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A rising tide of drug-resistant staph infections

Spider bites and pimples that just won't heal.

That's how parents are describing their children's skin infections that turn out to be caused by a deadly strain of drug-resistant "staph" bacteria, says C. Buddy Creech, M.D., M.P.H., assistant professor of Pediatric Infectious Diseases.

Creech has been following the rising tide of cases of community-associated methicillin-resistant Staphylococcus aureus, MRSA, and he's concerned.

He describes deaths of children, particularly adolescents, who are healthy and then develop sudden, devastating disease.

"These are cases where a child has a fever on Saturday night, feels bad on Sunday, collapses in the pediatrician's office on Monday, and then dies. It's horrible."

Skin abscesses are the most common presentation, and recent MRSA outbreaks have occurred among athletes, prisoners and tattoo recipients, with the germ spreading through skin contact or shared items like towels.

Of the skin abscesses treated in the adult and pediatric emergency departments at Vanderbilt from Nov. 1, 2004 to Oct. 31, 2005, about 70 percent were positive for MRSA, according to a study conducted by Thomas Talbot, M.D., assistant professor of Medicine.

These findings mirror the national scene. A study published this summer in the New England Journal of Medicine reported that 59 percent of all skin infections among adults treated in emergency rooms in 11 U.S. cities in August 2004 were caused by MRSA.

"We culture every abscess now," Creech says. "Not only do we want to know if it's MRSA, we want to keep tabs on what MRSA is doing – is it becoming resistant to the drugs that we think still work?"

Physicians have been able to turn to some "old" antibiotics to treat community-associated MRSA, sulfa-type drugs like Bactrim that were not being routinely used because other germs had developed resistance to them, Creech says.

"There are two MRSA treatment arms right now – we still have a small number of drugs that are easy to give to people at home for uncomplicated MRSA infections, and we have several intravenous drugs, such as vancomycin, that we reserve for the critically ill patients."

With any of these antibiotics, Creech warns, "it's the finger in the proverbial dike. We will inevitably see resistance – it's just a matter of time."

Wendy Inman, a 30-year-old mother of three from Waynesboro, Tenn., knows about resistance firsthand.

She has battled skin abscesses caused by MRSA for the past three years. Because of repeated boils in her underarm area, both wearing clothing and letting her arms hang at her side have been painful.

Bactrim would help for only about six weeks, then the pus-filled cysts would return. She was referred to Vanderbilt's Patty Wright, M.D., assistant professor of Medicine, in June, and prescribed Bactrim and a decontaminating-cleansing regimen that has kept the skin abscesses at bay.

Twice a day, for the first week of each month, Inman cleanses with a surgical-type scrub and uses an antibiotic nasal ointment. She also takes diluted bleach baths twice a week during that week, and takes a daily dose of Vitamin C. "People who have never had this don't realize how bad this is," she said. "It's like living with a toothache, a constant pain. But, now, it's such a blessing to be free of pain," she says.
- Leigh MacMillan and Nancy Humphrey


A rising tide of drug-resistant staph infections

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