The superbug sparks concern, and calls for vigilance

The flesh-eating bacteria called the superbug is more common than once thought, and the likelihood of getting it may depend on where you live.

A superbug may be loitering in your nose and you don’t even know it’s there.

Scientists say MRSA, a strain of flesh-eating bacteria known as the superbug because it is resistant to common antibiotics, is more widespread than previously thought, and the likelihood that you may have it could depend upon where you live.

MRSA, or methicillin-resistant Staphylococcus aureus, was once found mainly in hospital intensive care units. In recent years, varying strains of MRSA have spread from the ICU to other hospital wards and to the general public. Health advocates are calling for better information about the spread of the bug and more available means to prevent infection.

MRSA resides harmlessly in the nose, but can colonize the body’s surface waiting for a cut to seize the opportunity to invade the underlying skin, where it begins to destroy tissue. Experts say that hospitalized patients with weakened immune systems are most at risk. But healthy people can be at risk, too.

A study published in a recent issue of the American Journal of Infection Control (AJIC) concluded that the states with the highest rates of MRSA are east and northeast of the Mississippi River. They include South Carolina, Delaware, New York and New Hampshire and Maine.

Other states along the Atlantic coast--Massachusetts, Florida and Pennsylvania--ranked high, as did two Western states, California and Nebraska.

“Our study showed great variation in the geography of prevalence,” said Dr. William Jarvis, who designed the study and coauthored the article that appeared in AJIC. “We think it’s because of population density in big cities and the cluster of large academic hospitals that treat the sickest patients.”

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Three people walking down a crowded street. Could one be carrying the bug? (Photo by Manuel Cortazal)

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Ambulances outside the New York Presbyterian Hospital Emergency Room. (Photo by Manuel Cortazal)

The study, sponsored by the Association for Professionals in Infection Control, was based on a one-day snapshot of the number of infected patients at reporting hospitals.

What’s more, Jarvis said, only 29 percent of hospitals were screening for the bug. “There needs to be improvement on this front,” he said.

Before the findings were released, researchers and clinicians relied on prevalence data from the Centers for Disease Control and Prevention, which showed a national infection rate of 3.95 per 1,000 inpatients. But Jarvis and his colleagues at APIC estimate a national rate of 46.3 per 1,000 patients.

The infection can take on the appearance of a spider bite or small boil, which many people often ignore at first. Christie Griffith, a 29-year-old single parent in Southbridge, Mass., didn’t realize those small boils on her skin that she noticed while living in Sacramento, Calif., would lead to a widespread infection.

“At first the doctors never made the connection to MRSA,” she said. “I never heard of this disease before and wonder why there isn’t a public information campaign like AIDS.”

Last October, the Journal of the American Medical Association published a report by epidemiologists at the CDC that estimated 31.8 per 100,000 U.S. residents developed MRSA infections in 2005. The CDC report confirmed what Jarvis discovered: the medical community was relying on estimates that underreported the extent of the problem.

Patient safety advocates are pushing hospitals to screen all new patients for MRSA. Some of the more vocal advocates of screening, with the support of state legislatures, also want hospitals to publicly report their infection rates.

When MRSA infects an everyday wound, not only is the patient affected, the entire family is as well. Helen Gilson and her family came up against the superbug three years ago when her 10-year-old son cut his leg as a horse he was riding brushed up against a fence.

“After the doctor stitched him up, he did well, but soon he stopped healing,” said Gilson, a housewife in Mason, Ohio, a state that ranked near the middle in the Jarvis study.

Within weeks, the antibiotic-resistant bug spread throughout the wound, damaging the skin and stumping doctors.

Gilson found a pediatrician who correctly diagnosed the problem and started her son on a regimen of antibiotics that specifically targets the bug.

The Gilson family’s battle with MRSA didn’t stop at the hospital. Even though her son bounced back, the bacteria continued to live on his body. So the mother of two had to worry about other members of her family becoming infected. She replaced hand cloths with paper towels and disinfected the children’s shower with a bleach solution to prevent her other son from becoming infected.

The Gilson and Griffith families are now doing well. Others aren’t so lucky. The CDC analysis published in October estimated that MRSA killed 19,000 Americans in 2005, more than the number of people who died of AIDS.

Betsy McCaughey, a prominent advocate for patient rights, said many more people are dying than hospitals report. She founded RID, the Committee to Reduce Infection Deaths, a group that champions better infection control among health care workers and more public reporting of hospital infection rates.

“There are productive steps that hospitals can take but just don’t adopt,” McCaughey said. She argues that hospitals should screen all incoming patients for MRSA so health care workers can isolate infected patients from the general population. Her group’s Web site advises patients awaiting surgery to bathe with chlorhexidine soap for several days before entering the hospital.

The CDC and hospitals are stepping up efforts to counter the bug’s spread with new research and more stringent infection control procedures. Janet Haas, associate director of infection control at New York University Hospital, said hospitals are using rapid testing to identify and isolate infected patients more quickly. She added that NYU is now monitoring health care workers’ compliance with infection-control measures.

After the recent MRSA-related deaths of schoolchildren in two high prevalence states, New Hampshire and New York, received national press coverage, parents started paying attention to the threat of MRSA in schools, McCaughey said.

“We also want to empower parents,” she said. A former lieutenant governor of New York, McCaughey advises parents to pack alcohol-based hand sanitizers in their kids’ book bags and to pressure schools to encourage good hand hygiene practices and disinfect gym equipment. Experts say that frequent hand washing, not sharing towels, and cleaning gym mats and equipment are the best ways to prevent infection outside the hospital.

Now that her son has fully recovered, Gilson helps parents across the nation who grapple with MRSA infections. She has a blog on her Web site and offers advice to parents who post messages to an online MRSA support group.

“I’ve heard horror stories from so many parents whose doctors who wouldn’t take the extra step and test for MRSA,” Gilson said. “After what my family experienced, I knew I had to do something for others.”