MRSA Infections on the Rise, But Treatable If Caught Early

Now, in addition to terrorism, the slowing economy and global warming, comes another threat to our well-being: MRSA, a potentially deadly super bug that is resistant to many antibiotics.

First identified in the early 1960s, MRSA - methicillin-resistant Staphylococcus aureus - began infecting hospital and nursing-home patients in the mid-1970s. More recently, it's become a public health problem, with outbreaks especially found in schools and among amateur and professional athletes. A Centers for Disease Control and Prevention (CDC) report said about 94,000 Americans were infected by MRSA in 2005, and the germ was thought to have contributed to nearly 19,000 deaths that year.

Peter G. Sohnle, MD, Professor of Medicine (Infectious Diseases) at the Medical College of Wisconsin saw MRSA's infectious wallop increase over the years at the Zablocki Veterans Administration Medical Center, where he sees patients.

"In the late '70s and early '80s, only about 1 to 2% of our staph infections were resistant to the methicillin antibiotic," he says. "But by the mid-'80s, MRSA infections comprised almost 50% of our staph infections."

Bacteria tend to strengthen and evolve to fight back at antibiotics used to treat infected patients. After penicillin began to lose its effectiveness against staph, doctors starting using methicillin instead. And now we have this so-called super bug, MRSA, that resists methicillin.

Stronger Strain Outside Hospitals
MRSA remained primarily a hospital-acquired infection problem for 10 years, starting in the mid-'80s, Dr. Sohnle says. Then, in the late 1990s, a more virulent variant of MRSA began appearing in the community. This strain, called Community-Associated Methicillin-Resistant Staph Infection, or CA MRSA, can attack and destroy white blood cells that help us fight infections. "It can be even more aggressive than the HA (hospital-acquired) infection."

The reason CA MRSA seems to emerge so often among students and athletes is that young people tend to congregate and have close contact in schools, gyms and on playing fields. In addition to their close contact with other players, athletes tend to experience cuts and skin abrasions, where the infection can settle. (Newsweek reported that since 2002, MRSA outbreaks have plagued the Cleveland Browns and teams from the University of Texas and the University of Southern California.)

Early Detection and Treatment
If detected early, MRSA and other staph infections are treatable. A common symptom of MRSA is an inflamed skin infection that people think might be a spider bite, Dr. Sohnle says. These can abscess and erupt, and he recommends patients seek immediate medical attention for them. Many MRSA and other staph skin infections can be treated by having a health care provider drain the abscess, he says. Antibiotics may also be prescribed, but they alone may not stop the infection.

Once MRSA enters the bloodstream, however, it can progress to a serious condition such as septicemia (blood poisoning) or endocarditis (an inflammation of the lining of the heart). MRSA can also cause pneumonia, Dr. Sohnle notes.

Even though CA MRSA has been around for 10 years, MRSA infections have suddenly become front-page news. One survey found that in the first two weeks of October 2007, approximately 155 news reports were devoted to the topic. Then the Journal of the American Medical Association reported on the CDC's 2005 statistics, and the number of MRSA stories swelled to more than 1,650 during the last two weeks of the month alone. Newspapers, magazines and television news programs did stories about MRSA infections at schools around the country, typically followed by school closings and floor-to-ceiling disinfections of classrooms and locker rooms.

Is all that attention and cleaning really necessary, or is it an overreaction?

Hand Washing Can Help
A growing number of public health authorities think MRSA and many other infections, including common conditions like colds and the so-called "stomach flu," (usually caused by food contamination) could be prevented if people just washed their hands more often, with soap and water. Some MRSA-infected athletes admitted they didn't often wash their hands.

Public health authorities say even those who do wash their hands may not do a thorough job, rubbing soap between the fingers and under the nails.

Lack of proper hand washing is a common way MRSA spreads, both in hospitals and in the community, according to the CDC. It lists these factors as being associated with the spread of MRSA skin infections:

• Close skin-to-skin contact
• Openings in the skin such as cuts or abrasions
• Contaminated items and surfaces
• Crowded living conditions
• Poor hygiene

Alcohol-based hand sanitizers have also been introduced in recent years. Although they do kill germs, they are not a substitute for hand washing, according to the CDC, which notes that alcohol can't reach germs through a layer of dirt. Dr. Sohnle says they are used in hospitals, although he concedes they don't kill all hospital infections.

"But they're a good idea in hospitals, where sinks aren't always available. I like to use both hand washing and the alcohol sanitizers."

Putting MRSA in Perspective
One reason super bugs like MRSA seem to be flourishing, Dr. Sohnle and others say, is that antibiotics have been overused for years, including being added to animal feed and other agricultural products. When Americans consume these products containing antibiotics, over time the antibiotics lose their germ-killing properties.

Although MRSA infections (and related deaths) are increasing, many such infections can be prevented or effectively treated at an early stage, Dr. Sohnle notes. But their incidence is still relatively small compared with other common conditions. "Influenza can be just as serious as a staph infection," he says. "Every year, on average, influenza kills twice as many people as MRSA now does, which is why people are encouraged to get annual flu vaccines." Another 40,000 Americans die in car accidents annually, or twice as many as now die from MRSA complications.

"People shouldn't panic about MRSA," Dr. Sohnle says. "I think if people take time for proper hand washing or use sanitizers more often, they can help prevent infection. And since the first indication of a MRSA infection is typically a skin inflammation that looks like a spider bite, people should be alert to that and get medical help right away."

Barbara Abel
HealthLink Contributing Writer

This article includes information from the US Centers for Disease Control and Prevention (CDC).

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.