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BMJ 2006; 332 doi: (Published 16 March 2006) Cite this as: BMJ 2006;332:654
  1. Alison Tonks, associate editor (

    MRSA is endemic in some US communities

    While everyone panics about bird flu, a more immediate threat is advancing across the USA, says an editorial. The prevalence of methicillin resistant Staphylococcus aureus (MRSA) is increasing rapidly outside traditional hospital settings, and in some communities MRSA is already an established pathogen, especially in children and healthy young adults.

    Community acquired MRSA is not simply a hospital MRSA that has escaped. The two best known clones, USA 300 and USA 400, are genetically different from any staphylococci found in hospitals. They behave differently too, causing a wide range of diseases—from minor skin infections to overwhelming and rapidly lethal pneumonia.

    The response from doctors and other guardians of the public health has so far been muted, partly because the epidemic has happened so fast. In a recent study in one area of Atlanta, Georgia (pp 309-17), nearly three quarters of all community acquired staphylococcal skin and soft tissue infections were caused by methicillin resistant strains, predominantly the USA 300 clone. Other parts of the US are similarly afflicted.

    Unlike their hospital acquired cousins, community acquired MRSA infections remain treatable with a range of antibiotics, including vancomyin. The editorial urges doctors to get to know the pathogen so they can test for it (by culturing samples from skin and soft tissue infections) and treat it appropriately. Many superficial infections have a telltale necrotic patch in the centre.

    Small particle pollution increases hospital admissions among older Americans

    We already know that airborne pollution is bad for you, especially the small particles in pollution from traffic, heavy industry, and power stations. Particles with a diameter of up to 10 μm across are associated with increased rates of hospital admission in exposed populations, but little is known about finer particles, even though they are likely to reach much smaller and more vulnerable airways when inhaled.

    Researchers from the US exploited two large nationwide …

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