Staph infections putting local schools on edge

Section: Health

Kate Moran

After a special education teacher in Hammond was infected last month with a bacteria that resists treatment with antibiotics, a work crew scoured her classroom with chlorine bleach to prevent the "superbug" from spreading among the students.

When two students at a Catholic school in Bucktown were diagnosed with staph infections, the archdiocese canceled classes for a day and disinfected the building, even though administrators were unsure if the staph was of the drug-resistant variety.

Schools and sports teams around the region have taken heed of the drug-resistant staph since a student in New York and a high school football player in Virginia died after exposure to the bacteria, which can spread by skin contact or from the sharing of sports equipment, uniforms or towels.

Doctors say the majority of such infections are not life-threatening, and the panic surrounding the recent deaths has been overheated. Infections usually show up on the skin as painful boils that resemble pimples or spider bites, but the bacteria can pose a serious health risk if they enter the bloodstream, internal organs or other sterile parts of the body.

Between 1999 and 2004, more than 260 deaths in Louisiana were associated with the drug-resistant bacteria. This past winter, the Centers for Disease Control and Prevention reported that 10 people died in Louisiana and Georgia over a span of two months when they came down with influenza and a drug-resistant staph infection at the same time.

Ten deaths was "a higher number than expected for the two-month period," the CDC reported.

Pinpointing risks

While the bacteria are only now beginning to grab headlines, local doctors say they have charted a steady rise in the number of infections caused by methicillin-resistant Staphylococcus aureus, or MRSA, over the past six or seven years.

Doctors say two separate but related factors are at work. Patients have contracted staph infections in the hospital for decades -- they are considered a hazard of boarding among other sick people -- but doctors have found that a higher percentage of the staph in hospital cultures are now resistant to drugs.

In 1999, only a third of the staph isolated in hospital labs across the state were resistant to antibiotics. Just five years later, the Louisiana Office of Public Health determined that more than 60 percent of the staph found in hospitals did not respond to drugs.

At the same time, patients who have no association with hospitals or other health-care settings are showing up in emergency rooms with infections they caught in schools, health clubs or other public places. As recently as six or seven years ago, these patients were not considered at risk of contracting the drug-resistant staph.

What's more, the "community-acquired" strains of MRSA -- which have genetic differences from the strains that circulate in hospitals -- are often more virulent and aggressive than their cousins.

"Up until a few years ago, most MRSA was acquired in the hospital. We tended to see them in patients who had been in the hospital a long time who were very sick," said Dr. Russell Van Dyke, a professor of pediatric medicine at Tulane University. "We're now seeing many more of the community-acquired infections, mostly on the skin."

Bringing cases to light

Louisiana does not track all cases of MRSA, but only those that invade sterile parts of the body, such as the blood, spinal fluid or organs. Skin infections caused by the bacteria are too common to be tracked, said the state epidemiologist, Dr. Raoult Ratard.

The state attempted to monitor all infections, including skin infections, until 2002, but the reporting requirement was so onerous that many hospitals simply ignored it. When the state changed its policy and required hospitals to report only invasive cases in 2003, many more hospitals began to comply.

In 2002, the state logged 495 cases of MRSA infection. The next year, after reporting requirements changed, the number shot up to 733. The number of instances climbed again in 2004, to 887, before falling to 739 cases in 2005, the last year for which complete data is available.

The state's figures appear low in relation to numbers released last month by the CDC, which estimated that 94,000 cases of invasive, drug-resistant staph infection occurred nationwide in 2005, with 19,000 of those cases resulting in death. That would mean more people died in this country from exposure to the bacteria than from AIDS.

Although health professionals are required by law to report cases of the drug-resistant staph to the state, Ratard said only about half of them come to light. He said hospitals are the most dependable reporters, but even they sometimes fail to notify the state of every instance of MRSA, especially when patients contract it as they are being treated for another illness.

While doctors are vigilant about the threat posed by the bacteria, they said that most skin infections can be cleared up through simple procedures, such as draining boils. Treatment becomes much more difficult and expensive when the bacteria enter the bloodstream. They respond to only a limited number of antibiotics, which generally have to be given intravenously.

Root of the problem

Physicians say resistance to antibiotics is growing because doctors and patients have overused the drugs for years, allowing bacteria to mutate and develop protections against the medicines designed to eliminate them.

"When a mother comes in with a child who has a cold and says her child needs antibiotics, even when the pediatrician doesn't think the child needs them, it is hard for the mother to understand the downside of giving them," Van Dyke said. "The downside is that we end up with organisms that are much more difficult to treat."

Tulane Medical Center, where Van Dyke works, is the only hospital on the south shore that screens all patients for the presence of MRSA before they undergo high-risk, invasive procedures such as surgery. Infection control coordinators at other hospitals said they believe doctors and nurses could prevent transmission with less expensive procedures, such as by wearing gloves and face masks and washing hands thoroughly.

Dr. Fred Lopez, an infectious disease specialist at Louisiana State University, said people can avoid bacterial infections in public places by improving basic hygiene, bandaging open wounds and avoiding the sharing of items like towels and clothing where the bacteria might live.

School administrators have become vigilant about all bacterial infections, even nonresistant strains, since news reports about student deaths surfaced in other parts of the country. The principal of Lusher Charter School in New Orleans sent a letter to parents on Oct. 18 after a male athlete was diagnosed with a staph infection. Although the school did not know whether it was MRSA, the custodial staff disinfected the boys and girls locker rooms.

Dr. Susan McLellan, an infectious disease specialist at Tulane University, said the schools are overdosing on caution. When students come down with a staph infection, she said, it does not necessarily mean that they caught it or can spread it at school.

"These schools are being closed for cleaning when we have no reason to suspect it's necessary," McLellan said. "In the absence of trying to decolonize humans, it is probably a complete and utter waste of time."

Unless schools conduct tests to determine whether its various students have come down with the same strain of bacteria, she said, "There's enough of this stuff in the community that they all could have gotten it from home."