Drug-Resistant Staph May Get Nastier

Experts Call for Increased Efforts to Halt MRSA

Medically Reviewed by Louise Chang, MD on August 31, 2006
From the WebMD Archives

Aug. 31, 2006 - It may already be too late to bring the rapidly spreading drug-resistant staph bug known as MRSA under control.

That's the gloomy warning from a review article and editorial -- both by leading infectious disease experts -- in the Sept. 2 issue of The Lancet.

MRSA is methicillin-resistant Staphylococcus aureus. The bacteria are resistant to several important antibiotics. At least for now, some other antibiotic drugs still kill it.

But MRSA already is the most common skin infection in U.S. cities. Worldwide, anywhere from 2 million to 53 million people are carriers.

Staph in general, and MRSA strains in particular, are very tricky bacteria. It's easy for them to gain drug resistance. Staph bugs often infect the skin, but can infect other areas of the body as well.

The bug was first seen in hospitals. But new MRSA strains have arisen in the general community and, while on the loose, have become more easily transmissible -- and, in some places, more virulent.

Now these strains are going into hospitals, where they wreak havoc on vulnerable people -- and even on health care workers.

"The MRSA situation in hospitals, which still remains out of control in many countries, could potentially become explosive," warn Hajo Grundmann, MD, of the Netherlands National Institute for Public Health and the Environment, and colleagues, in The Lancet article.

An editorial accompanying the Grundmann article offers little solace.

""If we are going to act, we should do it now, before what is currently sporadic illness ... becomes epidemic, and commonly used antibiotics become useless," urges microbiologist Ian M. Gould, PhD, of Aberdeen Royal Infirmary, U.K.

Brief History of MRSA

Staph has been acquiring drug resistance ever since antibiotics were invented. In the 1950s, a penicillin-resistant staph bug called the 80/81 strain devastated hospital patients worldwide.

Normal staph causes potentially deadly blood infections in less than 3% of people carrying it. The 80/81 strain caused blood infections in 30% of carriers treated.

The invention of the antibiotic methicillin ended the reign of the 80/81 bug. But methicillin-resistant staph soon appeared.

That wasn't such a big surprise. The shock was that a change in a single genetic element gives methicillin-resistant staph -- MRSA -- resistance to multiple antibiotics.

Over time, MRSA has picked up more resistance genes. That was bad. But it was thought to happen only in hospitals, where there was more exposure to different antibiotics.

In the 1990s, however, it became clear MRSA strains were evolving outside hospitals. The bug appeared in communities -- such as indigenous Australians -- that had had little access to health care.

Other groups affected have been those likely to have greater levels of physical contact, such as incarcerated people, military personnel, and athletes.

These "community" varieties tend to have a nasty bit of genetic material called Panton-Valentine leukocidin, or PVL. Community MRSA causes skin and soft tissue infections -- giving such bugs the potential to become so-called "flesh-eating bacteria."

Community MRSA has caused this and other dangerous infections, including internal organ infections, joint infections, toxic shock syndrome, and severe pneumoniapneumonia.

Today, MRSA is the most common drug-resistant bug in North America, Europe, North Africa, the Middle East, and East Asia.

Fighting MRSA

Scandinavian nations, which don't yet have a large MRSA problem, are making a major effort to keep it out of their hospitals. They're screening new patients, and isolating any carriers they find.

Gould argues that MRSA efforts should be taken into communities. He urges tracing the contacts of infected people, wiping out MRSA even in people with no symptoms of infection, and decontaminating the households of MRSA carriers.

Grundmann and colleagues, too, urge action. They worry that if community MRSA isn't stopped outside hospital doors, it will cause dangerous infections not only in ill patients, but also in relatively healthy patients and health care workers.

And they worry that MRSA will become even more virulent. After all, they note, the devastating 80/81 bug of the 1950s is closely related to the Southwest Pacific clone of MRSA.

What can you do? Here's the CDC's advice on how to fight MRSA:

  • If you have an infected wound or pus-filled boil, see your doctor.
  • Carefully follow your doctor's advice on how to care for your wound.
  • Cover skin infections -- especially those with pus -- with clean, dry bandages. Pus from skin infections and infected wounds spread staph to other people.
  • If you have a skin infection or infected wound, tell your family and other close contacts to wash their hands often with soap and warm water. Remember to wash properly: Scrub your hands and fingers while saying the alphabet slowly. Don't stop until you get to Z.
  • Don't share personal items -- including towels, washcloths, razors, or clothing -- that may have come into contact with an infection. Wash contaminated bed linens, towels, and clothing in hot water and laundry detergent. Dry these items in a hot dryer, not on the clothesline.
  • If you have MRSA, tell any doctor who treats you that you have an antibiotic-resistant infection.
  • If your doctor gives you antibiotics for a skin infection, be alert for signs of treatment failure. If you get any new boils, sores, or new infections, call your doctor. If your fever gets worse -- or if you get a new fever -- call your doctor. If your infection doesn't look a little better after three or four days, call your doctor. Remember to take all your medicine as prescribed, even if you seem to be better.

Show Sources

SOURCES: Grundmann, H. The Lancet, Sept. 2, 2006; vol 368: pp 874-885. Gould, I. The Lancet, Sept. 2, 2006; vol 368: pp 824-826. CDC web site.
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