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<span style="color:#000080;">A number of previously healthy baby boys got MRSA from circumcision equipment and from the lidocaine used for penile nerve block. Too bad the conclusion of the article is to improve circumcision practices rather than to just get rid of it.</span><br><br>
Infect Control Hosp Epidemiol. 2007 Apr;28(4):406-11. Epub 2007 Mar 15Risk Factors for Neonatal Methicillin-Resistant Staphylococcus aureus Infection in a Well-Infant Nursery.<br>
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L.<br>
Center for Disease Control and Prevention, Atlanta, GA, USA. <a href="mailto:[email protected]">[email protected]</a>.<br><br>
Objective. To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery.Design. Case-control studies.Setting. A well-infant nursery in a nonteaching, community hospital.Methods. Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis.Results. Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. <b>All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices.</b> In outbreak 1, case infants (n=6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P=.01). <b>In outbreak 2, case infants (n=5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]).</b> Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114).Conclusions. Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.
 

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DH's friend just had a baby last week. I was wondering if they had him circumcised or not. The friend called to say that the baby has a "bad staph infection" and they were taking him to the hospital, which makes me think they circ'd <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

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My son and daughter (twins) got MRSA last August when they were 11 months old. It was in the same place, on the same butt cheek <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> They were hard, hot lumps under the skin. They were hospitalized for a week each, and it was 1 week apart from each other. There bums had to be cut open to drain the infection, which they had been treating for a normal infection, and MRSA is penicillian resistant. So they switched meds, and they got better. We still have NO CLUE how they got MRSA, no one else in my family had it. My husband did work for the local schools though, so it is possible he brought it home from there.<br><br>
Interesting story. MRSA is scary.
 

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Wow, thanks for the article. We had a mom in the hospital last week with MRSA and they were trying to figure out how to do the baby's circ. They were on contact precautions, of course, and it seemed like it would be out of the question but there were issues with her "rights" to have her baby circ'ed on schedule with everyone else. <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/rolleyes.gif" style="border:0px solid;" title="rolleyes">
 

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My response:<br><br>
Dr. Nguyen: Why didn’t you just state the obvious: Neonatal circumcision puts baby boys at great risk for MRSA and is contra-indicated?? Your findings are confirmed by Dr. Van Howe’s recent literature review of which a copy is attached hereto. As a person of (I am so bold to presume) Vietnamese extraction, why are you blinded by this dangerous, disfiguring, desensitizing (see attached articles from the BJU Int’l) American social custom with little, if any, basis in good medicine?? Why is the CDC so bent on circumcising everyone?? As a lawyer I see the damage done by both properly performed and mis-performed circs on a weekly basis. Righting those wrongs is a major portion of my practice. It’s time the American medical establishment joined the rest of the civilized world by condemning non-religious infant circumcision.
 

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Doctors Opposing Circumcision (D.O.C.)<br>
1727-14th Ave., Suite 18 Tel: 225-383-8067 / Fax 225-381-8200<br>
Seattle, Washington 98122 E-mail: [email protected]<br>
“Fear, pain, crippling, disfigurement and humiliation are the classic ways to break the human spirit.<br>
Circumcision includes them all.”<br>
Special Statement<br>
Increased Dangers of Neonatal Circumcision<br>
The present medical policy in the United States and some other English-speaking nations is to offer<br>
elective non-therapeutic circumcision of infant males, and to perform it at the request of the parents. New<br>
evidence of increased risks associated with that surgical operation has emerged. This statement is intended to<br>
inform hospital administrators, medical doctors, and parents of those increased risks.<br>
Hypovolemic Shock. The recent, highly publicized, death by hypovolemic shock of a healthy Canadian boy<br>
caused by hemorrhage from his circumcision wound has forced a reexamination of the risks occurred from<br>
bleeding.<br>
The prepuce is highly vascularized, so it is likely to hemorrhage when cut, and severing the frenular<br>
artery is very common. Infants have a miniscule amount of blood in their tiny bodies and can tolerate only about<br>
a 20 percent blood loss before hypovolemia, hypovolemic shock, and death. A 4000 gram male newborn has<br>
only 11.5oz (340 ml) of total blood volume at birth, 85 ml per kilogram of weight. Blood loss of only 2.3oz, (68<br>
ml) less than one-quarter of a cup, 20% of total blood volume at birth is sufficient to cause hypovolemia. The<br>
quantity of blood loss that might kill an infant—68ml—is easily concealed in today’s highly absorbent<br>
disposable diaper. Many newborns, and especially premature infants, weigh much less and a smaller amount of<br>
blood loss would be sufficient to trigger hypovolemic shock in those infants. Circumcision of infants, therefore,<br>
carries the inherent danger of hypovolemic shock and death.<br>
Methicillin Resistant Staphyloccus Aureus. This month’s edition of Archives of Disease in Childhood<br>
(London) reports a substantial increase in bacteremia (viable bacteria circulating in the blood) caused by<br>
Methcillin Resistant Staphyloccus aureus (MRSA) in children. The article (Archives of Disease in Childhood<br>
2004;89:378-379) identifies vancomycin as the treatment of choice against MRSA, but the authors caution that<br>
vancomycin resistant Staphyloccus aureus is now emerging. The authors report that “MRSA bacteraemia is<br>
associated with a higher mortality rate, longer hospital stays and is a significant independent risk factor for<br>
death.”<br>
St. Catherine’s Hospital on Long Island experienced an outbreak of MRSA infection among<br>
circumcised boys in the newborn nursery in 2003; Arlington Hospital in Arlington, VA had a similar outbreak in<br>
1995; and the naval hospital in North Carolina had an outbreak of non-resistant S. aureus in 1998.<br>
The time may be coming when antibiotics may not be effective against some infections. This would<br>
return us to the situation that prevailed before the discovery of penicillin in the 1940s.<br>
A reappraisal of the merit of non-therapeutic circumcision is underway. We hope the substance of this<br>
statement may serve to inform that decision.<br>
Issued at Seattle, March 25, 2004<br><br>
posted with permission of D. O. C.
 
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