MRSA Infection

[enigma731]

Drs recognize it occurs in dogs and cats but most know nothing about birds.

I think doctors also tend to hear birds + possible zoonotic illness and immediately jump to psittacosis no matter what.

 

[theletterv]

We saw the infectious disease doctor today (it seems it was policy to have us seen by them), and he switched us to sulfamethoxazole trimethoprim ourselves. He said it is much more effective -- whether that's just our specific strain or in general, I don't know. We only have to take two pills of the sulfa-trimethoprim a day rather than the four we had to take with clindamycin, so that's easier anyway. We were also advised to take bleach baths 2-3 times a week for 6 months; 1/2 cup of bleach in the bath water. It sounds like it will be very drying to the skin, but if it's helpful in eliminating the bacteria we will do it. We're also supposed to be re-tested in 6 months. That seems like a long ways away, but the babies will be tested long before then.

It was kind of funny, though, because the facility was somehow under the impression at first that we were there because of avian influenza. It must be simply because I mentioned that my baby birds had been tested positive for MRSA, and somehow the mention of birds led everybody to think avian influenza. Pretty crazy. They're two very different things! So that's even more of a leap than psittacosis.

 

[Hankmacaw]

Yeah, ya think so???? LOL MRSA is a bacteria and A. Influenza is a virus.

Just goes to prove that people hear what they think they should hear.

 

[WendyN]

@theletterv
You are doing an awesome job at keeping on top of this.
Positive thoughts coming your way that this will clear up soon.

 

[theletterv]

Hi again everyone. Resurrecting my thread to add an update.

My family and I were tested again 2 weeks after finishing our course of antibiotics. This nasal swab came back negative for MRSA, which was good news.

After finishing a month of trimethoprim-sulfamethoxazole, we waited 2 weeks before re-testing the babies. Unfortunately we learned yesterday that they are still positive for MRSA.

Initially, the vet told us that she doesn't recommend any other antibiotics and that we should only treat if they have symptoms because in her opinion they will just be carriers for life. However, we decided to call a vet that is further away from us, but sees birds exclusively and is considered very knowledgeable, to get a second opinion. We faxed her the lab results and had a phone consultation with her. She said that she thought maybe a month of treatment wasn't enough and they might need 90 or more days of treatment, and possibly a different antibiotic or an additional antibiotic added. Because we aren't willing to just give up, we are going to try to treat for longer, possibly with a different antibiotic or a second antibiotic.

Actually, we are a bit confused by the test results. The situation I currently have is that one baby is in a separate cage and then the other three are together. The reason for this is that this one baby was a lot younger and smaller than the others. I was trying to introduce him to the others but was having difficulty because he was quite aggressive with them. After learning about the MRSA, however, I figured I would keep him separate just in case there would be cross-contamination that could make things worse. So, partly because this has been a pretty big financial strain on us and partly because it is fairly logical and convenient, I had the one baby tested separately and then the three others' samples mixed together and tested as one.

So, the current results are that both have a "heavy" growth of the bacteria -- which is alarming to me because it was only "moderate" back in October -- but I am confused by the results. It seems that only the separate baby's sample was declared to have MRSA in it. The other test just called it "staphylococcus aureus", and it was resistant to amoxicillin and penicillin. The tests were done by two different technicians, however, and we were advised by the vet that we did the phone consult with that we should have our original vet call the lab and ask about it because she finds it confusing as well. The vets seem to think that it is MRSA too, as it was initially called MRSA in the first test, and is obviously still resistant to amoxicillin and penicillin (methicillin is not listed in the results at all), but it is really confusing that it was not listed as such in this second test. However, strangely enough, the three babies' results show that the bacteria they have is resistant to fewer antibiotics. Which suggests that what the separate baby is dealing with is somewhat different from the others, and it makes me glad that I kept them separate... His is, essentially, worse, because it is more resistant.

I know a few of you have talked about treating for four or more months to finally eradicate the bacteria, so I am just not willing to give up now, despite what my first vet said. It's important to me to try to do everything I can to eradicate the bacteria because of the risk it poses to my family in particular, considering that we have a cancer survivor and an 85 year old living with us (neither of whom, luckily, were positive for MRSA). I have discussed with the vet what we might do if we are unsuccessful at getting rid of the bacteria, and we may look around to see if any individual, or rescue organisation, is willing to take them on while knowing the risks. But I am going to put that out of my mind for the time being. I still have hope, because I think it is possible that it can take months for it to be treated. The babies are still too thin, despite having a very good diet and eating well, and their poop still smells very sour, so I know it is also not entirely innocuous, either.

I am focusing on a few questions in particular right now. First, why the growth of the bacteria is now heavy rather than just "moderate" -- how can it be worse after a month of antibiotics that the bacteria is supposed to be susceptible to? Second, of course, whether the three babies have MRSA or just amoxicillin and penicillin resistant staph aureus, and whether it is even possible for that to exist without being MRSA -- and furthermore, what that would really entail. From the smell of their poop, their thinness, and the fact that it is now a heavy growth, I think it has to be treated regardless of whether it is technically MRSA or not. However, it WAS concluded to be MRSA in the first test.

Third, I am wondering about which antibiotics are the most effective and what dosage they should be on. Because the trimethoprim-sulfamethoxazole is supposed to be effective, it is confusing that the growth of bacteria is even heavier now, as I said. It makes me wonder whether the dose was high enough. If anyone has experience with this antibiotic maybe they can chime in. The babies are about 60g or so each, and the formulation of Trimethoprim/Sulfa was 40/8mg per mL. The dose was 0.05mL every 12 hours. I'll talk to the vet(s) about it as well, but they seem to think it was probably okay, although I don't know how it can be adequate considering the results.

I also am going to attach some screenshots of the results, if that is allowed. If anyone can offer any thoughts or advice that would be great and I can run it by the vets... All in all, I am just not willing to give up yet like the first vet suggested.

Separate baby's results:



Three other babies:

 

[Clueless]

I am literally clueless.

Thanks for fighting for them. They're worth it.

Prayers up.

 

[Sarahmoluccan]

That's so puzzling but I'm glad to hear from you and that at least your family is free of MRSA. I'm saddened that your flock still struggles with it thou. It's good you keep fighting on!!

About the increase of bacteria the only thing I can think of is the it reminds me of a phenomenon I heard about with Aids patients and certain meds. I'm sorry I forget all the details. Basically the meds would kill most of the virus/bacteria, but not all of it. The virus/bacteria cells that didn't die started evolve to actively resists the meds. Sorry I can't remember what it was trying kill, whether it treating aids itself or fighting some sort of infections.

Ok I was confusing myself so track and article to explain it better
HIV Drug Resistance Explained - POZ

And Here's article with video
Superbug, super-fast evolution

Still I wish you well in this and thank you for the update

 

[theletterv]

I am literally clueless.

Thanks for fighting for them. They're worth it.

Prayers up.

Thank you, it's really appreciated.

That's so puzzling but I'm glad to hear from you and that at least your family is free of MRSA. I'm saddened that your flock still struggles with it thou. It's good you keep fighting on!!

About the increase of bacteria the only thing I can think of is the it reminds me of a phenomenon I heard about with Aids patients and certain meds. I'm sorry I forget all the details. Basically the meds would kill most of the virus/bacteria, but not all of it. The virus/bacteria cells that didn't die started evolve to actively resists the meds. Sorry I can't remember what it was trying kill, whether it treating aids itself or fighting some sort of infections.

Ok I was confusing myself so track and article to explain it better
HIV Drug Resistance Explained - POZ

And Here's article with video
Superbug, super-fast evolution

Still I wish you well in this and thank you for the update

Thank you for your well wishes. That's an interesting, and worrying, thought, but the sensitivity tests show the same sensitivity for trimethoprim-sulfamethoxazole as they did the first time around, so it doesn't seem like the bacteria has become resistant to it -- if it had, I would think the sensitivity test would show that it had? Both vets I talked to said the same thing and that the sulfa was still effective. So I really have no clue...

 

[Sarahmoluccan]

Thank you, it's really appreciated.



Thank you for your well wishes. That's an interesting, and worrying, thought, but the sensitivity tests show the same sensitivity for trimethoprim-sulfamethoxazole as they did the first time around, so it doesn't seem like the bacteria has become resistant to it -- if it had, I would think the sensitivity test would show that it had? Both vets I talked to said the same thing and that the sulfa was still effective. So I really have no clue...

That's really puzzling. It's good sulfa is still effective thou... I wish I could help you more... Please keep us posted and again I wish you the best of luck with it all!!

 

[zoo mom]

First off, moderate and heavy growth are somewhat subjective. They could be the same amount and one tech thought it was moderate and the other heavy.
2nd if they didn't plate (test) methicillin specifically then you don't know if it is MRSA.
Second, your babies need a probiotic supplement. The antibiotics will kill the good bacteria along with the bad, and yeast will start growing. Give the probiotic at a separate time from the antibiotics. And continue it for several weeks after they are off antibiotics. Good luck to you and the babies.

 

[Alien J]

All I want to say is thank you, thank you for not giving up. Our thoughts are with you and your family and your fids.

 

[Hankmacaw]

@theletterv
Judging from the sensitivity charts you posted, the infection that your birds have is MRSA (Methicillin Resistant Staphylococcus Aureus). I say that because the bacteria is resistant to all of the Penicillium and Methicillin and derivatives tested. It does take a long time to eliminate a MRSA infection. For both my Hank (throat infection) and Jasper (air sac infection) it took four months to cure. Jasper was tolerant of SMP-TMZ and was given that, while Hank was administered Doxycycline, because he was violently allergic to SMP-TMZ. SMP-TMZ is generally the favored antibiotic for MRSA treatment. They had the infections years apart from one another.

There can be several reasons that your babies are not getting better.
1. The dosage is not high enough to eliminate the bacteria.
2. The period given antibiotics has not been long enough.
3. There is cross contamination going on between the birds.
4. The cleaning regimen is not strict enough and they are getting re-infected over and over.

Have you purchased F10 ( Amazon.com : F10SC Veterinary Disinfectant (200ml) by F10 SC : Pet Health Care Supplies : Pet Supplies ) and used it to clean EVERYTHING your birds are in contact with DAILY? I can't tell you how important that is. Have you gotten swabs from your vet and tested around your house to see if the bacteria is latent on any surfaces? Unfortunately, with MRSA just giving an antibiotic will not get the job done.

I highly recommend that you get some probiotics (if you haven't already) and give your birds daily probiotics 1 - 2 hours after medicating them. I also recommend that you separate all of your birds into semi-isolation to eliminate the possibility of their cross contaminating one another.

That's all I can think of now - but will add to this if I think of anything else.

 

[Clueless]

I love your posts @Hankmacaw

Swabs from the vet to test for bacteria???

Can you buy those on line?

Do they have to be processed by a vet or a lab?

 

[Hankmacaw]

Yes, swabs from the vet to check for bacteria/fungus/mold. I suspect that veterinary supply houses carry them. but I don't know if they sell to the general public. They must be sterile and maintained that way until the sample is put in them. Here is an example of a sterile guarded swab' 07-846-9118 | Each | Guarded Culture Swab

Depending on what you are testing for either a lab or a veterinary office can process them. Some large veterinary offices have full labs and can process everything.

 

[theletterv]

Hello again everyone. That's interesting about the moderate vs heavy growth. My vet did switch to a different lab so maybe that was just the opinion of the technicians, or different practices at the new lab. I'm not sure.

Anyway I will answer a few things that have been brought up...

First, I do have a probiotic and did give it to the babies throughout their course of antibiotics and I still stir it into their chop. I will keep in mind that I should give it to them an hour or two after their dose of antibiotics. That's good to know.

Also, I do have F10 and have been using it pretty religiously. Throughout their course of antibiotics I did clean every day. I replaced all their perches with plastic ones because I did not trust that the wood perches could be disinfected enough. All their toys are also plastic for that reason. Every day I would do my best to scrub the poop off the bottom grate, wipe down the bottom tray, then spray everything until very wet, including perches and toys, taking out bowls and cleaning and then spraying with F10... Before they finished the antibiotic I also took the cages and put them in the bath tub, scrubbed them down and then sprayed liberally with F10 because I wanted to get every nook and cranny.

Should I remove every perch and toy and soak them in F10 rather than just spraying? Maybe they weren't getting wet enough, even though I sprayed heavily.

I also have used a steam cleaner and F10 to clean every surface of my home. All surfaces in my bedroom where the birds are, all hard floors, all counter tops... And all carpets and rugs with the steam cleaner, after being sprayed with F10 as well. I always feel like I'm not doing enough but I'm not sure what more I could do. I'll have to buy some more F10 soon but I still have a fair amount left and will continue the cleaning regimen. I don't really have money to throw at testing swabs around the house, though. I just took the "better safe than sorry" approach and cleaned absolutely everything with F10. In areas where birds are not located, and nowhere near, we also used a few other products that said they killed MRSA -- Lysol, for one. Also washed all clothes, sheets, blankets, towels, in hot water and bleach! We also have hand sanitizer located throughout the house and I have been wearing vinyl gloves while cleaning or touching the cages or the birds.

I am actually currently looking into locating some small cages to use as hospital cages so that I can separate them all. Kind of sad to think of doing so -- they get a lot of companionship from each other. But we have decided to test them all individually anyway after further antibiotic treatment, so it makes sense.

I still wonder whether the dose of SMP-TMZ was adequate but the vets seem to think that isn't the issue. I'm just really trying to rack my brain to see if there's anything I'm missing or not doing well enough...

 

[Hankmacaw]

Your cleaning regimen sounds excellent. Maybe separating them will eliminate any possibility of cross contamination.

I calculate that they were treated for 6 weeks. My vet doesn't believe that that is long enough and neither do I, so maybe that is why they are still positive. Four months is somewhat over 16 weeks.

Just be patient and consistent. It's hard to believe that there aren't standards for "light", "moderate", and "heavy" concentrations of bacteria in laboratories. But maybe that is what happened.

 

[theletterv]

I had the same thought; that there must be standards for what constitutes light, moderate, and heavy growth. But the sensitivity test shows that the bacteria is pretty much as susceptible to SMP as it can be. I looked into MIC -- minimum inhibitory concentration -- and it looks like the bacteria is about as susceptible to SMP as it is possible to be. The susceptible range is 10-40 and the resistant breakpoint starts at about 80. Basically, the further an antibiotic is from its resistant breakpoint, the better. It does still alarm me to think they might have even more bacteria than they started with, however, given that I have tried to be very careful. How can disinfecting daily and giving an antibiotic cause them to have more bacteria? I'm going to talk to my vet about the dose and see if she can look into prescribing a higher one. She's not in today, but hopefully tomorrow.

I also think that my vet has no idea about how long a course of antibiotic this bacteria sometimes requires. As I said, she was ready to give up and call them life-long carriers after one month. At least the second vet suggested they might need 90 days of antibiotics. I will mention that I've heard cases of it taking 16 weeks of treatment, and I hope that she will take that into account.

 

[Hankmacaw]

You are handling this very well and getting a good education. I think your babies will get well, if you keep up the excellent care. Believe me MRSA is about as tough of a bacterial infection that they can get. Don't hesitate to run any questions or doubts you may have across the forum - we may be able to help or make suggestions.

 

[janicedyh]

I have been a little confused reading this thread. I have had hospital based MRSA and have known several people that have community based. For treatment the doctor must not only test for positive results but do a panel to learn the antibiotic your individual MRSA is not resistant to. No matter how much, how strong or what type antibiotic is used it will not cure MRSA if it ultimately is resistant to that type of antibiotic. Could it be possible that coincidentally you have a different MRSA than your birds? Many people are walking around without symptoms and are carriers without even knowing it, usually we find that in community based. Typically you retest with a nasal swab after 3 months of completion of treatment. Luckily it seems whatever type you are dealing with is not hospital based, within hours of getting MRSA, at the hospital I worked, my face was swollen so bad it was grossly deformed and I was immediately admitted. The panel that was done said my MRSA was resistant to all but one antibiotic. I would suggest buying hospital wipe like this Sani-Cloth INF-635 Plus Germicidal Wipe Surface Cleaner, 15 Percent Alcohol, 6" Length x 6.75" Width (Tub of 160 Wipes): Amazon.com: Industrial & Scientific
When I came home from the hospital I used these and I also used them when I cared for my mom while she was taking chemo. There may be a stronger wipe but this is just an example. I'm not saying to use on the cages. I think F10 works pretty well, if you get the large concentrated container maybe not add as much water.

 

[Hankmacaw]

@janicedyh Her vet did perform cultures and sensitivities - she posted the results above. The only thing additional that the vet could have done is to identify the specific strain of the Staphylococcus Aureus. My vet had an extended culture identification done on Hank's MRSA and if I remember right it was pretty darned expensive.