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Antibiotic-Resistant Staph Now 'Epidemic'

Infection has moved from hospitals to general community, experts say

THURSDAY, Aug. 31, 2006 (HealthDay News) -- The prevalence of an infectious antibiotic-resistant Staphylococcus aureus bacteria has now reached the level of a global pandemic, experts warn.

Of some 2 billion individuals estimated to be carrying S. aureus worldwide, anywhere from 2 million to 53 million are now believed to be carrying the methicillin-resistant strain, conclude the authors of a review article published in this week's edition of The Lancet.

The rise of methicillin-resistant S. aureus (MRSA) is a symptom of a larger global problem, said outside experts.

"The issue is broader than MRSA," said Dr. Edward Chapnick, director of infectious diseases at Maimonides Medical Center in New York City. "The issue is antibiotic resistance as a whole. That's not the only resistant organism. It's a big problem, but it's not the only one, and at least it's treatable."

MRSA is indeed resistant to many standard antibiotics that have been used for years, but the bug can still be effectively treated with one of several antibiotics.

The bacteria lives uneventfully in the noses of many people, but sometimes it can trigger serious infection. Symptoms can range from an infected paper cut, to bloodstream infections, to infections of heart valves that can be fatal.

MRSA was, for a long time, limited to hospitals, nursing homes and other health care facilities or to people who had frequent contact with such facilities. In 1993, however, new strains among people who had not been in contact with the health care system emerged in Western Australia.

This development "heralded the worldwide recognition of the striking evolution of genuine community-acquired MRSA strains," wrote the authors of the The Lancet article, who are affiliated with the European Antimicrobial Resistance Surveillance System in the Netherlands.

The most pressing question now, experts say, is how to control the problem.

Screening can be effective but is also controversial. Many people without apparent infection carry the bug and can still spread it. "That's an issue that's really unresolved at this point," Chapnick said. "Logistically, it is very hard to do a culture on every patient. We don't have any proof that that measure by itself is beneficial."

Indeed, the authors say screening of high-risk patients, in tandem with hygiene and education, is more likely to make a real dent in transmission rates.

Hand hygiene is also extremely important, for health care workers and for "regular" individuals. "If we could, all of us, to do better at hand hygiene, I think that's far and away the biggest bang for the buck," Chapnick said.

In the community, people should avoid activities such as communal bathing and sharing towels.

And antibiotics should be reserved only for bacteria, not viruses. "The next piece of the puzzle is using antibiotics better, not just prescribers but also consumers," Chapnick said.

These advisories are taking on a new importance in light of recent developments.

The Lancet article points out that new MRSA clones have emerged in the community that combine antibiotic resistance with easy transmissibility and virulence. The worry is that these could take hold in hospitals, where patients are particularly vulnerable.

An accompanying commentary by Dr. Ian Gould, of the Aberdeen Royal Infirmary, Scotland, points out that the bug can be extremely destructive.

During the 1950s, a virulent staphylococci caused sepsis (blood infection) in 30 percent of those it colonized. And, during the 1918-19 influenza pandemic, staphylococcal pneumonia was a leading cause of death in the young.

"What will happen if there is another influenza pandemic, and we have done nothing to control community-acquired MRSA?" Gould asked.

More information

Find out more about community-acquired MRSA at the U.S. Centers for Disease Control and Prevention.

SOURCES: Edward Chapnick, M.D., director, infectious diseases, Maimonides Medical Center, New York City; Sept. 2, 2006, The Lancet
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