Antibiotic-resistant skin infections spreading among gay men, also in prisons.

In the last few months doctors have seen a large increase in aggressive, antibiotic-resistant "staph" (Staphylococcus aureus) skin infections in gay men in some areas -- and a separate epidemic in certain prisons. Symptoms include boils or blisters; treatment can be difficult, and sometimes requires hospitalization. One HIV doctor in Los Angeles who used to see about one case a year is now seeing two a week. In the past this infection occurred mainly in hospitals.

Physicians should note a February 1, 2003 review in the British Medical Journal ("Old Drugs for New Bugs," BMJ 2003; volume 326, pages 235-236) on evidence for the value of older antimicrobials for resistant bacteria, including staph. It suggests using co-trimoxazole (Bactrim[R] or other brand names) as an alternative to vancomycin for resistant S aureus (also called MRSA). In one case co-trimoxazole was used successfully after a patient had failed the new and very expensive antibiotic linezolid (Zyvox[R]). The article is at:

http://bmj.com:8O/cgi/content/full/326/7383/235?maxtoshow=?eaf

Below is a fact sheet published by the Los Angeles County Department of Human Services on how to avoid the infection (or avoid spreading it if you have it). Also, a fact sheet by the U.S. CDC, revised February 7, 2003, is at:

http://www.cdc.gov/ncidod/hip/aresist/mrsafaq.htm

For a recent overview, see "Skin Infection Spreads Among Gay Men in L.A.," Los Angeles Times, January 27, 2003.

Fact Sheet Published by Los Angeles County Department of Human Services

Antibiotic-resistant "Staph" Skin Infections

Recently, doctors in Los Angeles have been seeing an increasing number of patients with skin infections caused by Staphylococcus aureus ("Staph") bacteria that are resistant to many antibiotics (drugs that kill bacteria). The Los Angeles County Department of Health Services is working with doctors and other healthcare providers to better understand why this is happening and how to prevent antibiotic (drug) resistant Staph infections from spreading.

What is a Staph infection? Staph is a bacteria commonly found on human skin. Sometimes it does not cause any problems; sometimes it causes minor infections, such as pimples or boils. Staph skin infections often begin with an injury to the skin. Staph enters the skin weakened by the injury and develops into an infection. Symptoms of a Staph infection include redness, warmth, swelling, tenderness of the skin, and boils or blisters.

How do Staph skin infections spread? The cleanest person can get a Staph infection. Staph can rub off the skin of an infected person onto the skin of another person during prolonged (skin to skin) contact between them. Or, the Staph can come off of the infected skin of a person onto commonly shared objects and surfaces, and get onto the skin of the person who uses it next. Examples of commonly shared objects include personal hygiene objects (i.e. towels, soap, clothes), benches in saunas or hot tubs, and athletic equipment--in other words, anything that could have touched the skin of a Staph infected person can carry the bacteria to the skin of another person.

How can I prevent myself from getting infected? Avoid prolonged skin to skin contact with anyone you suspect could have a Staph skin infection. Do not share personal items with other persons. Clean objects and surfaces that you share with other persons, such as athletic equipment, before you use it. Always wash your skin, clothes, and towels that might be carrying Staph.

What should I do if I think I have a Staph skin infection? If you suspect that you might have a Staph skin infection, consult your doctor or healthcare provider as soon as possible. Early treatment can help prevent the infection from getting worse. Be sure to follow each direction from your doctor or healthcare provider closely, even when you start to feel better. Weak or incomplete treatments of Staph infections lead to stronger, antibiotic-resistant bacteria.

If my health care provider has told me that I have an antibiotic-resistant Staph infection, what can I do to keep others from getting infected? You can prevent spreading an antibiotic-resistant Staph skin infection to those you live with or others by following these steps:

1. Keep the infected area covered with clean, dry bandages. Pus from infected wounds is very infectious.

2. Wash your hands frequently with soap and warm water, especially after changing your bandages or touching the infected skin.

3. Regularly clean your bathroom and personal items. Wash linens and clothes that become soiled with hot water and bleach, when possible. Drying clothes in a hot dryer, rather than air-drying, also helps kill bacteria in clothes.

4. Tell any healthcare providers who treat you that you have an antibiotic-resistant Staph skin infection.