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.
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