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Community-based, resistant staph infections on the rise

Aug 20, 2006 | Milwaukee Journal Sentinel More than half of patients arriving at emergency rooms with skin lesions have drug-resistant staph infections, and doctors aren't necessarily following all the steps to make sure they prescribe the correct antibiotic, a new study shows.

Experts advise doctors to first drain the sores and then culture the infection before prescribing an antibiotic.

This treatment regimen is not new, said M. Lindsay Grayson, a leading expert on infectious disease who wrote an editorial that accompanied that study.

"However, over the years many doctors have simply assumed that the staph strain causing the infection will be susceptible to the routine antibiotics they choose," said Grayson, a professor of medicine at the University of Melbourne in Australia.

Methicillin-resistant Staphylococcus aureus, or MRSA, infections occur frequently among people who have been hospitalized or who have been taking antibiotics for an extended period.

However, these infections have become increasingly common among people who haven't been near hospitals or other health care settings.

Previously, the Centers for Disease Control and Prevention estimated that at least 12% of drug-resistant staph infections are picked up in the community and have no link to health care settings.

But a study published in the latest New England Journal of Medicine found that 59% of skin and soft tissue infections among patients seen at 11 emergency rooms around the country were caused by community-associated MRSA infections.

Although more than 80% of those patients were treated with antibiotics, doctors prescribed an inappropriate drug in 57% of the cases.
When 'normal' staph goes bad

MRSA infections are resistant to commonly prescribed antibiotics called beta-lactams, which include methicillin, penicillin and amoxicillin.

"This finding suggests a need to reconsider empirical antimicrobial choices for skin and soft-tissue infections in areas where MRSA is prevalent in the community," the study says.

"The high prevalence of MRSA among patients with community-associated skin and soft-tissue infections has implications for hospital policies regarding infection control," the article states. "Standard precautions (including the use of gowns and gloves by health care workers for contact with wound drainage) should be used for all patients."

Staph bacteria normally are carried on the skin or in the noses of healthy people.

If staph enters the body, which usually happens through cuts on the skin, it can cause infections that range from pimples and boils that can be treated without antibiotics to more serious complications such as surgical wound infections, bloodstream infections and pneumonia.

Though scientists aren't sure how MRSA infections migrated from hospitals into the community, factors such as crowded living conditions, cuts on the skin, poor hygiene and close skin-to-skin contact have been associated with spreading the infection, the CDC says.

Many cases are found among children, athletes, prisoners and military recruits, they say.
Local efforts

MRSA is not a reportable illness in Wisconsin, but some Milwaukee doctors say they've been seeing more community-associated MRSA infections in their practices.

"Community-associated MRSA is definitely here to stay," said David Fisk, an assistant professor of medicine in the division of infectious diseases at the Medical College of Wisconsin who practices at Froedtert Memorial Lutheran Hospital. "It's something we have seen, like wildfires, taking over for the last four or five years."

In 2004, there were 202 patients admitted to Froedtert with MRSA infections, compared with 222 cases seen in 2005, said Charles Edmiston, a professor of surgery at the Medical College of Wisconsin and epidemiologist with the hospital.

The hospital estimates that 250 to 260 cases will be seen this year.

Froedtert has initiated a two-year study to determine how cases of community-associated MRSA happen among people with diabetes because they are at high risk for development of skin infections, Edmiston said.

Physicians at Wheaton Franciscan Healthcare-St. Francis typically see about 10 cases of community-associated MRSA each month, said Pat Skonieczny, an infection control coordinator for the hospital.

"This is a growing burden in the public health field," said Paul Biedrzycki, the Milwaukee Health Department's manager of disease control and prevention. "We need to increase our intervention and prevention efforts to fight these infections."

And a lot of that can start with the basics, such as good hygiene and hand-washing, Fisk said.

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