News

19,000 fatalities a year, study says

By Judith Graham | Tribune staff reporter

12:53 AM CDT, October 17, 2007

Nearly 19,000 Americans died in 2005 of invasive infections caused by drug-resistant staphylococcus bacteria—more than were killed by AIDS, according to a new study in the Journal of the American Medical Association.

The report, written by experts at the Centers for Disease Control and Prevention, is the latest research to note the alarming spread of methicillin-resistant staphylococcus aureus in communities across the U.S. and to document the bacteria's deadly impact.

MRSA is a superbug that does not respond to treatment with common antibiotics such as penicillin. More than 94,000 Americans contracted life-threatening MRSA infections in 2005, including blood and bone infections, pneumonia and inflammation of the heart's lining. Most appear to be traceable back to hospitals, nursing homes or medical clinics, the new CDC report found.

"This is really a call to action for health-care facilities to make sure they're doing everything they can to prevent MRSA," said R. Monina Klevens, the lead author of the report and a medical epidemiologist at the CDC.

This year, Illinois became the first state in the nation to require hospitals to report infection rates, test patients in intensive-care units for the bacteria and to take specific measures to prevent its spread.

Nancy Foster, vice president of patient safety at the American Hospital Association, called the study an "eye-opener" and said hospitals across the country will need to evaluate whether current strategies for combating MRSA are effective.

But a growing number of MRSA cases are also arising at community gyms and schools, and these, too, can be deadly. On Tuesday, a high school senior in Moneta, Va., died after being hospitalized for a week with an infection that spread to his kidney, liver, lungs and heart.

"I've never heard of a bacterial invasive disease with an attack rate anywhere near this high in children and the elderly," said Dr. Robert Daum, a specialist in MRSA and a professor of pediatrics at the University of Chicago.

It's not known how the Virginia student contracted the infection, but officials ordered all 21 schools in the district closed for cleaning Wednesday. The bacteria can live on common surfaces, such as a table, for days or weeks and can be transmitted when someone touches it.

The CDC study found 32 of every 100,000 people in the communities studied contracted invasive MRSA infections. Rates were twice as high for African-Americans (66 per 100,000) and four times higher for the elderly (128 per 100,000). For infants younger than 1, the rate for blacks was four times that of whites.

African-Americans may be more vulnerable because they have higher rates of chronic illnesses such as diabetes, which require more visits to health-care providers, Klevens said. Infected individuals may then unwittingly spread the bacteria to other household members.

The new CDC report is the most reliable overview of serious MRSA infections prepared to date. The data came from nine sites: Connecticut; Baltimore; the metropolitan areas of San Francisco, Denver, Atlanta and Portland, Ore.; and three counties in Minnesota, Tennessee and New York.

Instead of using administrative data, researchers checked medical records to confirm cases of invasive MRSA infections and double-checked laboratory results. An earlier CDC study that relied on administrative data had estimated 5,000 people die each year of dangerous MRSA infections.

Dr. William Jarvis, former acting director of the hospital infections program at the CDC, called upon the agency to strengthen recommended measures for preventing MRSA's spread in light of the new report's findings.

"The CDC recommends routine screening for HIV for everyone who goes to a doctor, but it doesn't even recommend routine screening for all hospital patients for MRSA," he said.

Dr. John Jernigan, deputy chief of prevention at the CDC, defended recent agency guidelines that call for health-care facilities to lower MRSA infection rates. The guidelines are voluntary and there is no timetable or national reporting of the data. But Jernigan said the recommendations will work if health-care facilities are serious about following them.

jegraham@tribune.com

April 25, 2006

A potentially lethal strain of staph infection was once a worry mainly in hospitals. But MRSA (methicillin-resistant Staphylococcus aureus) is becoming increasingly common in gyms, day care centers, prisons, and other venues where people are in close contact and hygiene is often lacking.
MRSA is a type of Staphylococcus bacterium that is resistant to penicillin and some other antibiotics. The bacteria invade the body via cuts in the skin, causing infection that can be debilitating if not treated early and with the appropriate antibiotics. In rare instances MRSA can be lethal.
Athletes, including gymgoers, may be at risk. In 2003 five members of the St. Louis Rams football team were infected with MRSA. The infections of the players were associated with "turf burns." The bacteria were likely spread among players through shared towels, whirlpool baths, and weightlifting equipment.
MRSA is not, however, a disease that affects just athletes.
"This disease is spread by close skin-to-skin contact, crowding, sharing contaminated items," Nicole Coffin, a spokesperson at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, said. "Cleanliness is a big issue.
"At this point, everybody in the community can be at risk for MRSA," she said.
Changing Epidemiology
Staph bacteria are commonly carried by people on the skin or in their noses. Staph is the most common cause of skin and soft-tissue infection.
Some staph strains are resistant to conventional antibiotics, such as methicillin (a synthetic form of penicillin), and are known as MRSA.
"We think about one percent of the U.S. population, or about two million people, carry this drug-resistant form of staph," Coffin said.
MRSA has been seen in hospitals for about 30 years. There, it usually occurs among people with weakened immune systems, such as elderly patients with underlying illnesses, and patients who have had surgery.
The hospital-based infection may start out as redness around an intravenous line entry or a surgical wound, but it can spread to the lungs, causing pneumonia, or to the blood, causing breathing difficulties, fever, and malaise, possibly resulting in a life-threatening disease.
In 1998 health officials began seeing a new MRSA strain in people with no ties to health care settings. One major outbreak occurred in a prison.
Unlike the hospital-based MRSA, the community-based strain has been affecting healthy people.
"The fact that we're now seeing more infections among people without risk factors who are healthy represents a significant change in the epidemiology of this type of infection," Sara Zimmerman, an epidemiology specialist at the Mecklenburg County Health Department in Charlotte, North Carolina, said.
The community-based infections are usually more superficial and easier to treat than those in hospitals, and often resemble a pimple or a spider bite that can be red, swollen, and filled with pus.
If not treated appropriately, the infections can lead to serious infections of the blood or bone.
Health officials don't know how many people fall sick with the community-based MRSA. But the CDC's Coffin says about 25 percent of cases may result in hospitalization.
Gyms, Prisons, and Day Care Centers
Experts say the emergence of new MRSA strains shows the problem associated with antibiotics use.
"Due to the heavy use of antibiotics in Western medicine, these [staph] organisms have had the opportunity to develop mechanisms for resistance," Zimmerman said. "Unfortunately these organisms continue to exhaust our resources for combating these types of infections, making treatment options for clinicians very limited.
"Because this infection is so common, the focus has shifted to prevention and control versus eradication," she added.
MRSA is spread in two ways: by physical contact with an infected person or by touching inanimate objects like towels, linens, razors, or weightlifting equipment contaminated with bacteria.
It's not a disease that primarily affects athletes. But sports involving close contact, such as American football or wrestling, put athletes at higher risk for this infection.
Settings with close contact and lack of proper hygiene behaviors are particularly at risk, and prisons and day care centers may be highly vulnerable.
"Humans are reservoirs for staph," the CDC's Coffin said. "The most important thing for people to do is to keep an eye out for skin infections. Cover all wounds. If you have a skin infection, you should go to a doctor and have it looked at.
"Make sure your hands are clean, and don't share any personal items like towels and razors," she added.
After the outbreak among the St. Louis Rams players, officials there beefed up their defense against the disease by installing wall-mounted soap dispensers at the team's training facility and instructing players on how to care for wounds and how to monitor skin infections.

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Deaths from drug-resistant bacteria top those from AIDS

19,000 fatalities a year, study says

Last modified: 06/01/08