Tracking a New Strain of Drug-Resistant Staph

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A new type of drug-resistant staph infection is showing up primarily in gay and bisexual men. It is resistant to even more antibiotics than MRSA — the drug-resistant staph that has spread from coast to coast over the past seven years. Joe Neel, NPR's health editor, answers questions about the infection.

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

And - all right. If you are listening a moment ago, I forgot Ken Rudin's trivia question today. I apologize. We're going to post the trivia question on our blog. That's at npr.org/blogofthanation. So if you'd like to answer the trivia question you haven't heard yet, go to our blog at npr.org/blogofthanation. And Ken, I'm sorry.

Over the past few months, we've been hearing more about a type of bacteria that's resistant to a number of antibiotics. The official name is MRSA, M-R-S-A - a highly drug-resistant staph infection that's challenged researchers for most of this decade.

Now, according to a study published in the Annals of Internal Medicine, a new variant of the strain is resistant to even more antibiotics and it's spreading among gay and bisexual populations in San Francisco, Boston, New York and Los Angeles. There's been a lot of talk about MRSA recently, and even more questions.

NPR's health editor Joe Neel joins us to talk about MRSA in general and about this new variant in particular. If you'd like to know more about what it is, how it's spread, and how you may be able to protect yourself, our number is 800-989-8255. E-mail us, talk@npr.org. You can also join the conversation on our blog. That's at npr.org/blogofthenation.

And Joe Neel is NPR's health editor and he's with us here in Studio 3A.

Nice to have you on the program, Joe.

JOE NEEL: Nice to be here, Neal.

CONAN: So what is MRSA? What are those initials stand for?

NEEL: MRSA stands for methicillin-resistant Staphylococcus aureus, which is - which basically means it's a staph germ that is resistant to methicillin and several related antibiotics - penicillin, oxacillin, amoxicillin. It's been out there for at least seven years, maybe 10 years, mainly in hospitals. And we've started hearing about it more now because it's starting to spread out of hospitals into the community.

CONAN: And two different variants there as well.

NEEL: Well, several different variants. The one that we heard about this week was a new variant in gay men that seems to be circulating in several cities. This variant is resistant to even more antibiotics. Not just the three or four that I just mentioned, but also to Bactrim - a very commonly-used antibiotic and possibly vancomycin and - I'm forgetting the other one. I'll think of it in a second. But they're - clindamycin. And these are the drugs that are typically used to treat MRSA. So there's some concern that we're starting to lose treatment options for people who get MRSA.

CONAN: Does that leave anything left for people with this variant of MRSA?

NEEL: Yeah. There are several. I mean, the vancomycin-resistant - vancomycin is the antibiotic of last resort. Generally thought of, but there are a couple like that. That resistance hasn't been seen a whole lot. So that drug is still available. There are still several that are out there. But as you keep crossing drugs off the list, you know, there's concerned that there's not going to be anything left.

CONAN: And as we hear about this most recent variant that's been identified active among gay populations in large cities, and everybody looks at that and says, hmm, AIDS.

NEEL: Well, yeah. I mean, that's obviously the parallel that you would draw. But there are a lot of distinctions here that we should talk about. First of all, if MRSA is caught early, it's completely curable with one of the antibiotics. If you don't get it quite so early, you'll still probably get cured from it. Right now, MRSA, in the general population, is killing about 19,000 people a year. The headline we saw back in October was MRSA kills more than people - than AIDS does. AIDS killed about 17,000 a year.

But we know a lot more about how to control MRSA. We know a lot more about how to treat it. We have more drugs that are totally effective. In AIDS, the drugs can keep people alive for many years, but they are never cured.

CONAN: And how is it contracted?

NEEL: Well, it's - the study that came out this week had a lot of limitations. It didn't definitely show that sexual contact was the cause of these - the rise of these infections in gay men in these cities. But there were a lot of - there's a lot of circumstantial evidence. And it - we know that MRSA spread normally just through skin-to-skin contact, very casual skin-to-skin contact. So one would imagine that in any kind of sexual circumstance, where people are touching each other, whether it's sexual or not, that the infection might spread.

CONAN: We're talking with NPR's health editor, Joe Neel.

Again, if you'd like to join our conversation about MRSA, 800-989-8255. E-mail, talk@npr.org. Eli(ph) joins us from Midland, Texas.

ELI (Caller): Hi. How are you doing, sir?

CONAN: Very well. Thank you.

ELI: Good. And now, my question is this, now people with HIV, their immune system is compromised, meaning that they're more susceptible to MRSA, right?

NEEL: That's correct.

ELI: Okay. So now - so you have HIV and then because their immune system is compromised that MRSA has the ability to take hold in the person with HIV more - it's more likely that the MRSA will take hold in the person with HIV than a non-HIV person, right?

NEEL: Well, it depends on the person with HIV's immune status. If they're taking protease inhibitors and they're on their drugs and their immune system is fairly healthy, they're not going to be terribly susceptible to MRSA. We see MRSA infections when the immune system is pretty depleted, either in people with HIV or some other diseases. In the elderly, the elderly are more susceptible, and young children are susceptible because their immune systems aren't developed.

But you're right, that if someone has HIV and they get a skin infection - if they see a pimple or a boil - and it doesn't go away, it gets redder, it gets - it grows very quickly, they should take some action and go see a doctor right away.

CONAN: Is it possible - I think this may be, to some degree, be tying to Eli's phone question, is it possible that it's spreading in gay and bisexual communities in large cities in part because that's where a lot of people with HIV are?

NEEL: Well, you could say that, but it hasn't been studied scientifically. We don't know that.

CONAN: So that would be just supposition at this point.

NEEL: Supposition.

CONAN: Okay.

ELI: Okay.

CONAN: Eli, thanks…

ELI: Thanks very much.

CONAN: Thanks very much for the phone call.

Is there anything you can do to prevent MRSA in any of its variants?

ELI: Hand-washing, good hygiene. You should wash your hands for at least 15 seconds every time you are near - every time you come in contact with something that might possible have the germs on it. Fifteen seconds - a good thing to remember is you could sing "Happy Birthday" twice in that period of time. That is basically the main prevention method.

Some - you know, in certain environments like health clubs or in schools where there are people who've known - where people have had MRSA who've come in - you know, have been in contact with various surfaces, probably want to clean those surfaces and maybe do that more regularly. You might want to use hand sanitizer more often. Make sure that the hand sanitizers got at least 60 percent alcohol in it. So…

CONAN: Let's see if we can get another caller on the line. And this Sally([ph). Sally with us from Surfside in South Carolina.

SALLY (Caller): Hi.

CONAN: Hi, Sally. You're on the air. Go ahead, please.

SALLY: Thank you for taking this question. I'm wondering if the MRSA virus - MRSA could be evolving into other forms of disease or unidentifiable because I happen to know two people right now who are trying to get help that have their thing, it's a staph infection, they're not really able to identify it, but it's really - it's almost like plague-like. And interestingly, when they're trying to get help, their - the hospitals seem to be turning them away because it's not an easy fix and they really don't want to be associated with having that kind of disease around them.

NEEL: Well, MRSA is difficult to - can be difficult if diagnose. It - I know of two cases in the last year where it took between two and four days for the cultures to come back. And so hospitals are often scratching their heads about what could this be. Is it garden variety staph or is it the more resistant MRSA. The - but there are newer tests, rapid tests that can - that are - can make the diagnosis in just a few hours, which I think will be, you know, very helpful in detecting this much more often.

As far as evolving into another disease, you know, staph is a - it's pretty easy to figure out what it is, when you can find it, when you can grow it. I don't think it would - it's not mutating into some new life form, it just - what's happening here is it's evolving into more…

CONAN: Drug-resistant.

NEEL: …more drug-resistant form that has more defenses.

CONAN: Hmm. Thanks very much for the call, Sally.

SALLY: Thank you for taking my call.

CONAN: And we hope your friends - hope things work out for them,

SALLY: All right. Bye-bye.

CONAN: Thanks very much.

We call - you know, the common name is flesh-eating bacteria. You said a pimple, something like that, does that what it looks like when you first get it?

NEEL: Well, it's interesting. People start calling it flesh-eating bacteria, that a few years - maybe more than a decade ago, when Jim Henson, the Muppets creator died, that was actually strep, which is a different bacteria. But this form of staph is actually starting to look like the flesh-eating bacteria. It gets deep into the skin. It causes the skin to deteriorate, and it can go into bones, it gets into the bloodstream, can - in the worst cases, it causes pneumonia, blood infections. And as I think I said before, 19,000 people die each year from this. So it's a rather serious disease.

CONAN: Here's an e-mail question from Lucia(ph). Please, if you can tell me, why the pharmaceutical companies have not been creating new and more powerful antibiotics. Heard they haven't been concentrating on antibiotics lately.

NEEL: Well, I looked this up the other day, and there are something like 240 -I don't - I wouldn't want to be quoted as to the exact number. But there are more than 200 compounds under development by the drug companies. There was a period of time when there wasn't much emphasis put on antibiotics. I think that began to change several years ago. And that now, there is a lot more focus.

But clinical trials to get drugs to people do take many years - you know, five, seven, 10 years. So what started a few years back, we won't really see on pharmacy shelves for a while. At the same time, you know, it's - there are drugs that make more money than antibiotics, so, you know, it is a fear question to ask, you know, where the priorities are.

CONAN: Joe Neel is NPR's health editor, with us here in Studio 3A.

We're talking about MRSA in its variant, including one reported this past week, highly drug-resistant and appears to be attacking gay and bisexual communities in large American cities.

You're listening to TALK OF THE NATION from NPR News.

And let's get Carrie(ph) on the line. Carrie with us from Ypsilanti in Michigan.

CARRIE (Caller): Hello. How are you? How are you, Neal?

CONAN: Very well. Thanks.

CARRIE: I work at an AIDS service organization here in Michigan. And it's eerie how you keep referring to this MDR MRSA as a gay community disease or man who are bisexual disease. It's really the behavior that transmits the bacteria and not the identity of the individual. We really need to focus on trying to make sure that people don't stigmatize the community even further. Remember the AIDS epidemic?

CONAN: Joe?

NEEL: Yes. No, I absolutely agree with you. This study - we were concerned when we first saw this study for the exact same reason.

CARRIE: Well, I think our language should positively reflect that by making sure that every time we mention communities that it affects, that we talk about the men who had sex with men, or MSM community, as opposed to the gay community. Because gay is a really stigmatized and polarizing word here in this country and we really need to be respectful of the community.

NEEL: Okay. You're right, it has men who have sex with men, which include gay and bisexual men. But I'm very aware and share your concern about stigmatizing a group. I mean, this is a disease that does not have a preference for any particular group. The study showed that - you know, the - what the study found was that in the genital and buttocks area of gay men attending sexually transmitted disease clinics in Boston and San Francisco that they had a higher rate of infection in that area.

So the conclusion was gay partnering, you know, male partnering was, to some extent, a cause for concern. That, you know, these infections do occur in that area in heterosexuals as well. I mean, it's the number of people - the percentage of men who have sex with men, who were having infections in that particular area of the body, versus heterosexuals was about double. So, you're concern is well taken.

CONAN: Thanks very much.

CARRIE: Well, thank you very much and let's really try to use the MSM terminology.

CONAN: Thanks, Carrie.

CARRIE: Thank you.

CONAN: Let's talk now with Ben(ph). And Ben's calling us from Baltimore.

BEN (Caller): Hello. How are you doing, Neal?

CONAN: Fine, thanks.

BEN: Thank you so much for taking our call. Basically, just a couple of comments. I'm actually an emergency medicine resident at a busy urban ER and we've been dealing with MRSA for quite a few years. So, just to have some reassuring comments.

Number one, first of all, I think there was an increasing awareness among emergency medicine professionals and doctors in general as MRSA makes more of a headline that we tend to treat a lot more aggressively than we did before. And so, people that present to the emergency departments are much more likely to get the required treatment of MRSA. In other words, we tend to treat for it even before its tested for. So, the awareness is definitely spreading amongst the medical community.

And the other thing is that I can't echo enough the importance of really good hygiene. So when people get something that they think is a pimple that doesn't go away, its generally not a good idea to poke and to try drain it yourself, but to certainly follow up with a doctor, because sometimes, what we found with MRSA as opposed to other regular bacteria, is that they may require some systemic antibiotics instead of just, you know, a simple drainage procedure.

NEEL: Systemic, meaning, intravenous antibiotics.

BEN: Meaning like you administer - yeah, by mouth.

NEEL: I see. Right.

CONAN: Okay. And as it presents, is it - are you having great success with these procedures?

BEN: Well, I think so. The one thing is - as difficult as everyone has said, we don't always know based upon appearance what MRSA is and what MRSA is not. So, the conservative thing to do is you tend to treat for it. But the good news is if MRSA tends to form what's called abscesses, as you mentioned earlier, it can go into the deep tissues. And healthy individuals, as long as that abscess is drained, we do have good results in having that infection recur. But if does not drain and you see an abscess or temple that tends to get worse over time, especially coupled with fever and chills, that's something that needs to be followed up on, because that could indicate, as you were speaking about earlier, a more serious underlying infection.

CONAN: Ben, thanks for that. Appreciate it.

NEEL: Right, I think…

BEN: So long. Thank you so much.

CONAN: So long.

NEEL: Sorry. Yeah, it's the rapidity of the - how fast it starts to spread and especially fevers and chills, he's correct. It's not just an everyday-pimple pimple. I mean, they are red bumps on the skin people have all the time. So now, you don't need to go into a panic over it. It's the rapid progression that is certainly the concern.

CONAN: And quickly, a last e-mail question from T. Silva(ph). Can you MRSA from sweaty gym equipment? Should gyms be on high alert?

NEEL: Well, this has been a controversy. The CDC, the Centers for Disease Control and Prevention, recommend that you wipe down equipment after each use and perhaps, you want to use a barrier like a towel to sit on equipment. Although, it also - there is no evidence that its spreading this way in any large degree. So, the answer to your question is, the CDC says, yes, take precautions, but I don't know that there's cause for great concern.

CONAN: Joe Neel, thanks very much.

NEEL: Thank you.

CONAN: NPR's health editor Joe Neel joined us here in Studio 3A. You could find a Q&A about Staph infections and advice on how to prevent them at npr.org/talk.

And this is TALK OF THE NATION from NPR News. I'm Neal Conan in Washington.

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Q&A: Drug-Resistant Staph Infections

Hands being washed.

Experts recommend washing hands thoroughly with soap and water or using an alcohol-based hand sanitizer to prevent staph infections. Joe Raedle/Getty Images hide caption

itoggle caption Joe Raedle/Getty Images

Expert Advice on Preventing Staph Infections

  

Experts recommend practicing good hygiene. That includes:

  

- Washing your hands thoroughly with soap and water or using an alcohol-based hand sanitizer.

  

- Cleaning and covering cuts and scrapes until they are healed.

  

- Avoiding contact with other people's wounds and bandages.

  

- Avoiding sharing personal items such as toothbrushes, razors and towels.

MSRA infections have garnered much news coverage recently because of the release of the first nationwide study of the bacterium published in the Journal of the American Medical Association.

The study, conducted in 2005, showed a surprisingly high number of MRSA infections, which are a type of staph infection. This type of infection was found to be three times more prevalent than previously believed.

Recent studies are also showing that the germ is continuing to evolve into strains that are resistant to even more antibiotics.

Here are some answers about MRSA:

What is MRSA?

MRSA stands for methicillin-resistant Staphylococcus aureus. Staph is a common bacterium, present on the skin or in the noses of about 20 percent to 30 percent of the population. It's usually nothing to worry about. MRSA is a strain of staph that has become resistant to treatment with antibiotics, including penicillin, amoxicillin, oxacillin, methicillin and others. That makes MRSA harder to treat than regular staph infections.

What do staph and MRSA look like?

Both often start out as mild infections on the skin, showing up as pimples or boils. Infections with garden-variety staph are easily treated in most cases. Both staph and MRSA can cause more serious skin infections or they can lead to pneumonia or infections of the bloodstream, urinary tract or the lining of the brain. Surgical wounds are often prime targets for these germs.

How do you catch MRSA?

MRSA is nearly always connected to health care facilities. Most people who have MRSA have been hospitalized within the past year, or they've gotten treatment in an outpatient facility or nursing home. People can acquire MRSA in health care facilities but not show any signs of infection for weeks or months.

But in recent years, MRSA has spread beyond these facilities into places where people are in close contact, such as athletic facilities. The Centers for Disease Control and Prevention (CDC) estimates that about 15 percent of MRSA cases in the United States occur outside health care settings.

Skin-to-skin contact with a person who carries MRSA is believed to be the most common way people get MRSA in the community. In this situation, people who are otherwise healthy may get a skin infection with MRSA. It's also possible to get MRSA from surfaces that are contaminated with the germ, but this is less likely than person-to-person contact.

Who is at risk for MRSA?

The CDC says it has investigated clusters of MRSA skin infections among athletes, military recruits, children, men who have sex with men, and prisoners. Risk factors include close skin-to-skin contact, openings in the skin such as cuts or abrasions, crowded living conditions and poor hygiene.

What about schools?

Recommendations for preventing infections in schools focus on good hygiene. Cleaning regimens vary from district to district. The CDC says that in most cases, it is not necessary to close schools because a student has an MRSA infection. Covering infections will greatly reduce the risks of surfaces becoming contaminated. The CDC says the only surfaces that need to be cleaned are those that have been recently touched by someone with MRSA. "In general," the CDC says, "it is not necessary to close schools to 'disinfect' them."

What about health clubs?

The CDC says that the environment has not played a significant role in MRSA outbreaks, but it advises that you always practice good hygiene. At health clubs, this would include showering after working out and using a barrier such as clothing or a towel between your skin and shared equipment. The CDC also recommends wiping surfaces of equipment before and after use.

Why the sudden outbreak of MRSA?

There hasn't been a sudden increase. Drug-resistant staph germs have been spreading across the country for years now, causing deaths from time to time. In the JAMA study published last fall, the CDC estimated that 94,000 Americans get potentially life-threatening MRSA infections every year. That's three times the previous estimates and came as a surprise to many people.

How is MRSA treated if it is resistant to antibiotics?

So far, MRSA is not resistant to all antibiotics. Vancomycin is one treatment. If your doctor prescribes an antibiotic, take the whole prescription — stopping too soon can cause bacteria to become resistant to that antibiotic.

What is the new resistant staph being reported in gay communities?

It's a variant of the MRSA that's spreading nationally. It's resistant to more antibiotics than regular MRSA — not just penicillin-type drugs like methicillin but also clindamycin, erythromycin and mupirocin. The new strain is called multiply drug-resistant MRSA (MDR-MRSA).

The strain has caused serious infections in hundreds of people so far, mostly in the gay communities of San Francisco, Boston, Los Angeles and New York. Doctors say these infections are more fast-moving, so any delay in recognizing them and treating them with the right antibiotic can cause life-threatening infections.

Researchers think many of the infections so far have been transmitted during sexual activity. But MDR-MRSA is spread through skin-to-skin contact and sometimes by contaminated surfaces or shared towels. So anyone can get infected. The precautions are the same — frequent and thorough washing, and immediate attention to any boils or painful rashes.

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