Sludge Watch ==> Antibiotic resistant infections rampant in athletes

[Maureen Reilly]

Sludgewatch Admin:

Sewage sludge is a medium in which virulent bacteria survive after journey 
of several weeks in a wash of antibiotics and anti microbials.  Those 
bacteria with resistance survive and multiply - conferring resistance to 
antibiotics along with genes for virulence.  Many of the bacteria go into a 
'viable non culturable state'.  The DNA fragments transport the traits.

That sludge material  is what we are using as top dressing on homes and 
athletic fields.  The same issue is pertinent to the effluent from sewage 
plants used for spray irrigation on spinach and lettuce crops in Monterey 
County Salinas.

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http://www.infectiousdiseasenews.com/200705/frameset.asp?article=athletic.asp
May 2007

More than half of athletic trainers have treated athletes for skin 
infections caused by an antibiotic-resistant superbug, according to study 
results presented at the 17th Annual Scientific Sessions of the Society for 
Healthcare Epidemiology of America, held recently in Baltimore.


Methicillin-resistant Staphylococcus aureus was once a concern only among 
hospitalized patients and immunocompromised patients. During the past 10 
years, however, incidences of MRSA have increased among otherwise healthy 
people.

“All health care providers who treat athletes should be concerned about 
MRSA,” Kristin Brinsley-Rainisch, MPH, a health scientist at the CDC, told 
Infectious Disease News. Brinsley-Rainisch presented results from the study 
conducted by CDC researchers.

“If an athlete presents with a purulent skin infection, health care 
providers should consider MRSA as the cause. It’s also important to provide 
athletes with information on appropriate wound care to prevent 
transmission,” Brinsley-Rainisch said.


Increased risk
Athletes are at an increased risk because the bacteria can be spread through 
skin-to-skin contact in sports and from shared clothing, sports gear or 
other items such as towels. Increased likeliness of athletes to have open 
sores from sports injuries also multiplies their susceptibility to MRSA.

MRSA in otherwise healthy people was first widely recognized as a problem in 
the late 1990s. Although the infections are not considered life-threatening, 
MRSA skin abscesses may require surgical draining. Another concern is the 
bacteria’s resistance to first-line antibiotics.

In rare cases, MRSA can cause potentially fatal conditions, including 
pneumonia, blood stream infections and necrotizing fasciitis, also known as 
a ‘flesh-eating’ disease. There are reported deaths of athletes associated 
with MRSA infection.



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"If you are anticipating contact sports on this field, and then you should 
also be prepared for methicillin resistant Staph aureus in the players and 
the potential for some serious issues with attempting to control that and 
its potential spread into the community (see abstracts below)."

Dr. Edo Mcgowan -

----- Original Message -----






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From: "Edo McGowan" <edo_mcgowan at hotmail.com>



With respect to the story "Panel: Class A compost is 'good option' for 
town", I wonder if you would like some information that would turn this 
"good option" on its ear? I am concerned that the panel may have gravely 
erred because I read this same medical and scientific literature on the 
subject. My reading, however is in great depth as this is my specialty and I 
do not, in any way, come to the same conclusion as this panel.

I would not allow my grand son, who plays high school football on such a 
field, let alone have him play contact sports on it.

As noted in the abstracts below, the issue is not benign. The survival of 
indicator bacteria should alert anyone with the requisite background that 
the issue is not simple. If the indicators, E. coli and Salmonella, which 
are relatively easily killed, survive then the more robust pathogens will be 
found and most probably in relatively greater numbers. This includes those 
that, if in a hospital and contaminating semi-critical medical devices, 
would require high-level disinfection. It is doubtful that the composting 
conditions would be able to equate to this level of control. I would want to 
review the data.

Further, there is the chance for prions, which are essentially 
indestructible, to be in sewer sludge. Embalming practices in many states 
allow direct discharge of body contents to sewers. It has been reported in 
the medical literature that perhaps up to 13% of Alzheimer’s patients are 
actually suffering from variant Creutzfeldt-Jakob disease---the human 
equivalent of mad cow. Further, is there any control over source of the raw 
stock for the compost? In California, we have some serious issues with 
misrepresentation.

For another thing, there is no mention of transmission of antibiotic 
resistance . Suggest that you scroll down to see below what U.S. EPA knows 
on this subject, apparently nothing. Although the 2002 report by the 
National Academies of Science on land applied sewer sludge recommended more 
work in this area, EPA has evidently done little if anything. Thus how can 
it claim that the issue is benign?

If you are anticipating contact sports on this field, and then you should 
also be prepared for methicillin resistant Staph aureus in the players and 
the potential for some serious issues with attempting to control that and 
its potential spread into the community (see abstracts below).

Since there also may be ingestion of this material as it is kicked up as 
dust, the wiping of noses, eyes and licking of lips, reinserting a dropped 
mouth piece, these bacteria can enter and share the genetic information with 
the gut bacteria. Further, as Sjolund et al note, resistant strains may 
persist within the gut bacteria for 4 years once introduced into the gut and 
absent further administration and challenge of antibiotics. From there it 
can be transferred via the fecal veneer to other areas of the body such as 
nares, vagina, and skin where it can colonize.

Thus the presumption that this is a fleeting issue is a badly 
considered---but convenient argument that may be proffered by those who are 
ignorant or pro-sewer sludge.

So, how fast can resistance progress and to what ends? Let me give you an 
example.

The following is extracted from the recently published medical text by 
Christopher Walsh of the Harvard Medical School—Antibiotics, Actions, 
Origins, Resistance, (March 2003) New York: ASM Press. Resistance to 
atibiotics is not a matter of IF but one of WHEN. Schentag, et al., as 
presented in the Walsh text, looked at how rapidly resistance could be 
generated. They followed surgical patients with the following results. 
Pre-op nasal cultures found Staphylococcus aureus were 100% antibiotic 
susceptible. Pre-op prophylatic antibiotics were administered. Following 
surgery, cephalosporin was administedred. Ninety percent of the patients 
went home at post-op day 2 without infectious complications. Nasal bacteria 
counts on these patients had dropped from 10 to the 5th down to 10 to the 
3rd, but were now a mix of sensitive, borderline, and resistant Staph, where 
prior to surgery all had been susceptible to antibiotics. For the patients 
remaining in the hospital and who were switched on post-op day 5 to a second 
generation cephalosporin (ceftazidine), when assayed on post-op day 7, now 
showed bacterial counts up 1000 fold and most of these were methacillin 
resistant Staph aureus (MRSA).

Then these patients were switched to a 2-week course of vancomycin. For 
those still in the hospital on day 21, cultures revealed vancomycin 
resistant enterococcus (VRE) and candida. Vancomycin resistant enterococci 
infections produce mortality rates of between 42 and 81%.

Enterococcus not only survives compsoting but thrives.[Microbiological 
Monitoring in the Biodegradation of Sewage Sludge and Food Waste], Ivanov et 
al note, that during in-vessel composting with controlled temperatures held 
at 60 C, sewer sludge derived bacteria were not removed.