When baseball slugger Sammy Sosa was sidelined on May 4 with a staph infection, the news brought attention to a growing health problem that can become life-threatening. Members of the healthcare field, especially primary care physicians, are being encouraged to increase their awareness of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) so that they can quickly identify and appropriately treat cases before they become too serious.

Staphylococcus aureus, often called “staph,” is a common bacterium that lives on the skin and in the nose of about 25-30% of the population. It can cause infections if the skin is broken, such as with an injury or surgery, or if a person has a weakened immune system and is easy to pass to others. Infections can become serious, spreading from skin lesions into the bones, lungs, blood, heart, and other organs. Common in hospital settings, methicillin-resistant S. aureus (MRSA) has been a problem for many years. More recently, however, doctors are seeing strains that are genetically distinct from healthcare-associated MRSA. Physicians treating outpatients must rethink the type of antibiotic to prescribe for skin infections since this strain of staph is resistant to penicillin, amoxicillin, cephalosporins, and erythromycin.

As a result, serious and, in some cases, life-threatening cases have been reported and the numbers appear to be growing. At the emergency department of the Texas Children’s Hospital in Houston, cases of CA-MRSA recently doubled over the course of two years. From a study of MRSA cases in Baltimore, Atlanta, and Minnesota, researchers found that 1647 cases of CA-MRSA were reported during 2001 and 2002, with 73% resistant to prescribed antibiotics and 23% of patients becoming hospitalized. The incidence was much higher among children under the age of two than those older than two years.

CA-MRSA appears to be more common in crowded places, such as daycare facilities, or with activities that involve skin-to-skin contact, such as sports like football and wrestling. It is recommended that the public try to minimize sharing of things like towels and razors. People should also wash hands well, clean and cover skin injuries, and avoid contact with other people’s wounds. The public, especially parents, should be alert for skin lesions that are pimple-like with redness, swelling, and increasing size and that may appear like a spider bite. Such lesions should be quickly brought to the attention of a doctor. The physician will need to collect a sample from the affected area, such as an aspirate or drainage from a skin lesion or a sputum culture if pneumonia is involved, for culture and request susceptibility testing of all S. aureus isolates found.

With prompt attention and proper care, the severity as well as the spread of CA-MRSA in the community can be minimized. Fortunately, this was the case for the Baltimore Orioles and their cleanup batter Sosa, who was treated with antibiotics and had the infection site drained. No other Orioles player has shown signs of infection.

Sources
Fridkin SK, et al. Methicillin-Resistant Staphylococcus aureus Disease in Three Communities. New England Journal of Medicine. Vol. 352 (no. 14). April 7, 2005. p. 1436-1444. Abstract available online: http://content.nejm.org/cgi/content/abstract/352/14/1436

CDC: Community-Associated MRSA (CA-MRSA). Available online: http://www.cdc.gov/ncidod/hip/Aresist/ca_mrsa.htm

American Medical News (Kathleen Phalen Tomaselli): Infectious trend: Drug-resistant staph Outbreaks of CA-MRSA are becoming more and more common, prompting primary care physicians to learn about the strains circulating in their communities. April 4, 2005. Available online: http://www.ama-assn.org/amednews/2005/04/04/hlsa0404.htm

Kubatko, Roch. Making progress, Sosa may return sooner from injury. The Baltimore Sun. May 14, 2005.

Bor, Jonathan. Equal-opportunity germ targets the frail and pro athletes such as Sosa. The Baltimore Sun. May 12, 2005.