RESEARCH - Antibiotic-resistant staph now a major threat

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Antibiotic-Resistant Staph Now a Major Threat

08.16.06, 12:00 AM ET

WEDNESDAY, Aug. 16 (HealthDay News) -- In emergency rooms across the United

States, a tough-to-treat staphylococcus bug is now the leading cause of skin

and soft-tissue infections, a new study finds.

Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to many

standard antibiotics that have been used for years, but it can still be

effectively treated with one of several antibiotics, experts say.

" MRSA is now the most common cause of skin infections in most of the big

U.S. cities, " said researcher Dr. Moran, a professor of medicine at

the University of California, Los Angeles, Geffen School of Medicine.

" When doctors are deciding if a patient needs antibiotics, they should be

given them antibiotics that cover MRSA. That's a change from things we've

been doing for a decade. This has changed. A different type of bacteria is

now the most common cause of infections. "

The study is published in the Aug. 17 issue of the New England Journal of

Medicine.

In the same issue of the journal, another study found that the antibiotic

daptomycin is effective for treating bloodstream and heart infections caused

by Staphylococcus aureus bacteria.

Based on this trial, the U.S. Food and Drug Administration has already

approved the drug for use in these cases. Daptomycin has previously been

approved for treating skin infections caused by S. aureus.

MRSA was, for a long time, limited to hospitals, nursing homes and other

health care facilities. " It began to change several years ago, " said Dr.

Pascal Imperato, distinguished service professor and chairman of the

department of preventive medicine and community health, at SUNY (State

University of New York) Downstate Medical Center in New York City. " We began

to see it in people in the community who were not in hospitals. "

The bacteria live uneventfully in the nose of many people but sometimes lead

to serious infection. Symptoms can range from something as benign as an

infected paper cut, to bloodstream infections, to infections of heart valves

that can be fatal.

Community-associated MRSA most often appears on the skin as a boil or pimple

that may be swollen, red and painful, and have a discharge.

Moran and his colleagues cultured skin or soft-tissue infections from 422

patients at emergency rooms in 11 cities across the United States.

" This was the first time that anyone did a broad slice across the whole

U.S., " Moran said.

Of those 422 patients, 59 percent had MRSA. The prevalence of MRSA ranged

from 15 percent to 74 percent, depending on the city.

One genetic type (USA300) accounted for 97 percent of the samples, and 74

percent were a single strain (USA300-0114).

" We weren't surprised that it was the most common bug overall, " Moran said.

" But we didn't know how uniform it was going to be, and all across the U.S.,

it was remarkably similar. There's something about this particular strain

[uSA300] that gives it some survival advantage over other types. "

Almost all (98 percent) of the isolates had two toxins that make the germ

more aggressive.

When tested, 95 percent of the MRSA samples could be treated with the

antibiotic clindamycin, 6 percent with erythromycin, 60 percent with

fluoroquinolones, 100 percent with rifampin and

trimethoprim-sulfamethoxazole, and 92 percent with tetracycline.

But in 57 percent of cases, doctors had prescribed an antibiotic to which

the bacteria were already resistant.

In the second trial, daptomycin was about as effective as standard therapy

in treating patients. This trial was sponsored by Cubist Pharmaceuticals,

which makes daptomycin.

" Daptomycin is an IV drug, so that's something that we would use for more

serious infections that would need to be in the hospital, " said Moran, who

was not involved in this study. The infections studied were also not as

uniform as the ones identified in the first study.

There are already several effective drugs for the type of skin and

soft-tissue infections Moran studied. " Many of the drugs active against

community strains of MRSA are older antibiotics that have been around for a

long time, " Moran said. " We don't really need to go with big, new, expensive

antibiotics. "

" Most infections occurring in the community are relatively mild and

frequently resolve with very simple measures, " Imperato added.

People can prevent infections by not sharing towels, razors or other common

items, and by washing hands with soap and water, experts say.

More information

Find out more about community-acquired MRSA at the U.S. Centers for Disease

Control and Prevention.

http://www.forbes.com/forbeslife/health/feeds/hscout/2006/08/16/hscout534404.htm\

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Not an MD

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org