Henry I. Miller
There is a constant war between pathogenic bacteria and humans, and the microbes seem to be winning. New data from the Centers for Disease Control (CDC) indicate the incidence of serious invasive infections from a strain of bacteria resistant to most first-line, commonly used antibiotics was higher than previously thought. The CDC estimates methicillin-resistant Staphylococcus aureus (MRSA) kills 18,000 Americans each year and causes serious infections in more than 90,000.
The phenomenon is not new, but reports of outbreaks in schools across the nation and the death of a high school student in Virginia earlier this month have focused national attention on the problem.
The medical community has been worried for years about growing antibiotic resistance in many kinds of bacteria. Especially if an infection is contracted in a hospital — in a surgical wound, for example, or in the form of pneumonia — there is a high probability the bacteria responsible will be resistant to one or more antibiotics, and the outcome is often deadly. Almost 2 million patients contract infections in U.S. hospitals each year — approximately 4½ percent of admissions — and 100,000 die, according to earlier data from the CDC.
The death rate in such cases is alarmingly high not because the patients initially are gravely ill, but because hospital germs increasingly are resistant to multiple antibiotics: About 70 percent of those infections are resistant to at least one drug, so the infections are hard to treat. In many cases, we"re already out of good second- or third-line alternatives that are effective, can be administered by mouth and have few side effects, so we must resort to drugs that are inconvenient to administer or have significant toxicity.
Many bad bugs are spreading beyond our hospitals into the greater community. Bacteria are masters of evolutionary adaptation: Given sufficient time and exposure, they use a variety of clever genetic and metabolic tricks to resist any drug we invent. There is no antibiotic in clinical use today to which some resistance has not developed. A future with few effective antibiotics would be treacherous; many of today's routine medical procedures, from surgical operations to chemotherapy, would be far more dangerous if we permit the bacteria to outwit us.
To combat this public health emergency, important initiatives are under way by both government and the private sector to promote more sparing and intelligent use of antibiotics. Regulators and livestock producers are collaborating to reduce the amounts of antibiotics used to prevent disease in livestock, and many HMOs have adopted policies that restrict antibiotics to infections that seem unequivocally to be caused by bacteria. (For example, patients should not routinely get antibiotics for colds, which are caused by viruses, not bacteria.)
The CDC is promoting four strategies to prevent antibiotic resistance in health-care centers — prevent infection, diagnose and treat infection, use antimicrobials wisely, and prevent transmission — but federal officials have paid little attention to the flip side of the problem: the shortage of new antibiotics.
Twenty years ago, about a half-dozen new antibiotics would appear on the market each year; now it's at most one or two. For decades we've relied largely on new variations on old tricks to combat rapidly evolving pathogens: Most antibiotics in use today are chemically related to earlier ones discovered between 1941 and 1968. During the last 38 years, only two antibiotics with truly novel modes of action have been introduced — Zyvox in 2000 and Cubicin in 2003, the latter of which must be infused intravenously.
Market forces and regulatory costs have exacerbated the antibiotics drought. Until about a decade ago, all the major pharmaceutical makers had antibacterial research programs, but they have dramatically trimmed or eliminated these efforts, focusing instead on more lucrative drugs that treat chronic ailments and lifestyle issues: drugs for lowering cholesterol and treating erectile dysfunction, for example. Whereas antibiotics cure a patient in days, and may not be required again for years, someone with high cholesterol or erectile dysfunction might pop expensive pills every day for decades. Moreover, drug development has become hugely expensive, with the direct and indirect costs to bring a drug to the U.S. market now averaging about a billion dollars. Only about a half-dozen new antibiotics are now in late-stage clinical trials.
To address this public health threat, we need multiple strategies. In the short term, improved infection-prevention procedures at hospitals would have a tremendous impact. A pilot program at the University of Pittsburgh found that screening tests, gowns and other precautions that cost only $35,000 a year saved more than $800,000 a year in infection costs. A review of similar analyses published last year concluded that screening for MRSA bacteria both increases hospital profits and saves lives.
Longer term, we need to adopt the kinds of critical policy reforms suggested by the Infectious Diseases Society of America to spur new drug development. Among them: expediting the publication of updated guidelines for clinical trials of antibiotics, including a clear definition of what constitutes acceptable surrogate markers as endpoints; encouraging "imaginative clinical trial designs that lead to a better understanding" of antibiotics' efficacy; and the exploration of animal models of infection, in vitro technologies and microbiological surrogate markers to reduce the number of efficacy studies required.
In addition, regulation needs to be more enlightened. Regulators should grant accelerated review status to priority antibiotics and be more sensitive generally to the critical need for new antibiotics.
The two novel antibiotics that have been introduced since 2000 won't be enough to keep rapidly mutating pathogens at bay for long. Once resistance appears, it will spread rapidly. Unless we create economic and regulatory incentives for companies to develop antibiotics, it's unlikely we'll see many more wonder drugs in the near future. That's something to think about next time you contract bronchitis, or are hospitalized for elective surgery.
Henry I. Miller, a physician and molecular biologist, is a fellow at Stanford University's Hoover Institution and a former official at the National Institutes of Health and the Food and Drug Administration.
Henry I. Miller
by Deborah Brunswick
NEW YORK (CNN) -- Just days before his death, the Brooklyn, New York, middle-school student who died from an antibiotic-resistant staph infection had visited a hospital with skin lesions and was treated with allergy medicine, according to the family's lawyer, Paul Weitz.
Omar Rivera, 12, a New York seventh-grader, died of drug-resistant staph on October 14. Omar Rivera's mother, Aileen, took the 12-year-old boy to Kings County Hospital in Brooklyn because she had been dissatisfied with the treatment he received at a clinic, Weitz told CNN. He said the hospital treated him with Benadryl, a common anti-allergy medicine.
According to hospital spokeswoman Hope Mason, Omar did not show signs of a staph infection when he was treated at the hospital.
"I can confirm the child was brought to the emergency room after midnight on Friday, October 12. He was treated for non-MRSA-related conditions and was released," said Mason. "We will be closely examining whether more could have been done to detect the infection at that time."
MRSA is short for methicillin-resistant Staphylococcus aureus, and is responsible for more deaths in the United States each year than AIDS, according to new data. The germ resists all but the most powerful antibiotics.
Omar, a seventh-grader at Intermediate School 211, was pronounced dead on October 14 at Brookdale Hospital.
Twenty-five to 30 percent of the population carry the staph bacteria -- one of the most common causes of infection -- in their bodies, according to the Centers for Disease Control and Prevention. While such infections are typically minor, invasive MRSA infections can become fatal, because they are caused by drug-resistant staph.
By Dave Moller
To help stop the spread of staph infections, hospitals including Sierra Nevada Memorial are gearing up to adopt stricter cleansing procedures for visitors and patients.
The added precautions - in addition to policies that have been in place for years - come after some well-publicized outbreaks of community-acquired staph infections called "superbugs" that are resistant to most drugs.
A recent American Medical Association report also outlined the dangers of superbugs.
"This is getting to be a bigger issue all the time," said David Witthaus, laboratory manager at SNMH.
Sierra Nevada hospital's parent, Catholic Healthcare Wast, plans to combat staph with stricter cleansing procedures and checks of all Intensive Care Unit patients for the staph bacteria, Witthaus said. He called it a "smart, forward-thinking kind of a move, because it's not going to get any better."
Staph bacteria usually are harmless, and about one-third of all Americans carry it on their nose and skin, according to the Mayo Clinic. But staph can cause mild skin infections in healthy people, who can also spread it even if they don't get sick.
Experts also are worried because the community-acquired staph will cause more problems with people most vulnerable to it, including the young who don't have fully developed immune systems and people whose immunity is damaged, such as HIV patients. These people and others who have wounds or are in health care can develop serious skin infections or pneumonia, which sometimes can be fatal.
Staph infections often start out looking like small red bumps that can appear to be pimples, spider bites or boils, according to the Mayo Clinic. But they can burrow into the body and cause infections in bones, wounds, lungs, the heart valves, joints and the bloodstream.
Concerns also are being expressed about long-term care facilities and hospitals harboring the community-acquired strain and passing it on within and outside of hospitals.
About 94,000 Americans have the community-received staph, the American Medical Association estimated in its recent report. The figure was alarming, because annual deaths tied to superbugs could exceed those from AIDS.
Procedures have been in place for years at Sierra Nevada to stop the spread of hospital-acquired and community-acquired staph infections, according to Allan Finlay, the hospital's infection control practitioner.
When staph does show up, it's most often the community-acquired type, Finlay said. The finding, coupled with national concern about the community-acquired strain, is prompting Catholic Healthcare West to revamp its staph policy.
Starting Nov. 1, a pilot program will begin where all ICU patients will be checked for hospital-acquired and community-acquired staph, Finlay said.
"We'll probably do it throughout the hospital eventually," Finlay said. "This is a complex program, and we want to protect the ICU patients first because they're most at risk."
If a patient is found to have staph, they will be put in strict isolation, Finlay said. The policy already is in place. Now, however, people in contact with them will be issued sanitary gloves and gowns that will be disposed of when they leave the room "so we don't carry the staph to the next person," Finlay said.
The hospital will also do a more thorough job of cleansing rooms that staph-infected patients have occupied, Finlay said. Routine checks will be performed after cleanings to see if they meet muster.
Again, the hospital cleans the rooms thoroughly now, but a lengthy checklist will be introduced "so that we're more disciplined and to not miss anything," Finlay said.
The last part of the new plan is the easiest and perhaps the most important - a stringent hand-cleaning program throughout the hospital.
"We've been doing that for years" with doctors and staff, Finlay said.
Soon, the hospital will include patients and visitors in the hand-washing program, because they could have community-acquired staph, creating a weak link in the prevention chain.
The program will include compliance measurement, "so we'll have the data and statistics to work from" for improvement, Finlay said.
"You see those alcohol wipes and hand sanitizers all over now, just like in the hospital," Finlay said. People should avail themselves in order to protect each other from staff infections and many other bugs, Finlay said.
By Carol M. Ostrom
Seattle Times health reporter
ERIKA SCHULTZ / THE SEATTLE TIMES
Anna DeBord, 1, is back home after spending five nights in a hospital with the superbug.
Instead of going to her first birthday party, little Anna DeBord spent the weekend in the hospital with a superbug.
Anna had methicillin-resistant Staphylococcus aureus, or MRSA, a pathogen that has learned to thrive even when treated with the most common antibiotics. At Children's Hospital & Regional Medical Center, doctors gave Anna more-powerful antibiotics and performed surgery on her skin infection.
But her battle with MRSA at Children's won't be tallied by public-health officials or show up on reports tracking infectious diseases.
Unlike mumps or measles, MRSA cases need not be reported to public-health authorities in this state, even though health officials say they've been aware for years of the growing threat. A study published Wednesday in the Journal of the American Medical Association estimates that the most severe infections caused by this bug kill more than 18,000 Americans a year — more than die of AIDS.
The numbers — much larger than previously believed — set off a round of finger-pointing and blame-placing.
Why aren't all hospitals screening incoming patients, as they do in other countries, and isolating and treating those carrying the bug so it doesn't spread? Why don't lawmakers require hospitals — and perhaps schools, nursing homes and prisons — to report cases to public-health agencies so they can help control it? What has the nation's top disease-control agency, the Atlanta-based Centers for Disease Control and Prevention (CDC), been doing while the Staphylococcus aureus bug has grown so resistant to antibiotics?
"It's inertia," charges infection-control crusader Betsy McCaughey, chairwoman of the New York-based Committee to Reduce Infection Deaths. "For many years, it was assumed that infection was the inevitable risk you faced when you went into the hospital. Now, the evidence is compelling that as many as 90 percent of these infections are preventable through cleaning and screening."
McCaughey, a former lieutenant governor of New York state, says "the CDC's lax guidelines and failure to adequately count the number of hospital infections are largely to blame for this problem. They have given hospitals an excuse to do too little."
The CDC disputes that, saying it asks hospitals to document that they're reducing the rate of MRSA infections. But some activists say that gives hospitals too little public accountability.
Lisa McGiffert, director of Consumers Union's Stop Hospital Infections campaign, argues that MRSA can't be stopped unless it's tracked.
"Some people say, 'We know it's a problem; we don't have to count,' " she says. "But we've been kind of denying it is a problem. Denial is a dangerous thing when it comes to antibiotic resistance," because these bugs are so dangerous. "You cannot solve a problem until you're aware of the extent of the problem."
A hospital-reporting law passed by the Legislature earlier this year does not target MRSA. Rep. Tom Campbell, R-Roy, says he's planning to sponsor a bill in the next session requiring specific reporting of MRSA not only by hospitals but by nursing homes and other facilities.
For now, the only numbers come from voluntary efforts. In Pierce County, a years-long tracking of MRSA cases, spurred by a core group of hospital-infection specialists, public-health officials and local health providers, has produced startling results.
"Pierce County is leading the nation" in tracking, says Marcia Patrick, director of infection prevention and control for the MultiCare Health System. "We've got stuff that nobody else has, that other places are just getting caught up with."
Staph is a common bug, often living in people's noses or on shower benches, bed rails or lab coats. Over the years, because of what experts say is overuse of antibiotics in people and animals, the bug has grown increasingly resistant to common antibiotics.
"We recognized a long time ago that MRSA was going to be a really hot problem," Patrick says. "If you're not doing surveillance, how do you know?"
As a result of the voluntary reports by Pierce County hospital systems, Patrick says, "we have data that most counties have no clue about."
What that data shows is "very alarming," Patrick says: Staph is becoming increasingly antibiotic-resistant, and the resistant version is much more common.
The data have pushed some providers, such as MultiCare, which operates Tacoma General Hospital, to start screening new patients for MRSA.
The efforts, along with isolating patients with MRSA and "major work on improving hand hygiene," have helped MultiCare decrease rates of MRSA despite growing numbers overall, she says.
Experiments in this country and practices in others have shown that vigorous screening of incoming patients and other patient-safety measures can drastically reduce MRSA infections in the hospital.
But the CDC's MRSA expert, Dr. John Jernigan, said the CDC is providing demanding guidance that is geared toward reducing MRSA rates. "Isn't that what we want?" he asks.
Although many blame hospitals for refusing to track MRSA infections, Carol Wagner, vice president for patient safety for the Washington State Hospital Association, says her organization has encouraged tracking of multi-drug-resistant organisms, including MRSA. But she adds: "It is not beneficial to track only in hospitals; it needs to be communitywide."
For many looking at this problem, the question is whether money spent tracking and reporting could be better spent on prevention.
"Is the goal to count, or is the goal to reduce infections?" asks Jude Van Buren, an epidemiologist with the Washington State Department of Health. "The health-care dollar never really gets bigger — you take from something to do something else."
Public-health experts already know MRSA is a problem, Van Buren says. Getting more numbers "is not really going to give us any more information," she says.
One-year-old Anna DeBord is blissfully unaware of all the debate. She came home from the hospital Wednesday and seems fine, said her mother, Liz DeBord.
Now, Liz is spraying Anna's room with Lysol and washing all her sheets, she said. "We still have no idea, absolutely no idea, how she got it."
Carol M. Ostrom: 206-464-2249 or firstname.lastname@example.org
October 18, 2007
School districts in at least six states have reported students infected with Methicillin-resistant Staphylococcus aureus. Three youths have died as a result of the infections.
Ashton Bonds, 17, of Bedford, Va., died Monday as a result of the infection. Boscawen Elementary preschooler Catherine Bentley of Salisbury, N.H., and Shae Kiernan, 11, of Vancleave, Miss. both succumbed to the infection last week.
School officials at one North Carolina high school said Thursday at least six football players are infected with MRSA (MUR'-suh). And in West Virginia, at least seven students at three different schools have been diagnosed with it. Two teens in Connecticut have also have the infection.
School officials in upstate New York, Connecticut and New Hampshire have sent letters home to parents informing them of recent cases. Meanwhile cases have prompted schools in Indiana, Virginia and West Virginia to sanitize facilities, particularly locker rooms and gyms where the germs are most easily spread.
The concern is because MRSA doesn't respond to penicillin and other antibiotics. It can be spread by skin-to-skin contact or by sharing an item used by an infected person, particularly one with a cut or abrasion. A number of the cases have involved student athletes.
The Centers for Disease Control and Prevention reported this week that MRSA infections are a major public health problem and more widespread than previously thought. A government study out this week said more than 90,000 Americans could get the "superbug" each year.
This was underscored in a stunning report by CDC researchers published in the Journal of the American Medical Association that says MRSA infections ultimately could kill more people annually than AIDS. The report says the deadly strain killed nearly 19,000 Americans in 2005 and suggests such infections may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens.
In recent years, so-called superbug staph infections have been spreading through schools, hospitals, prisons and athletic facilities, CDC officials said.
The bacteria often is carried on the skin and in the noses of healthy people and can be spread by skin-to-skin contact or sharing an item used by an infected person, particularly one with an open wound.
"Essentially, what has happened here is that MRSA was, at one time, pretty much confined to patients in hospitals, and these were patients that were seriously ill," said Dr. Pascal James Imperato, the former commissioner of public health for New York City. "Now we know, there’s also a community-acquired strain of MRSA. That doesn’t mean that it hasn’t always existed. It’s just that now, we have become knowledgeable about it."
The MRSA strain is believed to have evolved through several biological mechanisms, including the overuse of antibiotics, said Imperato, chairman of the Department of Preventive Medicine and community health director of the Master of Public Health program at SUNY Downstate Medical Center.
All 21 school buildings in Bedford County, Va., were being scrubbed and sanitized Wednesday following the death of Bonds.
The schools, all in Bedford County, Va., were closed after students there launched a protest over unsanitary conditions Monday, using text messages and social networking sites.
The students took Bedford County Schools Superintendent James Blevins on a tour Tuesday of Staunton River High School to show him how unclean it was, in particular the
Michael J. Martin, superintendent of schools for SAU 46, which includes Boscawen Elementary, told the Union Leader that once they were advised of Bentley’s illness, the district worked closely with the state department of health to make sure students were not at risk.
"Initially they said there was no reason to be concerned. Then we heard about the report of the death in Virginia, so we contacted the department of health again. They reassured us there was no change," Martin said.
Kiernan, 11, was buried on Monday. The funeral took place in Kiernan’s hometown of Vancleave, a small community in Jackson County, Miss.
In the majority of cases, children are at no higher risk for the infection than the general population, Imperato said. But the bacteria do thrive in locker rooms and gymnasiums, he said.
"This scenario sets up the perfect scenario for the organism to invade the skin," he said. "In this setting, you have sweat and good exposure to skin. With youths who play football or lacrosse, the skin might also be cut or scraped, making the skin more vulnerable."
The best method of prevention is staying clean. Frequent hand-washing is a good way to prevent the spread of MRSA. And youths, as well as adults, who participate in sports or any type of physical fitness program should shower immediately after.
"Good old-fashioned cleanliness serves as the best barrier to these organisms," he said. "Just washing with ordinary soap and water is enough to remove any of the organisms that may have colonized in the skin."
About one-quarter of invasive cases of staff infection involve patients in hospitals and more than half are related to the health care industry, occurring in people who recently had surgery or were on kidney dialysis, according to the CDC study.
Officials still do not know how the infections were spread that killed the three youths. Ashton Bonds played football at one time, which would have required him to use the school’s locker room and athletic facilities, but school officials said he was not playing this year.
The Associated Press contributed to this story
What is community-associated MRSA (CA-MRSA)?
Staph and MRSA can also cause illness in persons outside of hospitals and healthcare facilities. MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are know as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.
How common are staph and MRSA infections?
Staph bacteria are one of the most common causes of skin infection in the United States and are a common cause of pneumonia, surgical wound infections, and bloodstream infections. The majority of MRSA infections occur among patients in hospitals or other healthcare settings; however, it is becoming more common in the community setting. Data from a prospective study in 2003, suggests that 12% of clinical MRSA infections are community-associated, but this varies by geographic region and population.
What does a staph or MRSA infection look like?
Staph bacteria, including MRSA, can cause skin infections that may look like a pimple or boil and can be red, swollen, painful, or have pus or other drainage. More serious infections may cause pneumonia, bloodstream infections, or surgical wound infections.
Are certain people at increased risk for community-associated staph or MRSA infections?
CDC has investigated clusters of CA-MRSA skin infections among athletes, military recruits, children, Pacific Islanders, Alaskan Natives, Native Americans, men who have sex with men, and prisoners.
Factors that have been associated with the spread of MRSA skin infections include: close skin-to-skin contact, openings in the skin such as cuts or abrasions, contaminated items and surfaces, crowded living conditions, and poor hygiene.
How can I prevent staph or MRSA skin infections?
Practice good hygiene:
1. Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer.
2. Keep cuts and scrapes clean and covered with a bandage until healed.
3. Avoid contact with other people’s wounds or bandages.
4. Avoid sharing personal items such as towels or razors.
Are people who are positive for the human immune deficiency virus (HIV) at increased risk for MRSA? Should they be taking special precautions?
People with weakened immune systems, which include some patients with HIV infection, may be at risk for more severe illness if they get infected with MRSA. People with HIV should follow the same prevention measures as those without HIV to prevent staph infections, including practice good hygiene, cover wounds (e.g., cuts or abrasions) with clean dry bandages, avoid sharing personal items such as towels and razors, and contact their doctor if they think they have an infection.
Can I get a staph or MRSA infection at my health club?
In the outbreaks of MRSA, the environment has not played a significant role in the transmission of MRSA. MRSA is transmitted most frequently by direct skin-to-skin contact. You can protect yourself from infections by practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using an alcohol-based hand rub and showering after working out); covering any open skin area such as abrasions or cuts with a clean dry bandage; avoiding sharing personal items such as towels or razors; using a barrier (e.g., clothing or a towel) between your skin and shared equipment; and wiping surfaces of equipment before and after use.
What should I do if I think I have a staph or MRSA infection?
See your healthcare provider.
Are staph and MRSA infections treatable?
Yes. Most staph and MRSA infections are treatable with antibiotics. If you are given an antibiotic, take all of the doses, even if the infection is getting better, unless your doctor tells you to stop taking it. Do not share antibiotics with other people or save unfinished antibiotics to use at another time.
However, many staph skin infections may be treated by draining the abscess or boil and may not require antibiotics. Drainage of skin boils or abscesses should only be done by a healthcare provider.
If after visiting your healthcare provider the infection is not getting better after a few days, contact them again. If other people you know or live with get the same infection tell them to go to their healthcare provider.
Is it possible that my staph or MRSA skin infection will come back after it is cured?
Yes. It is possible to have a staph or MRSA skin infection come back (recur) after it is cured. To prevent this from happening, follow your healthcare provider’s directions while you have the infection, and follow the prevention steps after the infection is gone.
If I have a staph, or MRSA skin infection, what can I do to prevent others from getting infected?
You can prevent spreading staph or MRSA skin infections to others by following these steps:
1. Cover your wound. Keep wounds that are draining or have pus covered with clean, dry bandages. Follow your healthcare provider’s instructions on proper care of the wound. Pus from infected wounds can contain staph and MRSA, so keeping the infection covered will help prevent the spread to others. Bandages or tape can be discarded with the regular trash.
2. Clean your hands. You, your family, and others in close contact should wash their hands frequently with soap and warm water or use an alcohol-based hand sanitizer, especially after changing the bandage or touching the infected wound.
3. Do not share personal items. Avoid sharing personal items such as towels, washcloths, razors, clothing, or uniforms that may have had contact with the infected wound or bandage. Wash sheets, towels, and clothes that become soiled with water and laundry detergent. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.
4. Talk to your doctor. Tell any healthcare providers who treat you that you have or had a staph or MRSA skin infection.
By Rob Stein
Washington Post Staff Writer
Wednesday, October 17, 2007
A dangerous germ that has been spreading around the country causes more life-threatening infections than public health authorities had thought and is killing more people in the United States each year than the AIDS virus, federal health officials reported yesterday.
The microbe, a strain of a once innocuous staph bacterium that has become invulnerable to first-line antibiotics, is responsible for more than 94,000 serious infections and nearly 19,000 deaths each year, the Centers for Disease Control and Prevention calculated.
Although mounting evidence shows that the infection is becoming more common, the estimate published today in the Journal of the American Medical Association is the first national assessment of the toll from the insidious pathogen, officials said.
"This is a significant public health problem. We should be very worried," said Scott K. Fridkin, a medical epidemiologist at the CDC.
Other researchers noted that the estimate includes only the most serious infections caused by the germ, known as methicillin-resistant S taphylococcus au reus (MRSA).
"It's really just the tip of the iceberg," said Elizabeth A. Bancroft, a medical epidemiologist at the Los Angeles County Department of Public Health who wrote an editorial in JAMA accompanying the new studies. "It is astounding."
MRSA is a strain of the ubiquitous bacterium that usually causes staph infections that are easily treated with common, or first-line, antibiotics in the penicillin family, such as methicillin and amoxicillin. Resistant strains of the organism, however, have been increasingly turning up in hospitals and in small outbreaks outside of heath-care settings, such as among athletes, prison inmates and children.
On Monday, Ashton Bonds, 17, of Lynch Station, Va., succumbed to MRSA, prompting officials to shut down 21 Bedford County schools today for cleaning to prevent further infections. The infection had spread to Bonds's kidneys, liver, lungs and the muscle around his heart.
The MRSA estimate is being published with a report that a strain of another bacterium, which causes ear infections in children, has become impervious to every approved antibiotic for youngsters.
"Taken together, what these two papers show is that we're increasingly facing antibiotic-resistant forms of these very common organisms," Bancroft said.
The reports underscore the need to develop new antibiotics and curb the unnecessary use of those already available, experts said. They should also alert doctors to be on the lookout for antibiotic-resistant infections so patients can be treated with the few remaining effective drugs before they develop serious complications, experts said.
MRSA, which is spread by casual contact, rapidly turns minor abscesses and other skin infections into serious health problems, including painful, disfiguring "necrotizing" abscesses that eat away tissue. The infections can often still be treated by lancing and draining sores and quickly administering other antibiotics, such as bactrim. But in some cases the microbe gets into the lungs, causing unusually serious pneumonia, or spreads into bone, vital organs and the bloodstream, triggering life-threatening complications. Those patients must be hospitalized and given intensive care, including intravenous antibiotics such as vancomycin.
In the new study, Fridkin and his colleagues analyzed data collected in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon and Tennessee, identifying 5,287 cases of invasive MRSA infection and 988 deaths in 2005. The researchers calculated that MRSA was striking 31.8 out of every 100,000 Americans, which translates to 94,360 cases and 18,650 deaths nationwide. In comparison, complications from the AIDS virus killed about 12,500 Americans in 2005.
"This indicates these life-threatening MRSA infections are much more common than we had thought," Fridkin said.
In fact, the estimate makes MRSA much more common than flesh-eating strep infections, bacterial pneumonia and meningitis combined, Bancroft noted.
"These are some of the most dreaded invasive bacterial diseases out there," she said. "This is clearly a very big deal."
The infection is most common among African Americans and the elderly, but also commonly strikes very young children.
"We see these cases all the time," said Robert S. Daum, a pediatric infectious-disease specialist at the University of Chicago. "In the last five weeks, I've taken care of five children who were sick enough to be hospitalized and require intensive care."
Studies have shown that hospitals could do more to improve standard hygiene to reduce the spread of the infection. Individuals can reduce their risk through common-sense measures, such as frequent hand-washing.
In the second paper, Michael E. Pichichero and Janet R. Casey of the University of Rochester in New York documented the emergence of an antibiotic-resistant strain of another bacterium known as Streptococcus pneumoniae, which causes common ear infections. Although all 11 children identified in the Rochester area with the microbe so far were successfully treated, five required an antibiotic approved only for adults, and one child was left with permanent hearing loss.
The researchers attributed the emergence of the strain to a combination of the overuse of antibiotics and the introduction of a vaccine that protects against the infection.
"The use of the vaccine created an ecological vacuum, and that combined with excessive use of antibiotics to create this new superbug," Pichichero said.
by Sean Kenniff/CBS News
A new study finds an infection found in hospitals may be more common and deadly than first thought. The Superbug is dangerous because most antibiotics can't kill it.
At Long Island College Hospital nurses take no chances when a patient gets the super staph infection MRSA. Nurse Eileen Abruzzo says, "We place the patient on isolation immediately." Isolation is a private room with dedicated equipment. Isolation is necessary because MRSA can spread quickly. It often starts on the skin but can lead to a deadly blood infection and most medicines won't stop it.
Dr. Daveed Frazier explains how strong it is. "You can hit it with this antibiotic and that antibiotic will not kill this infection." According to a new study, MRSA is more common and deadlier that first thought. Researchers estimate that in one year there were more than 94,000 infections resulting in an astounding 18, 600 deaths.
"That's extraordinarily high," says Dr. Frazier. "If you say there's a 20 percent death rate, that's shocking, that's almost unheard of."
The death rate is so high because MRSA usually attacks sick and elderly patients already susceptible to infection. And while it's most common in hospitals, that's no the only place you'll find it.
A rash of MRSA cases has shown up among student athletes. On Tuesday a Virginia High School Student died from MRSA causing local officials to shut down 21 schools for cleaning. The bug seems to spread in locker rooms.
Dr. Frazier has this advice. "Don't share razors. Don't share towels. Don't share soap with other individuals." MRSA can be treated with powerful intravenous drugs, but prevention is the best practice. Lots of hand washing is the most effective way to stop the spread of this deadly bug.
By LINDSEY TANNER, AP Medical Writer
Wednesday, October 17, 2007
Chicago (AP) --
More than 90,000 Americans get potentially deadly infections each year from a drug-resistant staph "superbug," the government reported in its first overall estimate of invasive disease caused by the germ.
Deaths tied to these infections may exceed those caused by AIDS, said one public health expert commenting on the new study. Tuesdays report shows just how far one form of the staph germ has spread beyond its traditional hospital setting.
The overall incidence rate was about 32 invasive infections per 100,000 people. That's an "astounding" figure, said an editorial in Wednesday's Journal of the American Medical Association, which published the study.
Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections — those that enter the bloodstream or destroy flesh and can turn deadly.
Researchers found that only about one-quarter involved hospitalized patients. However, more than half were in the health care system — people who had recently had surgery or were on kidney dialysis, for example. Open wounds and exposure to medical equipment are major ways the bug spreads.
In recent years, the resistant germ has become more common in hospitals and it has been spreading through prisons, gyms and locker rooms, and in poor urban neighborhoods.
The new study offers the broadest look yet at the pervasiveness of the most severe infections caused by the bug, called methicillin-resistant Staphylococcus aureus, or MRSA. These bacteria can be carried by healthy people, living on their skin or in their noses.
An invasive form of the disease is being blamed for the death Monday of a 17-year-old Virginia high school senior. Doctors said the germ had spread to his kidneys, liver, lungs and muscles around his heart.
The researchers' estimates are extrapolated from 2005 surveillance data from nine mostly urban regions considered representative of the country. There were 5,287 invasive infections reported that year in people living in those regions, which would translate to an estimated 94,360 cases nationally, the researchers said.
Most cases were life-threatening bloodstream infections. However, about 10 percent involved so-called flesh-eating disease, according to the study led by researchers at the federal Centers for Disease Control and Prevention.
There were 988 reported deaths among infected people in the study, for a rate of 6.3 per 100,000. That would translate to 18,650 deaths annually, although the researchers don't know if MRSA was the cause in all cases.
If these deaths all were related to staph infections, the total would exceed other better-known causes of death including AIDS — which killed an estimated 17,011 Americans in 2005 — said Dr. Elizabeth Bancroft of the Los Angeles County Health Department, the editorial author.
The results underscore the need for better prevention measures. That includes curbing the overuse of antibiotics and improving hand-washing and other hygiene procedures among hospital workers, said the CDC's Dr. Scott Fridkin, a study co-author.
Some hospitals have drastically cut infections by first isolating new patients until they are screened for MRSA.
The bacteria don't respond to penicillin-related antibiotics once commonly used to treat them, partly because of overuse. They can be treated with other drugs but health officials worry that their overuse could cause the germ to become resistant to those, too.
A survey earlier this year suggested that MRSA infections, including noninvasive mild forms, affect 46 out of every 1,000 U.S. hospital and nursing home patients — or as many as 5 percent. These patients are vulnerable because of open wounds and invasive medical equipment that can help the germ spread.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University, said the JAMA study emphasizes the broad scope of the drug-resistant staph "epidemic," and highlights the need for a vaccine, which he called "the holy grail of staphylococcal research."
The regions studied were: the Atlanta metropolitan area; Baltimore, Connecticut; Davidson County, Tenn.; the Denver metropolitan area; Monroe County, NY; the Portland, Ore. metropolitan area; Ramsey County, Minn.; and the San Francisco metropolitan area.
BEIJING, Oct. 17 (Xinhuanet) -- A total of 18,650 died in the United States in 2005 after being infected with a virulent drug-resistant bacterium that can be carried by healthy people, living on their skin or in their noses, said The Journal of the American Medical Association Wednesday.
Methicillin-resistant staphylococcus aureus (MRSA) was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005, researchers from the Centers for Disease Control and Prevention (CDC) reported in the journal.
MRSA is a leading cause of potentially life-threatening bloodstream infections, surgical site infections, and pneumonia, and also known as a superbug because it is resistant to so many antibiotics.
The drug-resistant superbug, which spreads through open wounds and exposure to medical equipment, has usually been found in people being treated in hospitals. But the CDC researchers who carried out the study said only about one-quarter of the invasive infections were hospital patients.
However, more than half of the people who developed the infections were in the health care system -- people who had recently undergone surgery or were on kidney dialysis, for example.
"This confirms in a very rigorous way that this is a huge health problem," said Dr. John A. Jernigan, the deputy chief of prevention and response in the CDC's Division of Healthcare Quality Promotion. "And it drives home that what we do in health care will have a lot to do with how we control it."
In order to curb the spread of MRSA, the CDC suggested cutting back on the use of antibiotics, which can increase the superbug's resistance, and improving hand washing and other hygiene procedures among hospital and other health-care workers.
By comparison, AIDS killed an estimated 17,011 Americans in 2005.