17 December 2013


Story first appeared in the Detroit Free Press.

Eric Allen went to bed March 1, thinking he had a light flu. By the time he staggered into the hospital in London, Ky., the next day, he was coughing up bits of lung tissue. Within hours, organs failing, he was in a coma.

Tests showed that Allen, 39, had a ravaging pneumonia caused by Methicillin-resistant Staphylococcus aureus, or MRSA, an antibiotic-resistant bacteria once confined to hospitals and other health care facilities. Allen hadn't been near a doctor or a hospital.

Same with the next victim, a 54-year-old man, who came in days later and died within hours. And the victim after that, a 28-year-old woman, dead on arrival.

The doctors were alarmed.

"What really bothered me was the rapidity of their deterioration, a matter of hours," says Muhammad Iqbal, a pulmonologist who chairs the infection control committee at Saint Joseph-London hospital. "We were worried that something was spreading across the community."

Indeed, a deadly form of MRSA had sprung from nowhere, picking off otherwise healthy people. The cases thrust Iqbal and his colleagues to the front lines of modern medicine's struggle against antibiotic resistant bacteria -- perhaps the nation's most daunting public health threat.

No drug-defying bug has proved more persistent than MRSA, none has caused more frustration and none has spread more widely. In recent years, new MRSA strains have emerged to strike in community settings, reaching far beyond hospitals to infect schoolchildren, soldiers, prison inmates, even NFL players.

In metro Detroit, MRSA infections have broken out in recent months in schools from Northville to Belleville to St. Clair Shores.

The first of a handful of MRSA cases at Northville High School was reported in August. Since then, the district has added two additional custodians to the day shift to clean the building while classes are in session, according to information on the district's website. Additional hand sanitation stations were set up, and the school undergoes a deep cleaning every weekend. Custodians also switched to a more aggressive disinfectant.

In May, all buildings within the Mt. Clemens Community School District were closed for cleaning after a teacher and para-professional at the high school were diagnosed with MRSA infections.

A USA TODAY examination finds that MRSA infections, particularly outside of health care facilities, are much more common than government statistics suggest. They sicken hundreds of thousands of Americans each year in various ways, from minor skin boils to deadly pneumonia, claiming upward of 20,000 lives. The inability to detect or track cases is confounding efforts by public health officials to develop prevention strategies and keep the bacteria from threatening vast new swaths of the population.

"It's not about winning or losing the battle (against MRSA), it's that the battle is shifting," says Ramanan Laxminarayan, a Princeton University scholar who heads the Center for Disease Dynamics, Economics & Policy. "You're seeing people who are young and healthy getting this (in the community), and it's very serious. ... And it's not picked up in the statistics."

To assess the evolving threat, USA TODAY reviewed federal data on hospitalizations and infection rates, academic studies and an array of government reports. Key findings:

  • Most cases go uncounted: Hundreds of thousands of MRSA cases a year are not included in government incidence estimates because the Centers for Disease Control and Prevention can track only the sliver of cases that escalate to life-threatening infections. In 2011, the CDC reported 80,500 such cases, but that figure represents less than 20% of the hospitalizations that year in which billing data show a MRSA diagnosis. Countless more cases, typically less-serious skin infections, were treated outside hospitals.
  • Successes are masking new threats: The medical establishment has made substantial headway reducing MRSA linked to health care facilities, cutting the worst of those infections 30% or more since 2005. That widely touted progress obscures the fact that there's been little or no decline in cases from community-based strains.
  • Infections in kids are climbing: MRSA cases in children continue to rise, jumping 10% a year among youths ages 3 months to 17 years. A much larger share of the infections hitting children have been linked to community strains that can pass from kid to kid by, say, brushing against a victim at school or handling a contaminated object, such as a locker room towel.
  • Officials have a patchwork control plan: Health officials have made little progress developing strategies to reduce severe infections from the community strains that have grown increasingly prevalent. That's partly because most states, like the federal government, collect virtually no data on where and when most community-based cases occur.

"The challenge now is in the community," says Robert Daum, an infectious disease physician and founder of the University of Chicago's MRSA Research Center. "With all due respect to our public health authorities, they made the transition in their minds very slowly that the epidemiology of MRSA had shifted. ... So we are left with a community problem that has been largely unaddressed."

Old bug, new threats

Staphylococcus aureus bacteria have been around for ages, but today's staph infections aren't what they used to be.

Staph occurs naturally and often exists without consequence on people's skin. It most often creates problems when it gets into cuts, causing skin infections -- from small pimples to painful boils -- that usually can be treated easily by doctors. In some cases, the infections advance, destroying tissue and causing large abscesses that can require hospitalization. When staph enters the bloodstream or attacks the lungs as bacterial pneumonia, it becomes especially dangerous -- often fatal.

In the 1940s, penicillin proved effective in treating staph infections, but the bacteria quickly grew resistant, so doctors switched to methicillin. By the 1960s, staph had beaten that, too.

Methicillin-resistant Staphylococcus aureus -- MRSA -- had arrived.

For the next 30 years, MRSA struck mainly in hospitals, creeping into patients via surgical sites, catheters and other paths. Then, in the '90s, new "community-associated" strains began showing up in people who'd had no contact with the medical system -- and the MRSA problem got far more complicated.

Community MRSA strains cause more than half of all the skin and soft tissue infections that send people to the hospital, various studies show. The good news is that there still are antibiotics that work against them -- most of the time. The bad news is that there are other, more dangerous strains that pose especially grave threats.

Perhaps most worrisome, some community strains carry a toxin linked to a lung-ravaging "necrotizing" pneumonia that tends to strike people with the flu or other underlying illnesses. When that pneumonia takes hold, victims often die in as little as 72 hours.

In a CDC-led report out this year, researchers found that MRSA is making its biggest gains among children. Not only did the study document a 10%-a-year rise in MRSA in kids from 2005-2010, it also found that the proportion of those cases involving community-associated MRSA jumped 55%.

Though upward of 30% of the public have garden-variety staph on their bodies, the CDC estimates that just 2% or so carry MRSA.

The CDC has issued guidelines encouraging better hygiene -- bathing and hand washing -- and warning people not to share personal items, such as sports equipment, towels or razors.

Many MRSA researchers say the best way to tackle community MRSA is to develop a vaccine for staph.

MRSA: What it is

  • MRSA is a contagious bacterium that in its different strains can cause medical issues ranging from easily treatable skin infections to painful, flesh-eating abscesses to even death.
  • MRSA is resistant to many antibiotics in the penicillin family.
  • MRSA infections cause nearly 19,000 deaths each year in the United States, far surpassing AIDS/HIV-related deaths of about 12,500 in 2005.

Where it comes from

Staph is commonly found in the nose and on the skin, mainly armpit, groin and genital areas, and normally does not cause illness. However, when the bacteria enter the body they can cause small infections such as pimples and boils.

Staph generally spreads through direct contact with the hands of someone who is infected or carrying the organism.

MRSA wounds look similar to spider bites.

Those at greatest risk

Anyone can get a staph infection. However, it is most commonly found among hospital patients, and there is an increase in staph cases among athletes, prison inmates and children. Risk is highest if you:

  • Are around an infected person.
  • Live in crowded conditions.
  • Play in close-contact sports.
  • Have poor personal hygiene.
  • Have recently used antibiotics.
  • Are an injection-drug user.
  • Have a weakened immune system.
  • Are a man who has sex with men.

What you can do

Although MRSA can't be effectively treated with common antibiotics, Vancomycin has some success. Newer antibiotics are being developed. Here are some preventive measures:

  • Wash hands carefully. This is the most effective measure.
  • Clean shared athletic equipment.
  • Don't share personal hygiene items like razors or towels.
  • Avoid contact with surfaces contaminated with wound drainage.
  • Keep infected areas covered with clean dry bandages.

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