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Antibiotic-resistant bacteria becomes more common

December 12, 2005|by JULIE E. GREENE

julieg@herald-mail.com

Staphylococcus aureus.

Lots of people have this common bacteria, but usually it doesn't cause a problem, doctors say.

In many cases, people don't realize they have an infection or their immune systems are able to handle it, says Dr. John Newby, director of laboratories for Washington County Health System.

It's when the immune system cannot handle a staph infection and requires antibiotic treatment that staphylococcus aureus can cause a bigger problem.

That's because, in some cases, staphy-lococcus aureus has become resistant to semisynthetic penicillins, a class of antibiotics, including methicillin, often used to treat skin and soft-tissue infections, Newby says. In those instances, staphylococcus aureus has become methicillin-resistant staphylococcus aureus (MRSA).

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Half of the staphylococcus aureus cases Hagerstown Medical Laboratory has cultured in the last several years have been MRSA, says Newby, a pathologist.

Dr. Dino Delaportas, an infectious disease specialist who consults with Washington County Hospital, says he's seen more cases of MRSA in the local community in the past two years, especially the last year, but the increase in MRSA cases is happening nationwide.

"I don't think we're any different than anybody else. This is not a local problem; it's a national problem," Delaportas says.

"The big difference between this and a routine run-of-the-mill staphylococcus aureus we've seen before is its susceptibility pattern," Delaportas says. "There are not that many antibiotics that can fight it."

What it is



Staphylococcus aureus is a bacteria, not a virus, that has been around for ages, Delaportas says.

"It's what causes boils in Ancient times, even in the Bible," he says.

Staphylococcus is everywhere, with one out of four Americans estimated to have staph in their nose, Delaportas says. Often MRSA colonizes in people, meaning it's in the body but is not causing illness.

People can get sick from MRSA when the staph gets in a cut or abscess under the skin, Newby says. It could start with something as simple as a pimple or infected hair.

"Sometimes you can't (prevent it). Sometimes it's just a matter of bad luck," Delaportas says.

Until recent years, many MRSA cases occurred in hospitals or long-term care facilities because that's where antibiotics are often used and resistance develops to those antibiotics, Delaportas says.

Staph infections associated with health care could be surgical wound infections, bloodstream infections and pneumonia, according to the Centers for Disease Control and Prevention's Web site.

Those cases could be hospital- or health-care-associated MRSA, whereas community-associated MRSA usually starts with a skin or soft-tissue infection, Newby says.

Community-associated MRSA will not be resistant to other antibiotics, whereas hospital-associated MRSA might be resistant to antibiotics beyond the methicillin family, Newby says.

A person with MRSA could have a boil or fever with redness in the infected area, Delaportas says. It could start with a bug bite, but then form an abscess with pus emerging.

According to the CDC, the skin infection might look like a pimple or boil and be red, swollen, painful or have pus emerging.

Newby says a boil looks like a big pimple.

Prevention



Good personal hygiene - washing hands - can help prevent MRSA because staphylococcus aureus is spread by touch and is not airborne, Delaportas says.

The CDC, at its Web site, recommends:

  • Washing hands thoroughly with soap and water or using an alcohol-based hand sanitizer.

  • Keep cuts and scrapes clean and covered with a bandage until they are healed.

  • Try to avoid contact with other people's wounds or bandages.

  • Do not share personal items such as towels or razors.


The CDC also recommends people who share workout equipment use a barrier such as a towel, between your skin and shared equipment, or wipe the surface of the equipment before and after use.

If you have MRSA and a wound that is draining or has pus, cover the wound with a clean, dry bandage to help prevent spreading MRSA to others, the CDC states.

Treatment



Staphylococcus aureus started showing significant resistance to penicillin in the 1950s and to traditional antibiotics such as methicillin more than 20 years ago, Delaportas says.

MRSA can be difficult to cure, he says.

A person with a mild case can be treated with pills as an outpatient. A more severe case might require having the person admitted to a hospital for intravenous treatment.

Because MRSA is resistant to more commonly used antibiotics such as penicillin, other antibiotics are used.

Vancomycin can be given intravenously or Zyvox can be given orally, through a shot or intravenously, Delaportas says. Other, less expensive, antibiotics can be used, but they are less effective, he says.

Treatment with Vancomycin can take a while, with some hospital stays lasting seven to 10 days or more, local doctors say.

MRSA can be fatal, but that's not new to staphylococcus aureus, which has the potential to kill once it gets in the blood, Delaportas says.

People more susceptible to dying from MRSA are those with chronic underlying problems such as congestive heart failure, diabetes and cancer; the elderly; and the very young, Delaportas says.

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