Outbreak of a Next Generation Germ

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Cuts, scrapes, sweaty equipment, and shared facilities: these are all breeding grounds for skin infections caused by Staph.

And that’s exactly what the University of New Hampshire football team provided when a staph infection began to circulate among players last summer.

Jon Dana is the Director of Sports Medicine at UNH.

Dana: Staph’s always around. You always have one or two athletes that have had it over the course of a year. But nothing like this. I have never seen anything like this in twenty years at UNH.

And in fact, New Hampshire had seen nothing like it either.

According to the state epidemiologist the staph outbreak at UNH was the first in the state from a new form of the bug, referred to as community-associated MRSA.

The MRSA stands for methicilin-resistant staph aureus.

That means the bacteria can’t be killed by any methicilin antibiotics.

MRSA has been around since the 60s, but it was mostly sequestered in hospitals.

About a decade ago, it moved into the community.

Lynda Caine, Elliot Hospital’s Director of Infection Control, says she now reports 2 to 5 cases of community staph a week.

Caine: When I first started working here I had a short list of total cases, and they were hospital acquired cases. And about 10 to 12 on my list. And now I have over 1200 on a list, and the majority of them are community acquired.

Those aren’t the result of any outbreak.

They are just the normal incidence of infection.

And it’s been flourishing across the country.

Dr. Brad Frazee at Alameda County Medical Center in Oakland California published a study in December that called the prevalence of community staph alarming.

Frazee: In fact, the genetic fingerprint of this bug was almost 99 percent of our isolates were community associated, if you look at it from a genetic standpoint.

In other words, nearly all of the staph infections he looked at in emergency rooms came from the community-associated MRSA.

Frazee says that staph in the community presents new challenges to healthcare.

First, the old approach of isolating patients in the hospital won’t work because people are contracting the infections at home or in school.

Second, it can take days to figure out the most appropriate antibiotic to use.

Frazee: There will be, as people probably continue to prescribe the wrong kind of antibiotics for these infections there’s going to continue to be cases where this bug gets into the blood stream and causes someone to get very sick or even die. And for the first few days, until an ID specialist or someone comes by they’re not going to realize they’re using the wrong kind of antibiotic.

The community-associated staph is known to cause nastier infections than the hospital kind.

But Elliot Hospital’s Lynda Caine adds that it can also be easily prevented by simple soap and water.

Caine: That’s why the good old hygiene practices, the hand washing, that’s why it’s so important. And I guess because it’s so simple people think, oh, how big a deal can that really be. It really doesn’t make a difference. It’s the difference between life and death.

Caine’s biggest fear is that community staph will become resistant to the last remaining antibiotics that work.

Vancomycin is presently the most popular antibiotic used to treat these infections, and two cases of vancomycin resistant staph infections have popped up in the states.

It has not shown up in New Hampshire, but as long as staph is around, antibiotic resistance will always be a threat.

Jon Dana at UNH says staph will be an ongoing battle.

Dana: I would love to tell you that it’s going away and we’ll never see it again. That’s not the impression I get from anybody, any of the physicians I’ve spoken with. It’s out there it exists, it’s something you gotta deal with.

Lynda Caine’s best advice is written on her license plate: Washem.

For NHPR News, this is Kerry Grens.