Peg McQueary is at war with bugs. They live inside her and she often leaves the invisible critters behind on the surfaces she touches. She can't see her enemies, only the nagging evidence they leave behind on her body.
They're microscopic and a million years old. Her weapons for battling them are heavy-duty antibiotics and disinfectants such as Lysol and bleach that she uses to clean her home. Despite her constant fighting back, the bugs are outsmarting her.
"There's a war between bugs and drugs, and the bugs are winning," said McQueary, who is 43 years old and lives in Roseville, Calif.
Her battle started three years ago, when she nicked her leg shaving on New Year's Eve.
"Two weeks later I was sicker than anybody can imagine — fever, nausea, just fatigued, very badly fatigued," McQueary said.
McQueary had no idea that her illness had anything to do with the small cut on her leg. She took a few days off from work and noticed that her leg and ankle had swelled.
"My leg and my ankle swelled to almost three times its normal size," McQueary said. "I got into the doctor, and he took one look at it and said, 'Oh my God, Peg, I think this is MRSA.'"
MRSA stands for methicillin-resistant Staphylococcus aureus, and is one of a number of bacterial infections commonly found in hospitals. But now, it is being found with an increasing frequency outside hospitals. McQueary isn't sure where she got it.
"That's what's frightening — very frightening— because everything that you touch has a potential of having that illness on it," McQueary said. "Elevator buttons, stairways, your keyboards at work, your telephones at work, it's everywhere."
Dr. Chip Chambers, chief of the Infectious Diseases Division at San Francisco General Hospital, said MRSA is an organism that stays with you but doesn't always affect those it lives within. MRSA can become fatal when it enters a sore or a pimple and gets into the bloodstream. The bacterial infection that was once confined to hospitals has now spilled out into communities at alarming rates, Chambers said.
"In the mid '90s and later, these strains began to be detected in people who had no hospital contact," Chambers said.
MRSA, and other bacterium like it, have become so prevalent in communities, and so resistant, that it's called a superbug. Chambers said the superbug is fatal in about 10 to 20 percent of cases in which there is a bloodstream infection.
As recently as mid-February, a 20-year-old college student in Washington state thought he was was battling the flu before he died from MRSA. The Centers for Disease Control and Prevention said that 19,000 Americans die from the infection each year.
CA-MRSA, which signifies the community-acquired kind of MRSA, came full focus in the news last fall after a 12-year-old middle school student, Omar Rivera, died from it in Brooklyn, N.Y. His death set off a panic in schools. That same month, 17-year-old Ashton Bonds, a Virginia high school football player, died after contracting it. News of the so-called superbug was everywhere and catching doctors by surprise. They were not used to seeing the infection outside of hospitals, and were too often missing the signs.
Anyone can get a staph or MRSA infection, Chambers said.
"The way you tell is, typically, it's the appearance of a boil," Chambers said. "Classic features are … redness, the skin is warm, it's tender, there may be swelling and there may be drainage of pus."
After the initial infected injury on McQueary's leg, there were more boils and sores that refused to heal. McQueary said that MRSA living inside of her has damaged muscles and tissue, and she believes that because her boils were not drained properly, the MRSA continued to thrive in her system. She's also quick to point out that people who believe they show signs of the infection should insist on a culture for MRSA.
"It's permanently in your system, McQueary said. "It can lie dormant. Some people never get it again, but some are like me." McQueary has been fighting off MRSA for three years now. Despite all the different antibiotics and precautions she takes, the infection keeps coming back.
Before the infection took over her life, McQueary and her husband used to make their living showing their prized Bernese mountain dogs. With the constant pain and therapy she can't do that anymore.
"I'm still doing pain management, still taking Norco, valium, just to get through my day with my leg because of the cramping and the spasms and the pain that goes through my leg," McQueary said. And as of today, McQueary is on two new antibiotic IV drips to fend off the latest recurrence of MRSA infection.
McQueary lives at home with her husband, their two children and toddler grandson. Her priority is to keep them safe. She makes sure that her 19-month-old grandson's hands are wiped and washed all the time to kill any staph bacteria. So far, none of her family members have contracted MRSA.
McQueary finds some comfort in doling out advise to other MRSA sufferers by sharing her experience with them on a Web site she moderates called MRSA Resources
Through her work with others on the Web site and through following news reports, McQueary knows that her story is actually quite common. " My case is not much different than thousands of others, it's crazy," she said.
Chambers and other infectious disease doctors are concerned that eventually the drugs they use to treat MRSA will stop working.
"We may eventually lose what drugs we do have, [and that] is a real concern in treating MRSA infections," Chambers said. "We know from the experience in the hospital that this organism-type of bacteria is very adept at adapting to any antibiotic that we throw at it."
Common infections are treated with a week or 10 days of antibiotics and they're gone, but McQueary has tried dozens of antibiotics and her infection goes away only to come back again.
Finding an antibiotic that works is not as easy as it used to be because bacteria grow more virulent over time. In a lab at the University of California at San Fransisco, where the latest and most aggressive MRSA strain, USA300, was discovered, researchers match patients with antibiotics they hope will cure them.
Using bacteria from infected patients, Dr. Jeff Brooks grows ''lawns'' of germs in petri dishes and adds tiny spots of antibiotics. He then waits 24 hours to see what works on that particular strain. The results show how complicated finding an antibiotic can be. After all, bugs such as MRSA are organisms whose very DNA is designed for survival.
Said Chambers: "They can mutate. They can adapt to virtually any pressure that we expose them to and the most important one now is antibiotics. From the bacteria point of view, antibiotics are the biggest problem they've had to face in their evolution and they're doing a good job of adapting."
There are antibiotics in the pipeline for some infections, including MRSA, but they are slow to arrive on the market and few are in a convenient pill form.
"The problem is oral drugs," Chambers said. "Most of these are not oral; they require intravenous administration."
That presents patients with a difficult and costly outlook for hospital treatment. The antibiotics that McQueary is getting right now are daptomycin and cephazolin.
"If I become resistant to the daptomycin, we don't know what we're going to do," she said.
Part of the problem is that developing antibiotics isn't a priority for pharmaceutical companies, according to the chairman of the University of California at San Franciso's Department of Clinical Pharmacy, Dr. Joseph Guglielmo.
"I would say for pharmaceutical companies, frankly, there is not as great a fiscal incentive to produce new anti-infectives as opposed to drugs for chronic disease states," he said. "And the reason for that is you give an antibiotic that may only be given for seven days. As opposed to, let's say a cholesterol-lowering drug, or an anti-depressant, which is given to you for the rest of your life, the fiscal return on the investment is better with those."
In fact, antibiotic development has dropped off dramatically. During the five-year period ending in 1987, the Food and Drug Administration licensed 16 new antibiotics. But in the five-year period ending in 2007, only five were approved.
The overuse and misuse of antibiotics is believed to be part of why the MRSA bug is growing so strong. There seems to be a general widespread practice of prescribing antibiotics for bacterial infections sometimes even before we are certain that the infection being treated is bacterial.
"We're too quick to give antibiotics," Chambers said, adding that the more we use them, the faster bacteria evolve to resist them.
"We would not have drug resistance if we did not have drugs. It's that simple," Chambers said. "Of course, we have to have antibiotics and antimicrobial drugs that are used to treat infections, but there is this tradeoff in using antibiotics."
Doctors regularly talk about a "post-antibiotic era" and if history is any indication, we are well on our way. The overprescribing and misuse of antibiotics have long been eroding their effectiveness.
Penicillin was the wonder drug of the 1940s, but now it is rarely prescribed. Cipro was once considered a miracle drug. In 1999, it worked on 95 percent of e-coli specimens. By 2006, it was effective only 60 percent of the time.
"When nature confronts an adversity there is a mutation that takes place to allow it to survive, and I think these bacteria are very simply trying to survive," Guglielmo said.
While doctors advise people to use antibiotics only when they're needed, the best prevention against MRSA is to wash hands with soap and water for at least 30 seconds at a time. It's a message that Peg McQueary has taken to heart
"This is all you need to wash your hands with. Just plain old soap and water. You don't need antibacterial that they're selling in the stores, plain old soap and water and wash your counters down, your door handles with bleach and make sure you've got your Lysol spray."
McQueary is in the practice of religiously spraying Lysol on her door handles, and washes all floors and counters with bleach every day. While MRSA has certainly changed her habits, the toll it has taken on her life and on her family is far more dramatic.
"It's changed everybody's life -- it's put everything on hold. Our biggest love is getting out there and showing our dogs, and that has just been nonexistent."
The Bernese mountain dogs have to be satisfied with short walks around the neighborhood for now.
"I hope to just be able to have the strength to go back out, show my dogs, do the things that we used to do before I got sick and just take it one day at a time. Deal with it one day at a time. If another boil comes, we deal with it. Just as we've been doing for the last three years."