Jordan began working out at Baylor Tom Landry Fitness Center in Dallas with a trainer about a year ago, he moves more naturally and confidently, his mother said.
His trainer, Lauren Jacobson, works with about half a dozen kids under 18. She said she's noticed that training helps build confidence and a sense of accomplishment, along with helping kids get in better shape.
Zachary Edgerton, 18, who graduated this spring from a Dallas-area high school, has been working out with a trainer since his sophomore year.
He was in the middle of doing a makeover on his body after he began jogging as a 5-foot-2, 210-pound eighth-grader. By the end of his sophomore year, he'd lost about 60 pounds. Edgerton, who saw a trainer for a time during middle school, decided training was a good way to get more toned.
"I was done being a fat kid and I wanted to get in shape and feel good," said Edgerton, now 5-foot-7 and 165.
Dr. LeAnn Kridelbaugh, a pediatrician and nutrition specialist at Children's Medical Center Dallas, said that if parents have the resources for a personal trainer and their teen wants to do it, having a set appointment can be a good motivator to exercise.
"If you have the money and you feel that your late adolescent is going to get in shape and be more fit by using a personal trainer, I don't think that most pediatricians would have a problem with that," she said.
She cautions though that for children who have not yet reached puberty it's important that the trainer know how to work with kids whose bodies are still developing.
Kridelbaugh also points out that kids can get the exercise they need on their own by swimming, riding bikes, jumping rope or taking walks with their family. And something as simple as playing catch can improve coordination, she said.
"They can probably accomplish just as much with a motivated parent, playing games," Kridelbaugh said.
It's important that it be fun, she said.
Parents don't always find that easy to do, however. Kathleen McGowan said she's been impressed by the variety that her 13-year-old daughter's trainer puts into their workout sessions — something she doesn't think she would be able to do.
"It's unpredictable, which makes it fun," said McGowan.
After a recent fast-paced, 30-minute workout, daughter Katie McGowan's face glows with a wide smile and rosy cheeks.
"You're doing something to make yourself healthier and it's a really good feeling," she said.
The teen, whose twice-a-week training includes stretching and lifting weights, began working with a trainer this spring.
Katie McGowan said that before she began training, she occasionally worked out on a treadmill at home and sometimes played tennis. She also enjoys swimming.
Now, along with her training sessions and other activities, the soon-to-be eighth-grader stretches and works out a home.
Kathleen McGowan said the training sessions give her daughter's activities not only another dimension, but also add structure.
"I think it's made the whole concept of healthy living fun, as opposed to a chore," she said.
