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Staph cases soar

Wed., June 6, 2007

A serious spike in cases of dangerous, drug-resistant bacteria has doctors at some Spokane health clinics treating first and testing later to stanch a “tidal wave” of potentially deadly infection.

More than half the people showing up at Community Health Association of Spokane clinics with what they think are spider bites, small cuts and other skin lesions that won’t heal are testing positive for MRSA – methicillin resistant staphylococcus aureus – said Dr. David Bare, CHAS medical director.

“It’s very worrisome; there are very few antibiotics that we can use,” said Bare, who simply has begun giving alternative drugs that have proven more likely to work.

That echoes a troubling regional and national rise in a highly contagious health threat that can lead to weeping wounds, serious infections and death, especially among the poor and those most likely to delay treatment.

Essentially, the staph bugs are becoming more difficult to kill with drugs, leaving them virtually free to ravage people through infection and illness, explained Roy Almeida, director of epidemiology at Sacred Heart Medical Center.

“You’ve heard of that flesh-eating bacteria stuff? It’s not quite that bad, but it can be virulent,” Almeida said.

“This is one of our top two community issues right now in terms of infection control,” he added.

About half of all staph tests analyzed last year by Spokane’s Pathology Associates Medical Laboratories showed resistance to methicillin and other most commonly used antibiotics, said Ann Robinson, director for microbiology and virology at Sacred Heart and PAML.

That’s about the same as the rest of Washington, where the percentage of MRSA detected in staph tests has more than doubled since 1999, said Dr. Tim Dellit, medical director for infection control at Harborview Medical Center in Seattle.

More worrisome, however, is where the infections originate. Once acquired mostly in hospitals and other care centers, MRSA is now showing up most often in people with little or no medical contact.

“It’s almost like from an infection control standard, there’s this tidal wave of MRSA coming in from the community,” said Dellit.

Even more troubling, the most common strain of community-acquired MRSA is far more toxic than the hospital-acquired variety, said a national expert scheduled to discuss the subject in Spokane today.

“The one that you don’t want to get is community-acquired MRSA because it will kill you,” said Gary V. Doern, professor of clinical microbiology at the University of Iowa Health Care pathology department.

Doern, whose visit is sponsored by Pfizer, the pharmaceutical giant, said Spokane is just now beginning to experience the effects of a national and global crisis of the drug-resistant bacteria.

“For the last 10 years, we’ve seen this spiral upward,” Doern said, noting that MRSA was almost unheard of until 2000.

Doern and other scientists worry that MRSA infections will soon eclipse anyone’s capacity to cope with them.

“I’m not sure it’s a soluble problem,” he said, noting that MRSA may parallel resistance that followed the discovery and widespread use of penicillin in the 1940s.

“What we ought to do is to turn our attention less to issues of identifying MRSA carriers and devote more attention to strategies for prevention,” he said.

That could mean wider community education about basic hygiene, from hand-washing to the use of alcohol-based cleansing gels. MRSA is spread by direct contact, including transmission at public places like health clubs and schools, through use of shared equipment or towels, for instance.

You don’t have to have an open wound to develop a MRSA infection, which can progress quickly to a serious condition. It often occurs in people without access to hygiene or those who postpone medical treatment, hoping infection will go away on its own.

Because MRSA is not a reportable condition in Washington or across the country, no one knows how many infections occur. A state sentinel system that monitored the problem was stopped in 2004, when funding from the Centers for Disease Control and Prevention ran out.

“There are no resources” for tracking MRSA, said Jo Hofmann, Washington state epidemiologist for communicable disease. “It’s a problem not just here, but all over the country.”

A MRSA infection can start as a red, pimplelike lesion that grows and spreads, Hofmann said. The infection worsens and then fails to respond to the most common antibiotics that doctors use.

“By then you need a surgeon to cut into it and cut the goo out,” she said.

In severe cases of invasive MRSA, the infection spreads to the bloodstream, causing often-fatal sepsis, or to the lungs, causing pneumonia that destroys the tissue.

The potential for the most dangerous MRSA infections worsens in hospital and long-term care settings, where vulnerable people are at the mercy of the growing incidence of community-acquired bacteria, Doern said.

“You’ve got a really bad bug in terms of virulence in the worst possible place, a hospital,” he said.

Some studies suggest the best way to prevent the spread of MRSA in hospitals is through aggressive precautions that include isolating patients and requiring gowns, gloves and masks for everyone who comes in contact with them.

In the meantime, some scientists who’ve watched the problem become a global health crisis during the past decade fret that they’ve waited too long to push for a solution.

“Most people are not ready to give in yet,” said Dellit, the infectious disease specialist at Harborview. “But there is a point when you wonder: ‘Is the horse already out of the barn?’ ”


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