MRSA On The Upswing
Reuters Health, By Karla Gale, April 6, 2005

NEW YORK (Reuters Health) - The number of people in the general community, rather than in hospitals, who are becoming infected with the 'superbug' dubbed MRSA (for methicillin-resistant Staphylococcus aureus) is on the upswing in cities across the US, according to a report in this week's New England Journal of Medicine.

Severe cases of the infection have led to extensive loss of tissue, a condition called necrotizing fasciitis, a second article in the Journal reports.

Dr. Scott K. Fridkin, at the Centers for Disease Control and Prevention in Atlanta, and colleagues conducted a surveillance of hospitals in Atlanta, Baltimore and Minnesota from 2001 through 2002. They looked for instances of community-acquired MRSA infections, in which patients had none of the usual risk factors such asa history of hospitalization or an indwelling catheter.

"We started this study because there were reports of MRSA infection occurring in scattered outbreaks, and there was a debate if this was emergence of a new strain of staph in the community or if it was just 'leakage' of hospital-based MRSA into the community," Fridkin told Reuters Health.

Community-associated MRSA was diagnosed in 20 percent of 7819 cases of MRSA in Atlanta, 12 percent of 3714 in Minnesota and 8 percent of 1720 in Baltimore, the investigators report.

"This was a surprisingly high proportion of all MRSA that was community associated, much higher than we anticipated when we started the study," Fridkin said.

The infection primarily affected skin and soft tissue, and hospitalization was required by 23 percent of patients.

According to Fridkin, data from the study indicate "that the most appropriate and best way to treat staph infections still needs to be identified."

In the second report, Dr. Loren G. Miller and colleagues identified 14 cases of necrotizing fasciitis among 843 cases of community-acquired MRSA total at Harbor-UCLA Medical Center in Torrance, California, between January 2003 and April 2004.
Although the patients all survived, Miller's group notes that they often required radical removal of dead tissue with reconstructive plastic surgery or skin grafting. Ten of the patients had to be treated in the intensive care unit and some required mechanical ventilation.

Four of the 14 patients had no co-existing conditions or risk factors that might have predisposed them to severe MRSA infection.

There is "clearly an epidemic of MRSA in the community," Dr. Henry F. Chambers, from the University of California-San Francisco, states in a related editorial.
SOURCE: New England Journal of Medicine, April 7, 2005.