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Drug-resistant bacteria increasingly causing infections in healthy people
Infection Control Monitor, October 1, 2004
Numerous studies on the rise in infections caused by methicillin-resistant Staphylococcus aureus (MRSA) among healthy people outside of the hospital-nearly unheard of a few years ago-were presented this week at the 42nd annual meeting of the Infectious Diseases Society of America (IDSA) in Boston.
A strain that is resistant to standard first-line antibiotics is causing an emerging form of so-called "flesh-eating bacteria." The same type of bacteria, MRSA, is causing record numbers of less-serious skin infections in children and also is emerging as a cause of pneumonia, which can be deadly.
MRSA is a concern because antibiotics prescribed by physicians only a few years ago typically no longer work. Over time, bacteria can mutate and become resistant to specific antibiotics. Effective antibiotics are available to treat MRSA, but physicians are concerned that the bacteria will eventually become resistant to those as well. Drug-resistant infections have long been a problem in hospitals and among the elderly and chronically ill, but in recent years physicians are seeing these infections more and more in healthy people.
One study presented at the IDSA meeting documented 14 cases of necrotizing fasciitis (known as the flesh-eating bacteria) in Los Angeles caused by MRSA, an uncommon cause of the illness. None of the patients died, but all had surgery to remove infected flesh, three needed reconstructive surgery (such as skin grafting), and 10 spent time in the intensive care unit, one for a month. Half originally were thought to have less-serious skin abscesses. Four patients initially were given antibiotics to which the bacteria were resistant, but all 14 patients were eventually successfully treated with the antibiotics vancomycin/clindamycin.
Necrotizing fasciitis infections can start in a small cut or trauma and spread throughout the body within hours or days if not treated with surgery and antibiotics. Most cases of necrotizing fasciitis result from a different type of bacteria called Group A streptococcus (the same type of bug that causes strep throat) and about a third are fatal.
Researchers say physicians need to be aware that if they see cases of necrotizing fasciitis, they should treat patients for MRSA in addition to the other known causes until they know the causing bacteria.
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