As reported by The Hartford Courant, October 24, 2007.

This 'Superbug' Vulnerable

But Doctors See Wake-Up Call in 'Hoopla' of MRSA

By William Hathaway

The flood of letters pouring out of principals' offices in Canton, Berlin, Newtown, West Hartford and Weston in the past week all contained similar and foreboding messages:

A student or students had contracted an infection resistant to a form of antibiotics. Be on the lookout, families were warned, for suspicious-looking infections.

Concerned parents called school nurses. Within two days, 450 people called a special hot line set up by the governor to answer questions about the exotic sounding germ: methicillin-resistant staphylococcus aureus, or MRSA.

Meanwhile, infectious-disease doctors tried to calm parents and rolled their eyes when the media described the bacterium as a "superbug."

If MRSA is a superbug, it is still vulnerable to various forms of antibiotic kryptonite, aside from methicillin. Moreover, it is rarely fatal outside a hospital.

And, they explained, many, if not most, state students might already be carrying around colonies of staph, including the MRSA form, and the great majority of them will never develop active infections.

"There's been a whole lot of hoopla and attention for something that we've been dealing with for more than 10 years," said Dr. Louise Dembry, associate professor of medicine and epidemiology at the Yale University School of Medicine.

The recent concern over MRSA was touched off by a study in the Journal of the American Medical Association that found the staph strain responsible for more than 94,000 serious infections and nearly 19,000 deaths a year nationwide, largely in hospitals. Recent deaths of students in Virginia and New Hampshire fueled that concern.

But while experts said deaths in the community, outside of hospitals, remain rare, the prospect of a truly antibiotic-resistant superbug is something to be concerned about.

Dembry and other doctors also say the rise of MRSA in our communities provides a valuable lesson about the threat of many pathogens that resist medicine's best efforts to treat them.

As they have since penicillin was introduced in the 1940s, bacteria of many types will develop resistance to antibiotics through evolution. So society needs to stay ahead of mutating germs by creating a new generation of antibiotics and by renewed efforts to prevent infections in the first place, doctors say.

"Wayne Gretzky used to say you have to skate to where puck is going to be, not where it is now," said Dr. Brian Cooper, chief of the infectious disease division at Hartford Hospital. "We need to think down the road 10 or 15 years because we know these infections will accumulate and use antibiotic-resistant traits."

The U.S. is seeing increased antibiotic resistance in acinetobacter, another type of bacterial infection that Cooper treated in soldiers serving in Iraq.

Some strains of well-known infections such as pneumococcus and gonorrhea have developed resistance to one or more forms of antibiotics.

And some strains of tuberculosis have nearly outstripped medical science's ability to treat them.

"So far, those are a tiny minority of TB cases," said Dr. Kevin Dieckhaus, chief of infectious diseases at the University of Connecticut Health Center. "If it evolves down that pathway, if it becomes a majority of cases, then we are in a world of hurt."

Dieckhaus said that development of a new generation of antibiotics has lagged behind research to treat viral conditions such as HIV or hepatitis C and that more effort is needed to stay ahead of mutating bacteria.

But for today, doctors say they can easily handle most cases of MRSA.

As a colonel in the Army Reserve in 2006, Cooper saw many such infections in a high-risk group: ground troops in Iraq. Skin infections of all types are common in soldiers who live in close quarters and can spend long days sweating and crawling in dirt.

While MRSA infections in hospitals tend to be resistant to many forms of antibiotics, those acquired in the community, whether in Iraq or in West Hartford, have evolved fewer defenses. Cooper said it is still possible to eradicate community- acquired MRSA with at least three different families of antibiotics.

What's critical is looking for it and treating it quickly.

Cooper and Dembry said people and doctors need to remain vigilant for MRSA - or, for that matter, any other infection. Some strains of MRSA are more dangerous than other forms of staph, but all staph infections can wreak havoc if lodged in bloodstream or lungs.

When staph appears, it is usually as a skin infection, characterized by reddish skin surrounding a boil topped by a black scab. The infection is often mistaken for a spider bite.

While the elderly and sick die by the thousands every year from MRSA in hospitals, only a few people who acquire the infection in the community get seriously ill; deaths are rare.

Dembry said there is a low-tech solution that will help slow down the march of resistant bacteria in the community:

Wash your hands.

"Hand hygiene isn't just important in hospitals," Dembry said. "We need to do all the things our mothers taught us to do - and we stopped doing."

Doctors should also use antibiotics judiciously and lessen opportunities for bacteria to evolve resistance, Dembry said. And patients themselves need to clean and cover skin infections so they won't spread to other people.