Staph infection 'superbug' strikes more often

Thelma Horton survived triple-bypass surgery this summer and thought she’d lived through the worst of it. Then her chest exploded.

The 72-year-old Mesa woman had contracted a virulent, drug-resistant staph infection that’s only now beginning to heal.

“It just blew. It just gushed. It soaked towels and washcloths,” Horton said of the gaping hole where her incision had been.

But she was lucky. Her infection hadn’t spread into her blood stream and doctors at Banner Desert Medical Center were able to remove the damaged tissue and stop the bacteria in its tracks with antibiotics she still takes intravenously.

A new study shows the potentially lethal version of the “superbug” is more common than previously thought, infecting an estimated 94,000 people a year and killing 18,650 of them, exceeding the death rate for HIV/AIDS.

The report, in today’s Journal of the American Medical Association, also shows that more cases are being acquired in the community, striking otherwise healthy people.

The results underscore the need for better prevention and monitoring of the stubborn bug, which doesn’t respond to antibiotics that once had been effective.

While drug-resistant staph — known as MRSA, or methicillin-resistant staphylococcus aureus — has long been associated with hospitals and nursing homes, it’s now the most common skin infection seen in hospital emergency rooms.

“When kids come in now that have a little impetigo or scratch that got infected, half the time it’s MRSA that’s in there,” said Dr. Steven Oscherwitz, medical director for infection control at Banner Desert.

“We used to give them a pill and they’d get better. You can’t do that anymore.”

The highly contagious bacteria slips into open wounds and can look like a spider bite or pimple at first. It travels quickly among family members.

“It’s pervasive, and it does run in households,” said Dr. Rustin Morse, associate director of the emergency department at Phoenix Children’s Hospital.

Morse said the common line of defense no longer works, so they’ve stepped up to new antibiotics, typically Bactrim. Time will tell how long it will take the germ to become resistant to these.

“It used to be an eye-opener when it was MRSA and now it’s routine,” Morse said.

The JAMA study is the most comprehensive look at the prevalence and sources of the bacteria, particularly the invasive variety, which enter the bloodstream and can lead to organ damage, pneumonia and septic shock.

Researchers at the Centers for Disease Control and Prevention found 5,287 invasive cases and 988 deaths in nine urban areas, and extrapolated the data to estimate 94,360 cases nationwide and 18,650 deaths.

If the projections hold true, that puts deaths from invasive drug-resistant staph infection above AIDS, as well as the combined death rates for several leading infections, including bacterial meningitis and strep.

Most invasive MRSA cases were related to a health-care setting, but nearly 60 percent of patients, such as Thelma Horton, were struck weeks or months after they had been hospitalized.

About 14 percent of the infections had no connection to a health-care facility. Ten percent were flesh-eating infections and the rest spread to the bloodstream.

A 17-year-old Virginia boy who died Monday appears to be the most recent victim of invasive MRSA, which doctors say attacked his kidneys, liver and lungs.

Maricopa County has recorded 646 cases of invasive MRSA so far this year, compared to 810 by this time last year.

“Old diseases have learned new tricks,” Dr. Elizabeth A. Bancroft of the Los Angeles Public Health Department wrote in an accompanying editorial.

“Consequently, new collaborations between the public health and medical communities are needed to identify and control antimicrobial resistance.”

Doctors and hospitals aren’t required to report the infections, so there’s no way to track it locally or determine whether it’s hospital-acquired. But county health officials and infectious disease specialists say it’s only a matter of time.

“Automated surveillance is really the wave of the future,” Oscherwitz said. “Getting hospitals to invest in that kind of technology is really the battle.”

But treating drug-resistant staph costs even more. Oscherwitz estimated that each hospital-acquired infection can cost $20,000 to $40,000 to beat.

That doesn’t even account for the human cost for even the simplest cases.

“You have to sedate the child. They require a scalpel... They’re painful. They miss school and work because of them,” Morse said. “And it’s only going to get worse.”

More than three months after her surgery, Thelma Horton is still on intravenous antibiotics and has a health-care worker come to her house every other day to dress her wound, which still stretches 5 inches long and 2 inches wide.

“The heart surgery was a snap compared to this,” Horton said. “People don’t realize how dangerous this is.”

To read the JAMA study, go to www.jama.ama-assn.org

Practice good hygiene:

-Keep your hands clean with soap and water or alcohol-based hand sanitizer.

-Keep cuts and scrapes clean and covered with bandage until healed.

-Avoid contact with other people’s wounds or bandages

-Avoid sharing personal items such as towels or razors.

To help prevent the spread of drug-resistant staph infections:

-See your doctor if you’ve got an infected wound or boil. Carefully follow advice on how to care for it.

-Cover skin infections with clean, dry bandages.

-Clean your hands regularly, and make sure your family and others in close contact do, too.

-Don’t share personal items. Wash soiled sheets, towels and clothes. Dry in a hot dryer — don’t air dry — to kill bacteria.

Source: Centers for Disease Control and Prevention

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