The combination of H1N1 swine flu and antibiotic-resistant staph bacteria could lead to a deadly form of pneumonia that kills half the people it infects within three days, according to a study published in The Lancet Infectious Diseases.

Researchers analyzed two patients who had experienced bacterial pneumonia that led to blood poisoning, concluding that the culprit was community acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), the form of MRSA that occurs outside of health care settings like hospitals and nursing homes.

"The threat from CA-MRSA in the USA is very serious concern, especially if there is a flu epidemic as this could trigger a large number of cases of necrotizing pneumonia, which has a mortality rate of more than 50 percent in 72 hours," said Richard James, of the University of Nottingham.

MRSA is already a highly lethal bacteria, because its resistance to first-line antibiotics makes it more likely to cause complications such as blood or organ infections, boils or even skin necrosis. The bacteria kills more people each year in the United States than AIDS.

CA-MRSA cases are sharply on the rise, with more and more cases being reported in settings gyms, schools and prisons.

"The concern is that this may be the start of an exponential increase as we saw with hospital MRSA infections in the 1990s," James said. "It took the UK 13 years to get to grips with hospital-acquired MRSA infections; we are not equipped to deal with large numbers of CA-MRSA infections in the community."

CA-MRSA appears to be particularly likely to cause pneumonia when it infects people who are recovering from a flu infection.

"Bacterial pneumonia following influenza can be very serious and in some cases fatal," said MRSA expert Mark Enright, of Imperial College London. "CA-MRSA pneumonia is particularly dangerous due to the rapid, aggressive nature of the infection and the difficulty in providing effective chemotherapy. The emergence of pandemic influenza and increased prevalence of CA-MRSA in many countries may cause increased morbidity and mortality in infected individuals."

Sources for this story include: www.telegraph.co.uk; news.bbc.co.uk.

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