CA-MRSA Front-Paged at Wall Street Journal

Update 20 Jan 2006: ABC News also has a CA-MRSA feature today.

While providing nearly real-time updates on avian flu, The Wall Street Journal has been late to the party regarding MRSA (antibiotic-resistant staph) coverage. Today it catches up with a front-page [subscription required] story on community-acquired MRSA (CA-MRSA), the methicillin-resistant staph strain that has established itself outside of hospital and nursing-home environments. CA-MRSA usually shows up as an innocuous infected scratch or "spider bite" that doesn't heal and can get serious fast.

This overview article, like most of its kind, is heavy on real-life anecdotes> It leads off with a harrowing account of 17-month-old Simon Sparrow's experience with CA-MRSA misdiagnosis, followed by intensive, high-tech medical intervention, followed by his death.

That account is followed by some good summary paragraphs:

What killed Simon Sparrow is a new form of an old foe: the staph infection. Identified as a lethal threat in 1999, this new strain is resistant to drugs and is highly virulent, responsible for 60% of all skin and soft-tissue infections treated in the nation's ERs. Infections can recur and ping-pong through families. The germ can penetrate bones and lungs, and the abscesses it causes often require surgery. In severe cases, up to a quarter of patients die.

Public-health officials see a silent epidemic on the rise. Almost 1% of the population, or more than two million people, carry drug-resistant staph without symptoms, according to an article in this month's Journal of Infectious Diseases by Matthew Kuehnert, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention. Carriers can spread the disease and suddenly become acutely ill themselves. In a separate study based on data from 1999 and 2000, Dr. Kuehnert estimates there are 292,000 hospitalizations a year for staph, of which 126,000 are for the resistant kind.

Public-health officials have warned for years that heavy use of antibiotics could breed drug-resistant bugs. This version, one of the most extreme so far, is breaking out as the attention of the federal health bureaucracy is focused on more explosive threats such as bioterrorism and bird flu. The test for drug-resistant staph may not be routinely covered by insurance, so many ER and family doctors don't administer it. Even if they did, the standard test takes up to 48 hours to complete, during which time the most serious cases have often turned fatal.

The Journal's article says that CA-MRSA researchers have limited funds, and that the CDC hasn't done a good job of publicizing the disease. The agency is, however, about to ask doctors to be alert for possible CA-MRSA infections in their patients, and to forward biopsy samples for analysis.

A companion article provides some practical advice about what to do about CA-MRSA in our daily lives, including these tips:

There aren't any magical or high-tech tools for avoiding it.
...
Use simple hygiene, take proper care of wounds, get prompt medical care for infections and request that infections be tested.

Instead of trying to sterilize everything, wash with soap and water....Cleaners such as liquid hand disinfectants that leave a residue will allow the bacteria to become more resistant....

Taking proper care of wounds is another key. "Keep the wound covered, change the dressing without contaminating others and don't share towels or other things that could be contaminated from the wound," says Rachel Gorwitz, a medical epidemiologist for the U.S. Centers for Disease Control and Prevention.

Infections can easily bounce around households, so family members with a possible infection shouldn't share personal-care items. If a family has a history of skin boils, doctors may prescribe mupiricin ointment for the nostrils [where CA-MRSA lives in many people] and suggest using chlorhexidine soap, which is sold under the name Hibiclens.

Brad Frazee, an emergency department physician at the Alameda County Medical Center in Oakland, Calif., advises parents to ask about staph, especially if their children are given antibiotics for skin infections without them being tested.

"It would be great for all the mothers out there to know, when their pediatrician gives them Keflex or dicloxacillin" -- two antibiotics that don't work against resistant staph -- "that they can say: 'Should you be thinking about CA-MRSA?'"

In May 2005 I posted some practical tips for identifying possible CA-MRSA infections. In April 2005 I wrote about several Pittsburgh-area hospitals having success with an apparently-worth-the-expense screening mechanism: taking nose-swabs from every new patient, and culturing them to find CA-MRSA.