The new drug resistant MRSA bug which is affecting gay men

http://news.bbc.co.uk/1/hi/health/7188741.stm

In short, is affecting gay men 13 times more likely in the San Fran area, in the form of large boils on the body which is multi-drug resistant. This is a matter of time before it spreads, if it already hasn't.

[Aunty]

MRSA infectons now kill more people in the US each year than AIDS!

... of the anti-gay "slur" - http://www.nytimes.com/2008/01/20/us/20 ... tml?ref=us (http://www.nytimes.com/2008/01/20/us/20castro.html?ref=us)

[Aunty]

There's no 'retraction' there, Beryl, that is a deliberate misrepresentation by you, and that is so typical of you. It's as disingenuous as the media beat-up which is the whole point of the NY Times story. Still it's not surprising is it when it comes from people who claim scientific credibility, but in reality, lack scinetific competence. Much like yourself, eh Hovelturd?

Here's what the journal article (the abstract) in the Annals of Internal Medicine actually said. I think it is informative and Gay men should be aware of this important health issue that effects them. And when they are having fun they need to pay particular attention to their hygiene, both before and after sex.

Emergence of Multidrug-Resistant, Community-Associated, Methicillin-Resistant Staphylococcus aureus Clone USA300 in Men Who Have Sex with Men

Binh An Diep, PhD; Henry F. Chambers, MD; Christopher J. Graber, MD, MPH; John D. Szumowski, MD, MPH; Loren G. Miller, MD, MPH; Linda L. Han, MD; Jason H. Chen, BA; Felice Lin, BA; Jessica Lin, BA; Tiffany HaiVan Phan, BA; Heather A. Carleton, MPH; Linda K. McDougal, MS; Fred C. Tenover, PhD; Daniel E. Cohen, MD; Kenneth H. Mayer, MD; George F. Sensabaugh, DCrim; and Fran├зoise Perdreau-Remington, PhD

19 February 2008 | Volume 148 Issue 4

Background: Infection with multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus (MRSA) has been reported but appears to be isolated.

Objectives: To determine the incidence of a multidrug-resistant MRSA clone (USA300) in San Francisco, and to determine risk factors for the infection.

Design: Population-based survey and cross-sectional study using chart review.

Setting: 9 hospitals in San Francisco (population-based survey) and 2 outpatient clinics in San Francisco and Boston (cross-sectional study).

Patients: Persons with culture-proven MRSA infections in 2004 to 2006.

Measurements: Annual incidence, spatial clustering, and risk factors for multidrug-resistant USA300 infection. Pulsed-field gel electrophoresis, polymerase chain reaction assays, and DNA sequencing were used to characterize MRSA isolates.

Results: The overall incidence of multidrug-resistant USA300 infection in San Francisco was 26 cases per 100 000 persons (95% CI, 16 to 36 cases per 100 000 persons); the incidence was higher in 8 contiguous ZIP codes with a higher proportion of male same-sex couples. MaleтАУmale sex was a risk factor for multidrug-resistant USA300 infection (relative risk, 13.2 [CI, 1.7 to 101.6]; P < 0.001) independent of past MRSA infection (relative risk, 2.1 [CI, 1.2 to 3.7]; P = 0.007) or clindamycin use (relative risk, 2.1 [1.2 to 3.6]; P = 0.007). The risk seemed to be independent of HIV infection. In San Francisco, multidrug-resistant USA300 manifested most often as infection of the buttocks, genitals, or perineum. In Boston, multidrug-resistant USA300 was recovered exclusively from men who have sex with men.

Limitations: The study was retrospective, and sexual risk behavior was not assessed.

Conclusions: Infection with multidrug-resistant USA300 MRSA is common among men who have sex with men, and multidrug-resistant MRSA infection might be sexually transmitted in this population. Further research is needed to determine whether existing efforts to control epidemics of other sexually transmitted infections can control spread of community-associated multidrug-resistant MRSA.

[Aunty]

Infections caused by community-associated, methicillin-resistant Staphylococcus aureus (MRSA) have become a major public health threat. A single clone of community-associated MRSA, USA300, was not seen before 2000 but is now widely disseminated in 38 U.S. states, Canada, and 9 European Union countries (1тАУ17) and can cause unusually severe human diseases, including necrotizing fasciitis, sepsis, endocarditis, and pneumonia (18тАУ23). Infections occur predominantly among healthy, community-dwelling persons lacking traditional risk factors for MRSA (9, 18, 24тАУ26).

Whereas hospital-associated MRSA strains are resistant to multiple antimicrobial classes, USA300 and other community-associated MRSA strains are typically resistant to β-lactams and 1 or 2 other drug classes. Older generic antimicrobials, such as clindamycin, tetracycline, or trimethoprimтАУsulfamethoxazole, are recommended for treatment of less serious community-associated MRSA infections, such as uncomplicated skin and soft-tissue infections (3, 27). However, increased use of these antimicrobials could drive the emergence of new subclones of community-associated MRSA that are multidrug resistant. Recently, Diep and colleagues (28) described a multidrug-resistant USA300 isolate that had accumulated multiple resistance genes, rendering it resistant to β-lactams, fluoroquinolones, tetracycline, macrolide, clindamycin, and mupirocin. Two of the resistance genes from this isolate, ermC and mupAтАФwhich determine constitutive resistance to macrolides, clindamycin, and mupirocinтАФare carried on a large conjugative plasmid called pUSA03 (28). Researchers have identified clusters of infections due to multidrug-resistant USA300 in San Francisco and Boston (29, 30), which could complicate disease management and contribute to development of persistent or recurrent community-associated MRSA infections (31, 32).

We report the incidence of multidrug-resistant USA300 in San Francisco and Boston among men who have sex with men, and we describe factors associated with its spread in this high-risk population, based on 4 studies: a population-based survey to estimate the incidence and spatial clustering of multidrug-resistant USA300 in the city of San Francisco; 2 clinic-based, cross-sectional studies to identify risk factors for multidrug-resistant USA300 infection; and a post-hoc analysis of multidrug-resistant USA300 isolates previously collected from emergency departments (1).

[Aunty]

Multidrug-resistant USA300 is the first widely disseminated community-associated multidrug-resistant MRSA clone. Emergence of multidrug-resistant USA300 in the community suggests that the USA300 lineage can overcome the presumed fitness cost of multidrug resistance. Data from this study suggest that multidrug-resistant USA300 has spread rapidly among men who have sex with men in San Francisco and Boston, and that having maleтАУmale sex seems to be a risk factor for multidrug-resistant USA300 infection independent of HIV infection. Although the use of clindamycin and mupirocin, 2 antimicrobial agents that can select for multidrug-resistant USA300 over nonmultidrug-resistant USA300 strains, may have contributed to the spread of multidrug-resistant USA300 in men who have sex with men in San Francisco (Tables 1, 2, and 3), the data also suggest that antimicrobial use is not an a priori condition for the spread of multidrug-resistant USA300 given the infrequent use of clindamycin and mupirocin among the Fenway Community Health sample.

Spread of the USA300 clone among men who have sex with men is associated with high-risk behaviors, including use of methamphetamine and other illicit drugs, sex with multiple partners, participation in a group sex party, use of the internet for sexual contacts, skin-abrading sex, and history of sexually transmitted infections (41тАУ43). The same patterns of increased sexual risk behaviors among men who have sex with menтАФwhich have resulted from changes in beliefs regarding HIV disease severity with the availability of potent antiretroviral therapyтАФhave been driving resurgent epidemics of early syphilis, rectal gonorrhea, and new HIV infections in San Francisco, Boston, and elsewhere (44тАУ46). Our findings that 27% (32 of 118) of men who have sex with men from the SFGH HIV clinic and 39% (47 of 121) of men who have sex with men from Fenway Community Health had infections involving buttocks, genitals, or perineum are consistent with sexual transmission of USA300 in this population. Cook and colleagues (47) recently reported MRSA infections involving the buttocks or genitoperineal area of heterosexual partners; these community-associated MRSA infections can progress to necrotizing fasciitis of the genitoperineal region (Fournier gangrene) (48). It is not clear whether the behavior potentiating these infections among men who have sex with men is anal sex (that is, dissemination of rectal carriage of community-associated MRSA), skin-abrading sexual practices, or increased frequency of intimate skin-to-skin contact; prevention messages may therefore need to suggest caution in each of these practices.

The risk for multidrug-resistant USA300 infections in the buttocks, genitals, or perineum was 30% (13 of 43) among SFGH HIV clinic patients and 47% (22 of 47) among Fenway Community Health patients, suggesting a similar role of sexual contact in the rapid dissemination of multidrug-resistant USA300. We also found that a patient treated at Fenway Community Health for infection with multidrug-resistant USA300 who had a history of frequent travel to and from the Castro District in San Francisco had an multidrug-resistant USA300 clone identical to that isolated from San Francisco patients. Since the beginning of the AIDS epidemic, sexual contact by men who have sex with men from Boston with partners from New York City, Los Angeles, and San Francisco has been associated with the dissemination of infectious pathogens (49). Because travel history is not frequently documented in patients' charts, it is not clear to what extent contacts between men who have sex with men from Boston and San Francisco could have contributed to the clonal dissemination of multidrug-resistant USA300. However, the genotype of multidrug-resistant USA300 in the patient from Fenway Community Health and the recent marked predominance of multidrug-resistant USA300 in Boston suggest the multidrug-resistant USA300 epidemic probably started in San Francisco and has been disseminated by the frequent cross-coastal travel of men who have sex with men. The recent emergence of multidrug-resistant community-associated MRSA with similar antimicrobial susceptibility profiles to multidrug-resistant USA300 was recently noted among men who have sex with men in New York City (32) and Los Angeles (Miller LG, Diep BA. Unpublished data), indicating the potential for rapid, nationwide dissemination of multidrug-resistant USA300 among men who have sex with men.

The high incidence of multidrug-resistant USA300 among men who have sex with men has major implications for empirical treatment of skin infections among these patients. Several important antimicrobial classes for treatment of MRSA infections or eradication of colonization, including clindamycin, tetracycline, and mupirocin, may not be effective in this population. Resistance to trimethoprimтАУsulfamethoxazole and rifampin remains rare among USA300 isolates and was not seen in multidrug-resistant USA300 in our study (Table 1). However, prophylactic antimicrobial use has selected for the emergence of trimethoprimтАУsulfamethoxazole resistance in subclones genetically related to the USA300 lineage in patients from San Francisco and New York City who were infected with HIV (50тАУ52). Prudent use of these antimicrobial agents for suspected MRSA disease in men who have sex with men is advisable to slow the emergence of even more resistant community-associated MRSA. The pUSA03 plasmid that determines multidrug resistance in multidrug-resistant USA300 belongs to a highly promiscuous class of conjugative plasmids that could readily accept transposons encoding resistance to aminoglycosides, trimethoprim, vancomycin, and other antimicrobials, potentiating the emergence of even more resistant community-associated MRSA (28, 53).

Our study has limitations. Our incidence estimates for San Francisco come from a passive surveillance system and may underestimate the incidence of true infection. We relied on retrospective chart review for identification of risk factors for multidrug-resistant USA300 infection in the 2 clinic populations; because data were not collected or documented systematically, our estimates of risk may be influenced by selection, referral, documentation, or other biases. Specific sexual behaviors were not assessed or documented in clinic charts; we therefore cannot comment on the association between multidrug-resistant USA300 infection and specific maleтАУmale sexual practices. Finally, because the number of multidrug-resistant USA300 infection within risk-factor subgroups was small, some of our higher estimates of risk are statistically compatible with more modest risk increases (that is, many of the CIs are wide and their lower bounds approach 1.0).

In summary, we show that multidrug-resistant USA300 has emerged as an important source of disease among men who have sex with men in 2 geographically distinct communities. The high proportion of infection involving the buttocks, genitals, and perineum suggests that community-associated MRSA may be transmitted in the setting of sexual contact among men who have sex with men. The link among USA300, multidrug-resistant USA300, and unsafe sexual risk behaviors should be evaluated further in prospective studies.