Resistant-bacteria reports cause alarm

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Resistant-bacteria reports cause alarm

 

Five cases are seen in Boston patients

By Stephen Smith, Globe Staff, 3/2/2003

Five men in Boston have been infected with a powerful, drug-resistant bacteria,

strikingly similar to larger outbreaks in Los Angeles and San Francisco.

Beginning last fall, doctors at the Fenway Community Health Center started

seeing patients with pneumonia, sinus infections, and skin conditions caused by

methicillin-resistant Staphylococcus aureus -- a germ normally caught only in

hospitals by patients already seriously ill from other diseases.

The germ, known as MRSA, can elude a whole class of antibiotics, making the

illness significantly more difficult to treat.

Its appearance in the general community has alarmed health authorities. All five

of the men have been treated and recovered without lasting complications, but

doctors are worried about the broader emergence of bacteria so wily that they

can outrun the best drugs that medicine can produce.

''It's of great concern,'' said Dr. Scott Fridkin, a medical epidemiologist at

the US Centers for Disease Control and Prevention. ''The reports are becoming

more frequent, and it appears to be a growing problem.''

Fenway physicians alerted the CDC about the cluster of cases, and the

Massachusetts Department of Public Health has begun an investigation, hoping to

establish whether the cases are linked and, if so, to identify a common source

of infection. The men are all HIV-positive, but neither physicians providing

treatment nor disease investigators can say with certainty that the patients'

HIV status had anything to do with the bacterial infection.

''There's no clear, obvious link that we can pick up with this,'' said Dr.

Stephen L. Boswell, executive director of the Fenway center. ''It could take

months before we know what's going on here.''

Drug-resistant bacteria are especially perilous because people infected with

them typically don't know -- and neither do their doctors. That means they're

often started on main-line antibiotics, which do not work because the bacteria

has found a way to get around that drug. In the meantime, the patients get

sicker as the bacteria advances, until doctors find an antibiotic that will

work.

And the threat is not limited to the patient with the original infection. That

resistant bug can spread to other people, which can ignite a cascade of illness

only treatable by more powerful pills or even antibiotics given intravenously.

Drug-resistant bacteria arrived in Boston in the late 1960s and early 1970s in

hospital wards, said Dr. Alfred DeMaria, state director of communicable disease

control, and they have remained chiefly a problem in hospitals. That's because

patients are already sick, and many have undergone surgery, leaving them with

incisions vulnerable to infection. ''What's really new is the degree to which

they are turning up in community-acquired settings,'' DeMaria said. ''But I

suppose it was sort of inevitable.''

On the West Coast, outbreaks of similar staph infections have stricken hundreds

of patients, with 928 reported in Los Angeles County jails during 2002. And

earlier this year, public health agencies in LA and San Francisco both reported

clusters of antibiotic-resistant bacterial infections in those cities' gay

communities.

Staph bacteria are pervasive, typically causing few problems. But if they invade

a cut or other opening in the skin, they can cause painful skin infections, bone

infections, pneumonia, and life-threatening blood conditions.

In the past, staph cases in the community have been treated with first-line

antibiotics, such as Keflex. But it is exactly those sorts of drugs that some

strains of the bacteria are outwitting.

''It's something we need to be on the outlook for and get better data on,'' said

Dr. Anita Barry, director of communicable disease control at the Boston Public

Health Commission.

To prevent further spread of antibiotic-resistant staph, specialists recommend

many of the same measures used to stop other infections, including rigorous

hand-washing. Patients with persistent skin infections are encouraged to contact

their doctors, and they are urged to make sure that any sores are properly

covered.

''The whole issue of antibiotic resistance is a huge problem for all of us,''

Fenway's Boswell said. ''And it's a problem that really needs to be addressed

because it has huge public health implications.''

 

Stephen Smith can be reached at stsmith.

 

This story ran on page B1 of the Boston Globe on 3/2/2003.

© Copyright 2003 Globe Newspaper Company.

 

 

 

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