Experts see rise in staph infections.

Byline: Tim Christie The Register-Guard

When Deborah Willis first noticed the angry sore on her stomach, she thought it was a spider bite, but within a few days, she said, it looked more like a bullet hole.

The first round of antibiotics prescribed by a doctor did nothing to heal the nasty-looking infection, and soon another sore appeared on her thigh. Willis is now on her third different antibiotic, and if this round doesn't work, she may be in for 14 days of intravenous antibiotics in the hospital, she said.

"I'm terrified of having to go to the hospital about this," she said.

What doctors finally suspected, and lab tests confirmed, is that Willis, a 43-year-old Eugene woman, has a virulent staph infection that has become resistant to the usual antibiotics used to treat the bacteria.

Long a problem in hospitals and nursing homes, drug-resistant staph infections are now becoming more common among the general population in Eugene and Springfield and around the country.

Hard numbers are hard to come by because doctors aren't required to report the infections, known as methicillin-resistant Staphylococcus aureus, or MRSA. But public health officials, emergency doctors and infection control specialists say MRSA is on the rise.

"At this point the only thing we can say is MRSA appears widespread in the community," said Nicole Coffin-Ott, spokeswoman for the Centers for Disease Control and Prevention in Atlanta. "It's an emerging disease."

Local hospitals have seen sharp increases in the number of people coming into the emergency room with MRSA.

At Sacred Heart Medical Center in Eugene, 104 cases of community-acquired MRSA were found from July 2003 to December 2003. From July 2004 to December 2004, there were 278 cases, said Susan Kline, infection control coordinator for PeaceHealth, Sacred Heart's parent corporation.

At McKenzie-Willamette Medical Center in Springfield, infection control practitioner Cathy Stone has been tracking MRSA since 1997, when just four cases were detected. After a "major jump" in 2003, Stone counted nearly 200 cases of MRSA in 2004 at McKenzie-Willamette, most of them acquired in the community. So far this year, they've had 38 cases.

The best protection, health experts say, is frequent hand washing and good personal hygiene. That's because the bug is most often spread from direct, skin-to-skin contact.

"This might be resistant to antibiotics, but it's not resistant to hand-washing," said the CDC's Coffin-Ott.

Staph are a class of bacteria commonly carried on the skin or in the nose of healthy people. About 25 to 30 percent of the population carries staph, and about 1 percent carries drug-resistant staph.

When someone carrying staph gets a cut or an abrasion on their skin, and the bacteria gets inside, that causes a staph infection. Most are minor, such as pimples and boils, and treatable with antibiotics, also known as antimicrobials or antibacterials. But staph also can cause serious infections, such as surgical wound infections, bloodstream infections and pneumonia.

The strain of MRSA that's emerging in the community carries a toxin called PVL that destroys skin tissue, causing ulcerating skin lesions, said Dr. John Townes, assistant professor of infectious disease at Oregon Health & Science University Medical School.

Inappropriate use of antibiotics is at least partly to blame for these bacteria becoming resistant to the usual treatment, Coffin-Ott said, although MRSA is still treatable with the right antibiotics.

The bacteria is forcing doctors to change the way they treat seemingly routine skin infections, and to change the antibiotics they use to treat infections.

In the past, doctors in the Sacred Heart emergency department would treat a patient with a skin infection for MRSA if they were injection drug users, or had spent time in close confines, such as the jail or a homeless shelter, said medical director Dr. Gary Young.

But now, "We're treating pretty much everybody as if they had it," regardless of risk factors, he said. "Now it's starting to spread to everybody."

In the past year, ER doctors switched the type of antibiotics they use for treating MRSA "because we don't want to give an antibiotic that doesn't work," Young said.

Certain groups are most at risk: Athletes, particularly football players and wrestlers; military recruits; injection drug users; children; men who have sex with men; Pacific Islanders; American Indians and Alaskan Natives.

The Los Angeles County Jail has been hit hard, with about 2,000 cases, Coffin-Ott said.

Numerous athletic teams, from high schools to the pros, have been hit with the bug. That's why the CDC is working with the National Football League and the NCAA to develop prevention programs.

CDC investigators reported last month on an MRSA outbreak on the St. Louis Rams' football team in 2003. Five players were infected that season, and three had recurring infections; all of the infections occured where players suffered turf abrasions. While none were sent to the hospital, each of the players had abscesses that required incisions and drainage, and three missed a total of 17 days of practices or games.

The researchers said the Rams probably were infected during practice and games, and use of communal whirlpools and sharing of towels may have played a role in the outbreak.

To date, no University of Oregon athletes have been diagnosed with a MRSA infection, said Dr. Bob Crist, director of athletic medicine and team physician. "We've not had anyone hospitalized for any skin infections," he said.

Basketball player Cathrine Kraayeveld missed 13 games in the 2002-03 season with a staph infection in her right knee, but that was not MRSA, Crist said.

UO trainers now make a point of talking to athletes about MRSA. "If they see a cut or abrasion or a pimple, they need to have someone look at it and make sure it's nothing more serious," he said. Trainers also make sure to aggressively treat cuts and abrasions, most often suffered by wrestlers and football players, Crist said.

Stone, the infection control practitioner at McKenzie-Willamette, said MRSA is just the most prominent example of an emerging problem.

"For me, because I'm also a microbiologist, I can see this evolution and increase in bugs," she said. "It's not just MRSA we need to be concerned about. I'm seeing resistance in so many other types of bacteria. Unless there's some other changes, these other bugs are going to fall in these high numbers as well."

PREVENTING STAPH

To prevent drug-resistant staph infections:

Wash hands thoroughly with soap and water or use an alcohol-based hand sanitizer 

Keep cuts and scrapes clean and covered with a bandage until healed

Avoid contact with other people's wounds or bandages

Avoid sharing personal items such as towels or razors

- Centers for Disease Control and Prevention