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New Outbreaks of Drug-resistant Staph Infection Reported in Schools

October 22, 2007 at 6:35 PM EST
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MARGARET WARNER: There were reports this weekend of more outbreaks of a dangerous staph bacteria infecting students in several states. The bacteria, which is resistant to common antibiotics, is known as MRSA. It most commonly appears in hospital patients.

The school cases, with three recent reported student deaths, come on the heels of new findings showing MRSA is now causing more deaths annually in the U.S. than AIDS. According to the new calculations by the Centers for Disease Control, MRSA is responsible for nearly 19,000 deaths a year and more than 90,000 serious infections. The figures suggest the infection is twice as common as previously thought.

For more about MRSA, we turn to Dr. Richard Shannon, professor and chairman of the Department of Medicine at the University of Pennsylvania School of Medicine.

And, Professor Shannon, welcome. First of all, what does MRSA stand for? And what is it?

DR. RICHARD SHANNON, University of Pennsylvania School of Medicine: Well, it’s good to be with you, Margaret. MRSA stands for methicillin-resistant staph aureus. It’s a type of bacteria related to a very common bacteria, typically known as staph, that, as you have said, becomes resistant over time to the use of conventional or first-line antibiotics.

So penicillin is a commonly used antibiotic to treat staph infections. This particular strain has become resistant to that antibiotic.

MARGARET WARNER: And then, we’re seeing a growth not only in the antibiotic-resistant strain, but in this particularly invasive form that can get, what, from the skin into the body?

DR. RICHARD SHANNON: Well, that’s right. I think what we’re really seeing is that MRSA has typically been confined to hospitalized patients whose immune systems were weakened by another illness or who may have had a surgical wound that became infected.

But now we’re seeing these strains emerging in the community. And in particular, there are some variations in the strain that, as you say, tend to cause very serious skin infections that, if it gets into your blood, can cause a life-threatening illness.

Symptoms of MRSA infection

Dr. Richard Shannon
University of Pennsylvania
But the first signs in a patient or in an individual in the community who is otherwise healthy is typically a redness of the skin in the development of a pimple or a blister that can sometimes be swollen and also quite painful.

MARGARET WARNER: So how does a healthy person know? What are the first signs or symptoms that a healthy person, a student or anyone else out in the community, has this?

DR. RICHARD SHANNON: Well, I think at first it's important to know that about 25 percent of the population carries staph bacteria on their skin normally, and about 1 percent of the population has this antibiotic-resistant form of staph, called MRSA.

But the first signs in a patient or in an individual in the community who is otherwise healthy is typically a redness of the skin in the development of a pimple or a blister that can sometimes be swollen and also quite painful.

MARGARET WARNER: Now, I noticed in the CDC figures the most -- the greatest fatalities were among the elderly and actually African-Americans. What determines whether this MRSA is fatal?

DR. RICHARD SHANNON: Well, I think typically whether the infection is fatal or not is predicated upon whether the antibiotics are administered rapidly when the infection is diagnosed, but also depending upon what systems of the body become infected.

So when MRSA infects the lungs, for example, it causes a very serious pneumonia that may take much longer to treat and respond to antibiotics because of its resistance. When it causes infections in the bloodstream, other organs, like the heart and the liver, can become infected. And this can lead to multi-organ failure, which really is what causes individuals to die.

Spreading person-to-person

Dr. Richard Shannon
University of Pennsylvania
I think that we are becoming increasingly concerned that very simple measures that could really help us to control this, simply health care workers don't appreciate how important they are.

MARGARET WARNER: Now, give us the scenario for how it is spread, first in hospitals.

DR. RICHARD SHANNON: Well, I think that one of the most disturbing things about MRSA is that it is spread almost exclusively by person-to-person contact. So in a hospital, that would mean most typically contact between a patient, who is colonized with MRSA, and a health worker, who is taking care of that patient plus several other patients. And the failure to wash hands in the hospital or to adhere to contact precautions, such as wearing a gown or wearing gloves, really leads to the ability for this bacteria to be spread from patient to patient.

MARGARET WARNER: And I gather studies have found that more than 50 percent of hospital workers, or rather hospital workers more than 50 percent of the time disregard the standard, which is you have to wash your hands between each patient and clean whatever equipment you've used.

DR. RICHARD SHANNON: That's exactly right. I think that we are becoming increasingly concerned that very simple measures that could really help us to control this, simply health care workers don't appreciate how important they are. So in a high-tech intensive care unit with lots of equipment, it's much easier to think about using some technological approach than really just good hand hygiene and barrier precautions.

Good hygienic precautions

Dr. Richard Shannon
University of Pennsylvania
So really the message should be that individuals should engage in very good personal hygiene. They should wash their own hands.

MARGARET WARNER: All right. Now, how is it being spread in the schools? And why are we seeing more incidents in schools?

DR. RICHARD SHANNON: Well, I think the spread among healthy individuals is basically the same, and that is it's usually skin-to-skin contact. And so typically where this is being seen is in daycare centers, where kids are playing together, or on sports teams, where individuals are huddled together and may come into contact, such as wrestlers would during the course of a meet.

So the mode of spread is exactly the same: It's skin-to-skin contact. I think the reason we're seeing more of this is that now we've had, unfortunately, three cases in the last week of otherwise young, healthy individuals developing very serious staph infections due to this resistant MRSA, and their deaths have really raised public awareness to a new level.

MARGARET WARNER: Now, we read stories about schools scrubbing down their gyms or showers. People talk about, if they go to a gym, a regular workout place, rubbing down the equipment before they use it. Are those necessary precautions or overkill?

DR. RICHARD SHANNON: Well, I think they're good hygienic precautions that people should take. But I think it's important to know that, while MRSA can live on those surfaces, it is still much more likely that the organism is spread from person-to-person contact.

So really the message should be that individuals should engage in very good personal hygiene. They should wash their own hands. They should make sure that their workout clothes are washed on a regular basis. And athletes should avoid sharing equipment like towels and razors in the locker room.

Advice for worried parents

Dr. Richard Shannon
University of Pennsylvania
Mounting evidence suggests that screening of individuals when they're admitted to high- risk areas of the hospital and absolute adherence to isolation procedures can really help to control the spread of MRSA.

MARGARET WARNER: So, bottom line, how worried should parents be?

DR. RICHARD SHANNON: Well, I think this is a concern, but I wouldn't be an alarmist about this. Most of the community-acquired infections cause skin infections, and many of those can simply be treated with topical measures.

I think the real message for parents is to really help their children understand the importance of personal hygiene. And I think, in the school systems and in daycare facilities, the importance is to recognize that students should engage in those practices at school, as well as at home.

MARGARET WARNER: And very briefly, in hospitals, is screening and isolation of patients who are carrying this bacteria an option?

DR. RICHARD SHANNON: Well, I think that's been controversial. Mounting evidence suggests that screening of individuals when they're admitted to high- risk areas of the hospital and absolute adherence to isolation procedures can really help to control the spread of MRSA.

MARGARET WARNER: All right, Professor Richard Shannon, thank you so much.

DR. RICHARD SHANNON: Thank you, Margaret.

JIM LEHRER: Two doctors will take your questions about the drug-resistant staph infection in our online Insider Forum. To participate, go to PBS.org.