Recently there were a couple of articles in the Los Angeles Times and the Long Beach Press Telegram newspapers about an outbreak of staphylococcal skin infections. Most alarming was that the staph bacteria are becoming resistant to the few remaining antibiotics we have to treat it. One of the articles suggested that the increase in cases was seen mostly in the gay population, and in prisons with inmates where the conditions are so crowded. The other article intimated that while it was more prevalent in these two groups, it was occurring in all and every group. In other words, there were no specific demographic groups that were “spared”. Needless to say, this generated significant concern for many parents and patients.
The first major problem with staph aureus in the United States was in the early 1960’s. There were scattered epidemics of staph infections across the country. After much epidemiological detective work these were partly traced to newborn nurseries. At that time, it was routine for moms to stay one week in the nursery with their newborn; the so-called “confinement period”. This provided ample time and opportunity for mom, baby and nurse to share their staph, and colonize themselves. Then, when they went home, the staph was spread to other family members, and so on, and so on...there were epidemics of boils, abscesses, styes and mastitis.
Much was learned, during this experience, about infection control and promoting early discharge from the nursery. Up until that time, penicillin was the drug of choice to treat staph infections. It worked like a charm. But around the early-to-mid 1960’s something new, something frightening was discovered. There was a new form of staph that was able to produce an enzyme (penicillinase) that would attack the very structure of the penicillin molecule and render it inactive. Sure enough, what emerged was a new resistant strain of staph. As a result of this new strain of staph, semi-synthetic penicillins were developed to take up the fight against the bacteria. Methicillin, Oxacillin and Nafcillin proved to be very effective antibiotics in treatment of resistant staph infections. At first, these infections were infrequent, usually seen in hospitalized patients that had some “hardware” in their bodies such as a ventriculo-peritoneal shunt for hydrocephalus (tubing from the brain to the abdomen for drainage of cerebrospinal fluid where there is a blockage) or certain orthopedic prosthesis etc.
Then in the 1980’s, as was anticipated, the medical community started to see Methicillin resistant staph infections (MRSA). These were originally seen in hospitalized patients, usually elderly persons who were transferred from nursing homes where antibiotic use is more liberal. It posed a challenge to infectious disease specialists, but was handled with the judicious use of special antibiotics. In the late 1980’s, Methicillin-resistant staph emerged from the community, mostly from IV drug abusers. Next it was seen in out-of-home day care centers. In 1998 there was a large outbreak in a neonatal intensive care unit in a Chicago hospital. Once again, the infectious disease specialists were called to service to help combat this serious problem. Vancomycin and clindamycin are two antibiotics that are currently being used effectively in treating MRSA. But their use must not be indiscriminate, and strict isolation of these patients when hospitalized is critical. Most hospitals have strict epidemiological guidelines and policies on how to handle these patients. As it stands now, we certainly have not won the war against MRSA. It is somewhat of a draw, but we must be vigilant and pro-active, and cannot let our guard down.
As for the average American family who has children without any significant medical problems, MRSA should not be a major concern. One would be remiss to say that it could NEVER happen to one of their children, but the odds are extremely remote. The groups that seem to be most recently affected are the gay community, and people who are incarcerated and living in the cramped conditions of jail. They are developing severe skin infections such as boils, draining abscesses and eye infections. A smaller percentage of these patients are developing more serious and even life-threatening infections such as a staph pneumonia or bacteria in the blood stream. In the general population we are seeing this, but on a MUCH smaller scale. The take-home point is that it is not just the at-risk group who can get MRSA. We are beginning to see it in the general population.
It is not time to worry or panic. The public and the medical community just have to be vigilant and not cavalier about treating a skin infection. It is important to identify a skin infection early and institute standard care that would probably only require good local measures. Touch base with the doctor, as he/she may want to see the infection before anything is done to it. If it does not respond in a timely fashion, it should then be evaluated by the doctor to determine if anything more aggressive should be done.
Dealing with MRSA is truly like a war. Right now we are holding our own and are able to deal with what is confronting us. The pharmaceutical companies are working hard to develop some new armaments for the fight against MRSA. It would be nice to have a few new “smart bombs” at our disposal, but this will take some time. At least we have learned from our mistakes of the past 35 - 40 years. We are much smarter about how MRSA spreads, the role of indiscriminate antibiotic use in antibiotic resistance, and the ability to recognize at-risk groups EARLY so that interventions can take place in a timely manner.