Staph bug thrives in state

In the bay area, half of a study's samples were drug resistant, showing rapid spread.

By LISA GREENE, Times Staff Writer
Published November 12, 2007

Lori Losowski, left, wheels her son, Justin Losowski, 11, near their Rome, N.Y., home. Justin contracted a serious staph infection last August after scraping a blade from his ice skate to his knee while attending a hockey camp.
	[AP photo]

ADVERTISEMENT [Getty Images] What can I do to prevent MRSA infection? Wash your hands with plain soap and water.

The drug-resistant bacteria whose deadly spread across the United States has been marked by panicky school closings and grim headlines is gaining ground across Florida.

State health investigators have tracked the bug, a form of staphylococcus bacteria known as MRSA, for the first time in a study released this year. They analyzed more than 67,000 cultures of staph infections taken by a large private lab across the state from 2003 to 2005. Almost all came from community doctors, not hospitals.

The results were startling: Drug-resistant infections zoomed from 35 percent of all infections in 2003 to 49.7 percent in 2005. The number of cultures tested more than quadrupled, from about 8,300 in 2003 to nearly 36,000 in 2005.

In the Tampa Bay area, more than half of the study's cultures were resistant. Local hospitals also report steady increases in the number of infections they see.

"This nasty little bacteria is thriving," said Cathy Ricchezza, manager of infection control at St. Joseph's Hospital.

While staph has long been one of the most common causes of skin infections, MRSA worries health officials because some antibiotics won't kill it. Once rare outside hospitals, it now has spread into the community, and a new, more aggressive strain can kill patients rapidly.

MRSA made news this fall with the deaths of a Virginia teenager and a New York City 12-year-old. A study saying that nearly 95,000 people got serious infections in 2005 added to the scare.

"We are fighting a bug that's out there, and it's a difficult one to fight," said Roger Sanderson, a state health epidemiologist and co-author of the survey published this summer.

Four years ago, Dr. Juan Dumois, infectious disease chairman at All Children's Hospital in St. Petersburg, was among the first local doctors to notice unusual MRSA infections. Patients hadn't been in hospitals or had health problems that made them more vulnerable.

Back then, patients would tell Dumois that their infection was first diagnosed as a spider bite.

That doesn't happen anymore. Instead, Dumois got a call a few weeks ago from a patient's father, upset after seeing MRSA on TV.

"He was upset that he had not been told that his child could die," Dumois said.

That child's infection was minor. But Dumois has treated more serious cases. A few children have died. Others have spent weeks in intensive care, getting IV antibiotics. Some have had to get pus drained from inside their chests or rely on a machine to help them breathe.

"We usually can't predict who's going to get sicker," he said. "That's the scary thing."

Even relatively minor infections can be painful and persistent. In July, New Port Richey resident Mark Kowalick noticed what he thought was a spider bite on his knee. Within a few days, the pain and swelling were so bad that he couldn't walk.

A few months ago, it happened again, this time on his finger. Last month, it was his face.

Kowalick still doesn't know where it came from.

"I'm not shy," he said. "I tell people, you can get it anywhere."

Kowalick washes his hands often, uses disinfectants, and does his laundry separately to avoid spreading the bug.

More patients like Kowalick are showing up in Tampa Bay emergency rooms. Although they count their numbers differently, most of the area's biggest hospitals report increases in their total number of MRSA cases.

Tampa General saw a 20 percent increase last year in the number of MRSA patients coming there. St. Joseph's averaged 150 patients coming in with MRSA per month in 2005, but sees about 300 a month now. The All Children's lab did 170 positive MRSA cultures in 2003, but 600 last year.

Still, health officials say some fears are overblown.

"There's a significant amount of hysteria," said Dr. John Greene, chief of infectious disease at H. Lee Moffitt Cancer Center and Research Institute.

People should have "a respect for the bug but not an overreaction," Greene said.

For example, the increased number of cultures in the Florida survey probably isn't just because of more infections, but also because doctors are asking for more tests, Sanderson said.

The vast majority of MRSA infections are still relatively minor skin infections that can be successfully treated with other drugs. Even just lancing and draining the infections is often enough to get rid of them.

Most health officials say that daily hygiene is the most effective prevention, rather than such dramatic measures as closing schools, or the full-scale weekend cleaning done at a Hernando school after a report that one student might be infected.

As the traditional breeding ground for drug-resistant germs, hospitals are taking new steps to try to stop their spread. Several hospitals are testing high-risk patients and isolating those who test positive. They're treating patients who carry the germ before certain surgeries to cut down on postsurgical infections.

All Children's tests every baby coming into its neonatal unit. This week, Bayfront Medical Center started testing all patients entering its neuro-intensive care unit. St. Joseph's keeps a database of past MRSA patients. Moffitt nurses wear buttons: "Ask me if I've washed my hands."

What is MRSA?

MRSA stands for methicillin-resistant staphylococcus aureus. Staph bacteria is the most common cause of skin infections, but it can infect other organs. MRSA is a strain of staph that doesn't respond to methicillin and related antibiotics. 

Prevention tips

Where did it come from?

MRSA has been around for decades. Methicillin was developed in the late 1950s, and resistant staph was identified in 1961. But until recently, the biggest problem was in hospitals. In the past few years, health officials have seen more infections in people who have no links to hospitals.

How dangerous is MRSA?

Nearly 95,000 people got serious, invasive MRSA infections in 2005 and more than 18,000 of them died, a study reported. Most of them - 85 percent of the infected, and 92 percent of those who died - got MRSA in health care settings.

So if I get MRSA, are my chances of dying 20 percent?

No. Most MRSA infections are relatively minor skin infections that may not need any drug treatment.

What can I do to prevent MRSA infection?

Wash your hands with plain soap and water. Clean cuts and scrapes and keep them covered. Don't share personal items, such as towels and razors. Keep away from other people's cuts and bandages. Use alcohol-based hand sanitizers. Get a flu shot.

Why a flu shot?

When the flu becomes deadly, it's often not the flu virus that kills. It's a bacterial infection - like MRSA - that takes advantage of the flu patient's weakened immune system.

What about antibacterial soap?

Such soaps may encourage drug resistance, so officials don't recommend them.

What about hand sanitizers? Don't they do that, too?

No. As long as they're at least 60 percent alcohol, they kill germs by drying them out.

Sources: Roger Sanderson, director of Centers for Disease Control and Prevention; Florida Department of Health; infection control officials at local hospitals

[Last modified November 12, 2007, 00:38:08]