As germs are catching up to medicine, a new strain similar to one long found in hospitals is becoming a "problem for the healthy kid," doctors say.
By LISA GREENE
Published February 9, 2004
ST. PETERSBURG - She was just 3 months old when she came to All Children's Hospital with pneumonia.
It probably began with a minor virus and turned serious when bacteria took advantage of the baby's weakened immune system and invaded her lungs.
It was bad, but at first, it looked like any other pneumonia case - except she wasn't getting better.
When lab tests came back, Dr. Juan Dumois, infectious disease chairman at All Children's, saw why.
The baby's lungs were teeming with a strain of bacterium rapidly becoming more common in Tampa Bay, one that can't be killed by most antibiotics.
After switching to different drugs and staying three weeks in the hospital, the girl recovered.
But during the past two years, All Children's has seen its cases of infection by the bug more than double. Across the bay at Tampa General Hospital, the numbers are even higher.
"It's now out there in the community and has become a run-of-the-mill infection," Dumois said. "It's a new problem for the healthy kid."
The bug comes from a particular kind of staphylococcus aureus bacterium. Staph, one of the most common kind of skin and soft-tissue infections, usually is easily cured, but sometimes it can progress to life-threatening blood, bone or other infections.
What doctors are starting to see is staph infections that are resistant to the family of antibiotics that includes methicillin. Known as methicillin-resistant staph aureus, or MRSA, it has long been common in hospitals and nursing homes.
What worries doctors now: They're seeing patients, both children and adults, come in who have no obvious link to health care settings, who seem to have picked up MRSA infections going about their everyday lives. It's unlikely these patients would know whether they had MRSA or another kind of staph infection unless it was cultured.
Even the most minor cut can lead to a MRSA infection, said Peggy Thompson, Tampa General's director of epidemiology.
"We've seen people come in with things like bug bites, where the culture turns out to have MRSA," she said. "That's not something that ... five years ago, we would have ever considered."
Dumois is advising doctors of the problem during All Children's lecture series. At Tampa General, Dr. John Sinnott, director of the Florida Infectious Disease Institute, also is giving lectures on the topic.
Dr. Clinton Holder saw his first case of community MRSA a few months ago. Holder, infection control director at St. Anthony's Hospital, Bayfront Medical Center and Palms of Pasadena Hospital, saw his second soon after that.
"That was, to me, worrisome and perplexing," Holder said. "The second was a little more worrisome."
The first patient, who arrived with an advanced infection, died. The second, who came in with a skin abscess, recovered after a hospital stay.
Similar outbreaks are occurring throughout the country, prompting federal scientists at the Centers for Disease Control and Prevention to host a meeting on the topic last year. And a national group of scientists who track disease has called for increased study of MRSA.
"We're encouraging doctors to take diagnostic tests if they're seeing or hearing about MRSA in the community," CDC spokeswoman Nicole Coffin said.
About 120,000 U.S. residents are hospitalized each year with MRSA, but the CDC doesn't count hospital and community infections separately.
The CDC reported four children died of MRSA infections in the late 1990s in Minnesota and North Dakota. In the fall, two Houston children died of MRSA infections after their immune systems were weakened by the flu.
In some cases, outbreaks are occurring among particular groups who are in close contact, such as sports teams or jail inmates. In Pinellas County, there was an outbreak among sponge divers last year and within an addiction support group the year before that.
But what doctors are seeing now is more random and harder to link to any particular group.
"My experience is it's an even broader cross section than that," Sinnott said. "This resistant organism is establishing itself in the community."
Doctors are concerned about more than the emergence of a new strain of bacterium. After all, even drug-resistant staph often clears up if abscesses are surgically drained.
Sinnott and other doctors view MRSA as one more sign that antibiotics, medicine's best weapons against bacteria, are losing ground as more organisms develop strains that can withstand them.
Local doctors report turning to vancomycin, a powerful antibiotic that until a few years ago was known as the drug of "last resort."
"The problem is ... the threshold to use this previously reserved drug has lowered," Holder said.
In the past few years, a handful of new drugs has come onto the market as alternatives to vancomycin. And just in time: The world's first case of vancomycin-resistant staph was reported in 2002.
Other bugs have become resistant to vancomycin, and doctors worry that, as vancomycin becomes more widely used, resistance could become more common.
"We're one step ahead of the germs," Holder said. "Luckily, we are one step ahead. But barely."
Dumois said he is worried that other serious, aggressive staph infections will join the ranks of infections resistant to methicillin.
Scientists aren't sure why MRSA is on the rise. In the past, resistant germs often have gotten a toehold in hospitals and health care settings, then have seeped out into the community. But at the CDC, investigators are seeing signs that MRSA in the community is different from the typical hospital strains, Coffin said.
"When we do lab work on these particular germs, they're resistant to different antibiotics, and they're resistant to more antibiotics," she said. "That's also an indication that it's not simply leaking out."
CDC scientists are worried, she said, because MRSA is affecting young, otherwise healthy people and is becoming serious more quickly because the community infections sometimes are more invasive.
It's possible that people taking antibiotics when they don't need them or taking them incorrectly might be contributing to the problem, Coffin said.
Some of the MRSA increase also might be because of more testing, said Julia Gill, epidemiology program manager at the Pinellas County Health Department.
"As there is more awareness that there are resistant strains, more (lab) cultures are being done," she said.
