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Sports teams, schools, hospitals wrestle with global MRSA epidemic

MRSA has claimed yet another young life.  Seventeen year-old Ashton Bonds of Lynch Station, Virginia, died following a bout with the disease.  MRSA is the acronym for Methicillin-resistant Staphylococcus aureus, a particularly nasty bacteria that is showing up all over the nation.  In Mr. Bonds' case, MRSA had spread via his bloodstream, attacking his kidneys, liver, lungs and heart muscle.

MRSA apparently began its life in hospitals.  The probable cause grew from lax oversight of hospital infectious disease control protocols. 

From a Bloomberg news story of December 19, 2005:  http://www.bloomberg.com/apps/news?pid=10000103&sid=aQGnyaFWj2FA&refer=us :

Researchers are concerned especially about antibiotic resistant bacterial infections that arise in hospitals and spread to homes and crowded workplaces. The microbe, called methicillin-resistant staphylococcus aureus, or MRSA, is creating a health hazard in the U.S. dwarfing the threat posed by the H5N1 avian flu, said Steve Projan, vice president of protein technologies for Wyeth, the drugmaker that markets the Tygacil antibiotic.

``This is a hyper-virulent virulent bug,'' Projan said in a press conference at the Interscience Conference on Antimicrobial Therapy and Antibiotics on Friday. ``While we're very concerned about H5N1, we do have in front of us today this outbreak of community-acquired MRSA.''  (bold mine)

Increasingly, researchers are finding these drug-resistant infections outside the hospital, leading to concerns about widespread outbreaks of hard-to-treat microbes.

In some hospitals in San Francisco and Los Angeles, the new toxic strain is the leading cause of drug-resistant staph infections. More than half the MRSA's at the Harbor-UCLA Medical Center are the community-acquired strain, according to a study presented Dec. 17 by Cynthia Maree, an infectious disease specialist at the University of California, Los Angeles Geffen School of Medicine.

``That's more than twice the rate we had in 1999,'' she said in an interview at the conference. ``When patients make repeat trips to the hospital with the same strain, health workers will sometimes clean the patient's home,'' in an attempt to get rid of the source of infection, she said.

MRSA has become a major pain in the rear for school districts.  It has hit sports teams especially hard -- especially those sports with a great deal of abrasion on hard surfaces, where the bacteria can transfer from skin to skin.  As a result, athletic coaches and trainers are learning about MRSA in clinics and lectures at coaches conventions.  Today, for example, wrestling coaches in several states are required to disinfect all wrestling mats after practice and before and in some cases, even during wrestling matches.

But the disease is certainly not limited to high school athletics.  In 2003, the St. Louis Rams had to disinfect their playing surface and their practice fields, following the revelation that opposing teams were contracting MRSA after playing the Rams in their domed stadium.  In fact, the New England Journal of Medicine published a scientific paper on the outbreak, submitted by researchers from (among other entities) the National Center for Infectious Diseases and the Epidemic Intelligence Service, Division of Applied Public Health Training, Centers for Disease Control and Prevention.  The abstract is located at: http://content.nejm.org/cgi/content/abstract/352/5/468 . It says, in part:

We conducted a retrospective cohort study and nasal-swab survey of 84 St. Louis Rams football players and staff members. S. aureus recovered from wound, nasal, and environmental cultures was analyzed by means of pulsed-field gel electrophoresis (PFGE) and typing for resistance and toxin genes. MRSA from the team was compared with other community isolates and hospital isolates.

During the 2003 football season, eight MRSA infections occurred among 5 of the 58 Rams players (9 percent); all of the infections developed at turf-abrasion sites. MRSA infection was significantly associated with the lineman or linebacker position and a higher body-mass index. No MRSA was found in nasal or environmental samples; however, methicillin-susceptible S. aureus was recovered from whirlpools and taping gel and from 35 of the 84 nasal swabs from players and staff members (42 percent). MRSA from a competing football team and from other community clusters and sporadic cases had PFGE patterns that were indistinguishable from those of the Rams' MRSA; all carried the gene for Panton–Valentine leukocidin and the gene complex for staphylococcal-cassette-chromosome mec type IVa resistance (clone USA300-0114).  (bold mine)

From the Bloomberg story of 2005:

Episodes of drug-resistant infections have occurred in the past year on professional U.S. football teams, including the St. Louis Rams, Baltimore Ravens, and San Francisco 49ers, said Dan Jernigan, chief of CDC's epidemiology branch at the National Center for Infectious Diseases. Infections have been seen among newborns in nurseries, he said.

In an article in today's Washington Post, reporter Rob Stein gives some unbelievable new factoids.  http://www.washingtonpost.com/wp-dyn/content/article/2007/10/16/AR2007101601392.html?hpid=topnews

A dangerous germ that has been spreading around the country causes more life-threatening infections than public health authorities had thought and is killing more people in the United States each year than the AIDS virus, federal health officials reported yesterday.

The microbe, a strain of a once innocuous staph bacterium that has become invulnerable to first-line antibiotics, is responsible for more than 94,000 serious infections and nearly 19,000 deaths each year, the Centers for Disease Control and Prevention calculated.

MRSA is a strain of the ubiquitous bacterium that usually causes staph infections that are easily treated with common, or first-line, antibiotics in the penicillin family, such as methicillin and amoxicillin. Resistant strains of the organism, however, have been increasingly turning up in hospitals and in small outbreaks outside of heath-care settings, such as among athletes, prison inmates and children.

The CDC's Scott K. Fridkin discloses the results of a multi-state study of MRSA.  It yielded the following information:

In the new study, Fridkin and his colleagues analyzed data collected in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon and Tennessee, identifying 5,287 cases of invasive MRSA infection and 988 deaths in 2005. The researchers calculated that MRSA was striking 31.8 out of every 100,000 Americans, which translates to 94,360 cases and 18,650 deaths nationwide. In comparison, complications from the AIDS virus killed about 12,500 Americans in 2005.

"This indicates these life-threatening MRSA infections are much more common than we had thought," Fridkin said.

In fact, the estimate makes MRSA much more common than flesh-eating strep infections, bacterial pneumonia and meningitis combined, Bancroft noted.

"These are some of the most dreaded invasive bacterial diseases out there," she said. "This is clearly a very big deal."

The infection is most common among African Americans and the elderly, but also commonly strikes very young children.

So there are more deaths from MRSA in the United States that there are from HIV/AIDS, a recognized pandemic.  And perhaps MRSA is a candidate for true pandemic status, based on this snippet, also from the Bloomberg article of 2005:

The Netherlands has taken a ``search and destroy'' approach to drug-resistant superbugs, said Vincent Jarlier, an infection control officer for the Assistance Publique hospital network in France. Dutch doctors and nurses who test positive for the superbugs must have six negative tests before they can return to work, he said. Hospitals are required to shut down wards where the superbugs are detected; one hospital shut down ten at one time.

But wait, there's more!  Vietnam has had its own MRSA epidemic. From the National Institute of Health, published just last month:  http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1950567

An Outbreak of Severe Infections with Community-Acquired MRSA Carrying the Panton-Valentine Leukocidin Following Vaccination

We carried out a field investigation after adverse events following immunization (AEFI) were reported. We reviewed the clinical data from all cases. S. aureus recovered from skin infections and from nasal and throat swabs were analyzed by pulse-field gel electrophoresis, multi locus sequence typing, PCR and microarray. In May 2006, nine children presented with AEFI, ranging from fatal toxic shock syndrome, necrotizing soft tissue infection, purulent abscesses, to fever with rash. All had received a vaccination injection in different health centres in one District of Ho Chi Minh City. Eight children had been vaccinated by the same health care worker (HCW). Deficiencies in vaccine quality, storage practices, or preparation and delivery were not found. Infection control practices were insufficient. CA-MRSA was cultured in four children and from nasal and throat swabs from the HCW. Strains from children and HCW were indistinguishable. All carried the Panton-Valentine leukocidine (PVL), the staphylococcal enterotoxin B gene, the gene complex for staphylococcal-cassette-chromosome mec type V, and were sequence type 59. Strain HCM3A is epidemiologically unrelated to a strain of ST59 prevalent in the USA, although they belong to the same lineage.

So while we all try to figure out what the heck H5N1 is doing, remember that the Devil you know -- MRSA -- is out there, multiplying, mutating and killing.  Sometimes we'd prefer the Devil you know over the Devil you don't know.