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MRSA Infections: Deconstructing the Superbug

Several months ago, my father developed a blood infection after being admitted to a hospital in Arizona. Lab tests suggested it was caused by a strain of MRSA—methicillin-resistant Staphylococcus aureus. Much in the news lately, MRSA is a potentially fatal staph infection that is resistant to methicillin, penicillin and other common antibiotics.

By the time I arrived at my father's bedside, he was in "contact isolation," requiring all visitors to use rubber gloves and gowns. The antibiotic vancomycin fought the infection but ultimately caused his aging kidneys to shut down.

Until then, I had only a passing acquaintance with MRSA. But since October, news of MRSA infections has proliferated in the headlines. Scores of schools around the country have been shut down for cleaning after reports of students becoming ill or dying from MRSA. In December a teacher at a Montgomery County, Md., school died from the infection. The U.S. Centers for Disease Control and Prevention (CDC) in Atlanta also released a report indicating that MRSA—both in health care facilities and the outside community—is far more widespread than previously believed.

There are two main types of MRSA infections. The first, community-acquired infections (known as CA-MRSAs), are spread in places like schools or gyms. They typically result in skin or soft tissue infections—such as small abscesses or boils—that are usually treated easily by lancing and draining the wound and are not life-threatening in healthy people.

The second type of MRSA is transmitted in health care settings, such as hospitals or long-term care facilities. An MRSA infection can be lethal—as it was in my father—if it invades the bones, bloodstream or organs in the body, especially in people with weak immune systems or in older patients with multiple health problems.

The first cases of MRSA were reported in the 1960s, but in recent years transmission rates have soared. MRSA-related hospital stays have more than tripled since 2000, according to the federal Agency for Healthcare Research and Quality. Experts pin much of the blame on the overuse and misuse of antibiotics, which has allowed staph to mutate into ever more resistant strains. "Bacteria become resistant," says CDC spokesperson Nicole Coffin. "That's their job, and they consistently achieve it."

Physicians may feel pressured by patients into prescribing antibiotics as a quick fix for ailments, such as colds and ear infections. But in the end, Coffin says, the drugs don't work and ultimately create more resistant strains of bacteria. "It's important that we use antibiotics judiciously, so we don't speed up the resistance process."

Infectious disease specialists say staph bacteria, and methicillin-resistant strains of it, are all around us. A quarter to a third of us carry colonies of MRSA in our noses or on our skin but are not sick, according to David C. Hooper, M.D., chief of infection control at Massachusetts General Hospital in Boston. "Generally, we live happily with it," he says. The problems occur when a cut or break in the skin—a wound or a surgical incision—enables bacteria to enter the body. If a cut becomes red, hot or swollen, or a fever or chill develops, Hooper says, seek medical attention.

Only 1 to 2 percent of us carry resistant forms of MRSA in the nose or skin, Hooper says, and they can cause infection if they penetrate the body.

Clinicians maintain that simple commonsense steps such as frequent and thorough hand washing—if vigorously observed—can significantly reduce MRSA transmission in health and long-term care facilities as well as the community. Stephen Peters, director of laboratory medicine at Georgetown University Hospital in Washington, points to the example of Sweden, where strict enforcement of hand hygiene among health care workers and tight control over the use of antibiotics have eliminated MRSA altogether.

"If you focus on hand hygiene and do it well, you can interrupt transmission not only for MRSA but for other organisms as well," says Hooper. Infection rates at Mass General have dropped by 50 percent in the past five years since the hospital instituted a hand-washing policy, achieving a 90 percent compliance rate among its staff. The national average, according to the CDC, is only 50 percent.

Despite the challenges, health experts are optimistic that solutions to the MRSA problem will be found. For Georgetown's Peters, Sweden's example offers strong proof that these supergerms can be vanquished. "In due time, we will break the backs of some of these bugs," he says.