Drug-Resistant Bug Becoming More Common

Antibiotic-resistant staph infections are eight times more common than thought.

June 25, 2007— -- Fifty-six-year-old Sandi Sampson dusted herself off after falling in her backyard. Her ankle hurt, but she thought the pain would go away on its own.

As days passed, however, she realized that she wouldn't be able to just shrug this one off.

Sampson went to see her doctor, who recommended surgery to replace her ankle. She woke up from the operation believing everything was fine, but the months that followed would prove otherwise.

"My ankle kept bothering me, and we decided in about July that it didn't seem to be 'setting,' as they call it -- healing to the bone," she said.

Seven months after the initial operation, she went back to have her "replacement" ankle replaced.

"And that's when they found the MRSA," she said.

MRSA, short for methicillin-resistant Staphylococcus aureus, is a form of staph bacteria that resists the usual arsenal of antibiotics and requires much more aggressive treatment.

Sampson underwent months of "last resort" antibiotic therapy through a PIC line -- a tube that fed straight into her heart. Her surgeons put antibiotic spacers into her ankle to deliver medicine directly to the site of infection, and they made attempts to clean the wound in hopes it would heal better, and even tried replacing the joint.

None of it worked. Despite all their attempts, Sampson's doctors could not save her ankle.

Nearly three years after her initial surgery, Sampson went back into the operating room, this time to have her leg cut off below the knee.

Today, she simply hopes that the battle is over.

"Fighting MRSA is not something you do for a short period of time; it's something you have forever," she said.

"Hopefully, I've gotten rid of it because I had my leg amputated -- that's the end result."

Survey Says

For years, doctors have been well aware of the threat of MRSA, which has been around since at least the 1970s.

"It certainly is the major hospital pathogen," said Dr. John Bartlett, an infectious disease specialist at the Johns Hopkins Hospital. "That organism just has an enormous number of different ways it can cause disease."

But infectious disease experts continue to debate exactly how common the infection is -- and a controversial new survey of some United States health care facilities has added fuel to the flames by suggesting that the bacteria may be much more common in hospitals than previously thought.

The new study, conducted by volunteer members and affiliates of the Association for Infection Control and Epidemiology, finds that an average of 34 out of every 1,000 hospital patients has a MRSA infection, which includes people who contracted it during their stay as well as those who came into the hospital with it.

The numbers in this report are more than eight times higher than those reported in 2005 by the U.S. Centers for Disease Control and Prevention on the disease, which measured just 3.95 diagnoses of MRSA infection for every 1,000 patients discharged.

Authors of the study stood by their findings.

"I think it's a message both for the public and our clinicians, and that's that MRSA is a major problem," said Dr. William Jarvis, a member of APIC and the primary researcher of the study.

Some experts were critical, however, because the study did not measure a random sample of hospitals or patient populations.

Additionally, factors such as the type of hospital or the population of the surrounding area were not taken into account, and no steps were taken to confirm that the responses on the surveys were factually accurate.

"They set out to try to get a sense of the burden of the disease, and that is important, but I think we've ended up with data that is difficult to interpret," said Dr. Trish Perl, senior hospital epidemiologist at the Johns Hopkins Hospital, of the more recent survey. "We don't really know how generalizable it is."

Unlike the CDC study, the new research aimed to get a "snapshot" of the disease in action. To do this, the survey asked APIC-affiliated health care workers to count the number of people with MRSA who were at their hospital on a single day of their choosing, between Oct. 1 and Nov. 10, 2006.

"We felt like that would be much more comprehensive, accurate and practical than asking to get info for the past two years," Jarvis said.

In their survey, conducted at 1,237 U.S. hospitals, they looked at how many patients were infected and what medicines they were resistant to, among other factors.

But it is also notable that the report and the CDC study measured slightly different outcomes -- meaning that comparing the two could be a bit like comparing apples to oranges.

Stemming the Spread

Even though the precise rate of infection remains somewhat of a mystery, MRSA is known to be prevalent throughout hospitals in the United States and cases like Sampson's are not unheard of.

"In some settings we've seen some really dramatic infections -- like, almost your heart would stop, very dramatic sort of pictures," said Perl.

"It's really a big problem. We need to put some serious resources not only into studying the magnitude of the problem, but -- what we can do about it?"

In its report, APIC makes some suggestions for how hospitals can follow up.

It advises hospitals to find high-risk areas for MRSA, such as operating rooms, and test them often for MRSA. Additionally, simple measures such as thoroughly cleaning beds, using gloves and gowns when working with patients who have MRSA, and washing hands or rubbing them with alcohol solution to kill germs can also curb infection rates.

Bartlett, for one, has already seen how these safety measures can be effective.

"Hand hygiene with the alcohol that's at the bedside has become a remarkably efficient way to get rid of all germs," he said. "That has been a huge step forward, especially for this organism."

But Sampson said she believes that more should also be done to warn patients.

"I think the hospital should have to report their cases of MRSA; I don't think restaurants should have report cards when hospitals don't," she said.

"I think when you go in you should have an idea of how many MRSA cases this hospital has had. I think you should at least be able to make an informed decision. I had no idea when I went in for an ankle replacement that this was going to happen."