Community — Staph infections rise in state, nation

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MRSA (methicillin-resistant staphylococcus aureus) hospitalizations have doubled since 1999, a new study says, bringing fresh evidence that drug-resistant organisms are becoming a major public health issue.
The problem is compounded by a lack of reporting on the problem, said Dr. Berandette Albanese, medical director of the El Paso County Department of Health and Environment.
“MRSA is not a reportable condition, either in the state or nationally, so there’s no active community surveillance,” she said. “Hospital-associated MRSA usually arises as a complication of a hospital stay, so it’s documented at the hospital. But there’s no reason to assume that our local experience is any different from the rest of the country.”
She said the problem is increasing throughout the Pikes Peak region, because diagnosis and treatment of community-associated MRSA can be difficult for doctors.
“If someone without risk factors (e.g., a recent hospital stay) walks into a G.P.’s office with a skin infection, the clinician has to make a judgment. There isn’t a bedside test for MRSA — it has to be cultured, and that takes 48 hours. So you just have to make a decision,” she said.
And, she added, such infections are common.
“We haven’t seen community-associated MRSA in the context of an outbreak — it’s been in the context of individual infections. You ask any G.P. — they’ll tell you that they see it,” she said.
Albanese believes new and stronger antibiotics are important to combat MRSA.
Asked whether she sees MRSA infections as an emerging epidemic, calling for more serious and focused efforts by health authorities, including universal reporting, Albanese said: “We have surveillance data — it may not be universal, but it’s strategic, so we know enough about what’s happening. (To combat MRSA) we need a whole new kind of antibiotic — one that targets the organism in a very different way.”

Growing problem

The Centers for Disease Control study, which appears in the December issue of the Journal of Emerging Infectious Diseases, is one of the latest to comprehensively examine MRSA infections.
MRSA presents many uniquely troubling problems to the American healthcare system. For many years, staph-associated infections could easily be controlled by any of a dozen antibiotics. But with the widespread use of antibiotics, new strains of S. Aureus arose which were resistant to most treatments. Particularly in hospital settings, MRSA infections have become common.
MRSA is a bacterium that causes infections on various parts of the body. It usually causes infections on the skin, which begin as pimples or boils. If untreated, these infections can spread rapidly, and lead to serious complications. Such complications can include more serious skin infections, massive systemic infection and possible death. MRSA is difficult to treat, because it is resistant to most antibiotics. The Centers for Disease Control says MRSA infections kill as many as 250 people each day. Approximately 90,000 Americans come down with drug resistant MRSA every year, and one in five of them die.

Rising costs

According to the CDC, MRSA infections impose much greater costs than non-resistant infections.
“Several studies have estimated that antimicrobial drug-resistant infections increase death, illness, and direct costs by 30 percent to 100 percent,” the study said. “Estimates of the excess cost of an infection with MRSA compared with an infection with methicillin-sensitive S. aureus range from $3,000 to $35,000. This suggests that MRSA has cost the healthcare system (patients and hospitals) an extra $830 million to $9.7 billion in 2005, even without taking into account indirect costs related to patient pain, illness and time spent in the hospital.”
Hospitalizations caused by MRSA more than doubled between 1999 and 2005, increasing from 127,000 to nearly 280,000. The study concluded that MRSA and related staph infections are now “endemic, and in some cases epidemic” in many U.S. hospitals, long-term care facilities and communities.
As MRSA infections become more frequent, bacterial resistance becomes stronger. The increase in MRSA-related infections has increased demand for vancomycin, a powerful antibiotic of last resort. As the use of this drug has increased, so too has the occurrence of vancomycin-resistant S. aureus, which is highly resistant to any treatment.
To combat MRSA, hospitals have introduced multiple regimens to prevent the spread of resistant bacteria from healthcare workers to patients. Local hospitals, as the Business Journal has reported recently, have been among the first to adopt such protocols, which appear to have had some success.
Although hospital-acquired MRSA infections threaten patients, an emerging and potentially more deadly strain has begun to circulate outside of medical centers. Richard Wenzel, president of the International Society for Infectious Disease said that community-associated MRSA is equally dangerous. Addressing a recent healthcare conference, Wenzel talked about CA-MRSA.
“What we’re seeing today is a second kind of staph infection and people outside of hospitals are getting it,” he said. “It’s even more worrisome than hospital MRSA because the community MRSA infections almost always have a toxin called PVL (Panton-Valentine Leucocidin). When this staph gets into the lungs or blood, it’s truly devastating and worse than even the healthcare-associated MRSA because the toxin chews up tissue and tends to cause shock in patients.”
MRSA is spread by close contact.
“Any kind of close contact can spread staph infections. You may remember a couple years ago, some of the Los Angeles Rams had cuts and were bleeding, and they all jumped into a common whirlpool and a lot of the team got infected,” he said.
Wenzel worries that the two endemic strains of MRSA may, in effect, merge, as the community-associated strain spreads into hospitals.
“It takes different types of drugs to treat the toxic-producing community strains, and it’s much more difficult to get rid of it than the healthcare MRSA. It’s also more difficult to identify,” he said. “The hospital ones you find in the nose, but with the community one, we’re not sure where it hides all the time. So we now have two epidemics: one is continuing in hospitals, but the traffic is now going two ways. To me that’s the most threatening thing in the next five years.”