Drug-Resistant Infections on the Rise

More cases of 'flesh-eating bacteria' seen

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HealthDay Reporter

THURSDAY, Sept. 30, 2004 (HealthDayNews) -- A bacterium that is becoming more resistant to first-line antibiotics is causing record numbers of skin infections in otherwise healthy children, according to a new study.

The bacterium, called methicillin-resistant Staphylococcus aureus (MRSA), is also emerging as a cause of pneumonia, which can be fatal. And while MRSA has been considered an uncommon cause of necrotizing fasciitis -- a rare bacterial infection, sometimes called "flesh-eating bacteria" -- another report documents 14 such cases in Los Angeles.

MRSA "has been a concern for a couple of decades," said Dr. Kevin Purcell, principal investigator of the first study and a health-care consultant for Driscoll Children's Hospital in Corpus Christi, Texas.

While the bacterium used to affect primarily hospitalized patients, in the last few years more and more such infections are being detected in healthy people who haven't been hospitalized, he said, implying that they are picking up the infection from the community.

The work is to be presented Oct. 1 at the Infectious Diseases Society of America's annual meeting in Boston.

His team tracked the records of S. aureus infections in the Driscoll Children's Hospital and its clinic, comparing data from 2002 and 2003 with that from 1990 to 2001, including whether the infections were community-acquired.

"We are seeing over 500 cases a year in the hospital, clinic and emergency department," said Purcell. "In the mid 90s, we had about five cases a year."

"We are not quite sure why we are seeing so many of these out in the community, and why the number has skyrocketed so fast," he said.

"These community-acquired MRSA infections are genetically different than hospital-acquired," Purcell said. "It's a new strain of the bacteria that is out there in the community and it's different."

The good news, he said, is that the community-acquired organism is more susceptible to antibiotics. "It's a little easier to treat than the hospital-acquired one."

The infection can be stopped if detected early, Purcell said. Normally, it first shows up as a redness or swelling on the skin, or as a pustule. "Parents recognize it as an infection," he said.

The problem often happens, he said, when kids get breaks in the skin or an insect bite and the area becomes infected with the organism.

"The fatality rate is far less than 1 percent," he said. But it does need prompt attention so that antibiotic therapy can be prescribed to treat it. "About 5 percent of children will have some more invasive, life-threatening infection," Purcell said, when it goes to the bloodstream, causing sepsis, or to the lung, causing pneumonia.

Left untended, patients can also get necrotizing fasciitis, in which skin and underlying tissue are destroyed rapidly.

In another presentation at the meeting, researchers from California reported on 14 cases of necrotizing fasciitis caused by MRSA. All patients were admitted to Harbor-UCLA Medical Center in Torrance between February 2003 and April 2004. All survived, but many needed a prolonged stay in the intensive care unit.

And in a third presentation, researchers from the U.S. Centers for Disease Control and Prevention and other institutions reported on 17 people in nine states who got pneumonia caused by MRSA outside the hospital during last year's flu season. (While S. aureus is a common cause of pneumonia in hospitalized patients, the resistant form of staph is now emerging as a cause of pneumonia in healthy, non-hospitalized people, the researchers found.)

Of the 17, five died, 16 were hospitalized for 22 days on average, and 12 had to be admitted to the intensive care unit.

In a prepared statement, Dr. Joseph R. Dalovisio, the society president, said: "These reports highlight our concern over the crisis of antibiotic resistance, a problem that is magnified because there simply aren't enough new drugs in the pharmaceutical pipeline to keep pace with the evolution of drug-resistant bacteria, the so-called 'superbugs.' This crisis has the potential to touch us all, because drug-resistant infections can strike anyone -- young or old, healthy or chronically ill."

While the problem is a challenge for health-care providers and public health officials, Purcell said consumers can help reduce the problem by being sure everyone in a household gets medical attention if they suspect others have the bacteria.

More information

To learn more about infectious diseases, visit the Infectious Diseases Society of America.

SOURCES: Kevin Purcell, M.D., Pharm.D., health-care consultant, Driscoll Children's Hospital, Corpus Christi, Texas; Oct. 1, 2004, presentation, Infectious Diseases Society of America annual meeting, Boston; Infectious Diseases Society of America statement

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