Dangerous Germ Becoming More Common
- From: "georgia" <jwissmille@xxxxxxx>
- Date: 17 Apr 2005 11:08:00 -0700
http://www.washingtonpost.com/wp-dyn/articles/A31852-2005Apr6.html
The Washington Post
Dangerous Germ Becoming More Common
By Rob Stein
Washington Post Staff Writer
Thursday, April 7, 2005; Page A11
A dangerous germ easily mistaken for an innocuous one has become
alarmingly
common around the United States, raising concern that seemingly minor
boils,
pimples and abscesses could increasingly become disfiguring or even
life-threatening, researchers reported yesterday.
Because the microbe has become invulnerable to the most commonly used
antibiotics, the discovery means doctors should now routinely test all
skin
infections to identify patients who need urgent treatment with one of
the
handful of drugs still capable of killing the aggressive pathogen,
experts
said.
"This should serve as a red flag to doctors whenever they are treating
skin
infections," said Scott K. Fridkin of the federal Centers for Disease
Control and Prevention, who led the study reported in today's issue of
the
New England Journal of Medicine. "This is a new bug that has emerged in
the
community. It's a cause for concern."
The widespread emergence of the microbe is the latest manifestation of
the
growing threat of antibiotic resistance, a trend that has seen an
increasing
number of microorganisms evolve into strains that defeat many of modern
medicine's most important weapons.
"This is just another sign that, unfortunately, the bugs are winning,"
said
Loren G. Miller of the Harbor-UCLA Medical Center, the lead author of a
companion paper describing 14 cases of people stricken by
"flesh-eating"
cases of the infection.
In the first systematic attempt to assess how common the infections
have
become, researchers did a comprehensive analysis of these
methicillin-resistant Staphylococcus aureus (MRSA) infections in
Baltimore,
Atlanta and Minnesota in 2001 and 2002. They found 2,107 cases in
people who
had no contact with hospitals, the primary locales where such
infections
turned up in the past. The non-hospital cases accounted for 8 percent
to 20
percent of all such infections identified in the study. Children ages 2
and
younger appeared to be especially vulnerable.
"A decade ago, it would have been zero percent," Fridkin said. "We
wanted to
see if this had become commonplace in the community. The answer is a
resounding 'yes.' It's clearly no longer limited to the hospital."
The microbe is a strain of the ubiquitous bacterium Staphylococcus
aureus,
which usually causes well-known "staph" infections that are easily
treated
with common antibiotics in the penicillin family, such as methicillin
and
amoxicillin.
In recent years, small outbreaks of infections with a strain that is
impervious to those antibiotics have been reported among athletes,
inmates,
children and other groups, but otherwise resistant staph strains had
been
almost exclusively limited to hospitals.
"We're used to resistant staph in the hospital as a problem among
patients
with heart failure, liver failure, cancer or other health problems,"
said
David N. Gilbert of the Oregon Health & Science University. "It's
started
attacking normal healthy people, causing serious, often fatal illness."
The germ, which is spread by casual contact, produces potent toxins
that
kill disease-fighting white blood cells. That rapidly turns minor rug
burns,
cuts and other skin infections into serious health problems, apparently
including "necrotizing" abscesses that eat away tissue. Previously,
such
cases were thought to be caused only by strep bacteria.
In other cases, the microbe gets into the lungs, causing unusually
serious
cases of pneumonia, often on the heels of the flu, or spreads into the
bloodstream, triggering life-threatening complications.
"This has now become a significant problem in this country," said
Donald M.
Poretz, an infectious-disease expert at Georgetown University who
serves as
president of the National Foundation for Infectious Diseases. "We see
dozens
of these cases in our offices."
The infections can often be treated simply by lancing and draining
abscesses
and quickly administering less commonly used antibiotics, such as
vancomycin. The risk of becoming infected can be minimized by taking
common-sense precautions, such as frequent hand-washing. But experts
fear
doctors, especially in areas where the microbe is not yet well known,
will
not recognize it.
"Some of our patients had to have very extensive surgery to remove all
of
the dead tissue, and many of them were quite ill and required intensive
care," said Miller of UCLA. "It's an infectious-disease emergency,
because
without prompt surgery, treatment and antibiotics, people will die."
The resistant strain probably emerged because of the overuse of
antibiotics.
Public health officials have become increasingly concerned about this
trend,
especially because little work is underway to develop a new generation
of
antibiotics.
Experts are also concerned that the shrinking number of effective
antibiotics may also be slowly losing their power.
"What people are concerned about is that we'll be losing these drugs
one by
one until we don't have any effective ones left," said Walter E. Stamm,
president of the Infectious Disease Society of America.
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