MARK ANDERSEN/Lincoln Journal Star | Posted: Monday, October 17, 2005 7:00 pm
Dr. Lisa Peterson was dismayed.
Four recent skin infection cases involved bacterial strains resistant to frontline antibiotics.
Until recently, those strains were almost always associated with people who had been treated at hospitals or long-term care centers.
These patients had gone nowhere near those places.
“I don’t know why these people got it,” Peterson told the Lincoln-Lancaster County Board of Health.
Four was too many, she said.
“I shouldn’t be seeing that many.”
One patient had failed three consecutive courses of antibiotics.
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In an unrelated incident, Marsha Ward, Lincoln, 58, had a boil on her buttocks.
She received antibiotics from her workplace health service.
If it gets worse, she was told, go to the emergency room.
The antibiotics did nothing. Her boil grew. It was a hard, red, hot-to-the-touch, softball-sized, pus-filled blister when she walked into the emergency room days later with a 103-degree fever.
“It hurt so bad to sit down,” she said.
Her emergency room bill was $750.
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Earlier this year, 18-month-old Zahra Al-Hashawi had what looked like a mosquito bite on her bottom, said her mother, Zaineb.
The mother had washed the sore carefully.
In mid-August, the girl spiked a fever of 105-106 degrees. Her bite was the size of a golf ball.
Zahra was transported from the BryanLGH Medical Center West emergency room to BryanLGH East, where she underwent two surgeries to clear the infections. One pocket had reached deep, nearly to her leg bone. After five days, Zahra was released to home nursing care.
She’s fine now, said her mother. Medicaid paid the bills.
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Physicians and health care workers around Lincoln have recently begun to notice a rising number of problematic skin infections.
The cause is the age-old staphylococcus aureus but with a twist.
Usually called staph, the bacteria is commonly carried on the skin or in the nose of about one in four healthy people. A common cause of skin infections, like pimples and boils, it occasionally results in serious blood infections and pneumonia. It can kill.
Dr. Suzanne Vandenhul of Antelope Creek Family Physicians first began noticing unusual skin infections two years ago.
As it starts, “It looks like a spider bite,” she said. Today, anybody coming to her office complaining of a spider bite is likely to be checked for something called methicillin resistant staphylococcus aureus. It’s typically referred to as MRSA (pronounced mer-sa).
It’s not a new organism. It’s staph. The difference is that it doesn’t die in the presence of the beta-lactam class of antibiotics, which includes penicillin, amoxicillin and methicillin.
In hospitals, MRSA is a clear danger to those with weakened immune systems. Even when it doesn’t kill, it lengthens patient stays and raises costs.
Increasingly, MRSA has been found outside of health-care settings. It began on the coasts and spread inward.
In the Lincoln area today, about 45 percent of staph infection cultures also come up MRSA. In 2001, it was 15 percent less.
Just recently, however, health officials learned that the MRSA they’re seeing in the general community isn’t the same thing giving hospitals trouble.
Studies show community-acquired MRSA is genetically distinct, said Tim Timmons, public health nurse with the Lincoln-Lancaster County Health Department.
Among other things, the findings led to more acronyms: HC-MRSA, for health care MRSA, and CA-MRSA for community-acquired.
The Centers for Disease Control and Prevention advises that CA-MRSA spreads through close skin-to-skin contact, skin cuts or abrasions, contaminated items, crowded living conditions and poor hygiene. Clusters of CA-MRSA infections have been found among athletes, military recruits, children, Pacific Islanders, Natives, men who have sex with men and prisoners.
At least three different strains of CA-MRSA circulate in the United States. Some may cause more skin sores than their common ancestors, according to the CDC. Studies are under way to learn more.
At one time, the recommended treatment for somebody with MRSA was hospitalization with intravenous vancomycin, often referred to as the antibiotic of last resort.
Newer treatment guidelines distinguish between HC and CA forms of MRSA, said Dr. Lori Snyder, epidemiologist at Saint Elizabeth Regional Medical Center.
With HC-MRSA, she said, the “M” stands for methicillin, but it might just as easily stand for “multiple,” because these germs have developed resistance to many different antibiotics.
With CA-MRSA, immunity isn’t as widespread. Methicillin isn’t effective but other antibiotics are.
Dr. Larry Kresbach, an epidemiologist at BryanLGH Medical Center, said a number of patients have come to the emergency room in the past few months with boils and abscesses.
The typical treatment is to incise and drain the sore, then order antibiotics, he said.
The best course is prevention. Do not share soap or towels. If you have a skin cut, keep it clean and covered. Don’t scratch.
Hand washing is important.
Not all MRSA infections will require antibiotics, Timmons said.
Our immune systems deal daily with staph. In many cases, incision, drainage and cleaning may be enough.
If you do need antibiotics for CA-MRSA, Vandenhul said, it will likely be Levaquin, 750 mg, one per day for 14 days. The dose and quantity sells on the Internet for about $270.
And if you’re taking antibiotics, physicians stressed, take all of them. It’s important, both for you and others.
Antibiotic resistance occurs naturally through evolutionary processes.
Resistance can be accelerated when antibiotics are prescribed unnecessarily or when patients don’t complete their full course.
They’re prescribed unnecessarily because people demand antibiotics even for viral infections. Antibiotics do nothing to stop viruses.
Taking only a partial course of antibiotics — taking four of 14 prescribed pills — encourages resistance because while it knocks down bacteria to the point symptoms disappear, the survivors can infect again. Among them may be those genetically equipped to better survive antibiotics.
Health officials have long feared what will happen when germs overcome all antibiotics.
Then, when an infection spreads into the bloodstream, Timmons asked, “What do you do?”
Reach Mark Andersen at 473-7238 or mandersen@journalstar.com.