Perfect Climate for a Superbug

Until recently, methicillin resistant Staphylococcus aureus, or MRSA, was a hospital-based infection. No more. A recent edition of the New England Journal of Medicine reported that MRSA now accounts for more than half the skin infections treated in U.S. emergency rooms today.

Staphylococcus aureus, or staph, is a fairly common bacterium that can be found on the skin and in the nose of about one in every three people. When the bacterium enters the body through a cut or break in the skin, it can cause a mild to serious infection. MRSA is one strain of the staph bacterium that is very resistant to antibiotics, which is why MRSA is called a “superbug”.

For years, many physicians have been sounding the alarm about the rise of superbugs. They’ve said that antibiotics have been inappropriately prescribed to treat viruses (which do not respond to antibiotics) and that powerful antibiotics have been prescribed to treat bacteria that can be effectively treated with less powerful medication—the result, they’ve warned, is that some bacteria can become resistant to many antibiotics. That prediction has come true.

Julie Jefferson, director of epidemiology and infection control at Rhode Island Hospital, is concerned about the new strain of community-acquired MRSA (CA-MRSA); while it is less resistant to antibiotics, it is more virulent and as the strain continues to evolve, it could become more problematic to treat.

Conditions that promote the spread of skin infections like CA-MRSA include close personal contact in crowded conditions, lack of cleanliness and activities that cause skin-to-skin contact, such as contact sports. Outbreaks have occurred among athletic teams, inmates at correctional facilities, military recruits, intravenous drug users and patrons of health clubs. Although CA-MRSA is most often transmitted by physical contact with someone who has the bacteria, it can also be contracted indirectly through contact with contaminated surfaces or personal articles like towels and razors.

Many patients who seek treatment believe they have a spider bite, when in fact they have a skin and soft tissue infection that looks like a boil, abscess or an inflammation of the connective tissue under the skin (cellulitis). If not treated in a timely fashion, CA-MRSA can lead to more serious infections. CA-MRSA can be even more serious, leading to pneumonia and death.

The number of CA-MRSA cases continues to grow and has already surpassed those that develop in the hospital. Rhode Island Hospital has seen increased numbers and Jefferson estimates they are reflective of the national trends.

Fortunately, community-acquired MRSA can be easier to treat than hospital-acquired MRSA. Many times, simply draining the site of the infection is all the treatment needed. However, all possible infections should be cultured to determine if they are MRSA.

To prevent the spread of MRSA, it is essential to maintain a clean environment and keep skin intact. Do not share towels or other personal items, Jefferson says. At the gym, it’s important to keep equipment and mats clean and germ-free. If you suspect you may have CA-MRSA, consult your physician.

Rhode Island Hospital is committed to keeping both hospital-acquired and community-acquired MRSA under control. Several members of the epidemiology and infection control staff recently attended a conference on MRSA. Rhode Island Hospital continues to determine how best to recognize and aggressively treat the infection. They hope to continue to research the causes of CA-MRSA and methods for prevention.

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