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Second Opinion

Readers point out mistakes and warn of MRSA’s spread.

Spring 2006
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Staph’s Spreading Influence

Your most recent issue highlighting the problems linked to hospital-associated methicillin-resistant Staphylococcus aureus, or MRSA (“A Killer Called Staph,” noted only briefly that MRSA has become a growing threat outside the hospital. New strains of the bacterium are circulating in the community and causing disease in previously healthy people.

Community-acquired MRSA generally involves skin and soft tissue infections, and less commonly, severe necrotizing lung disease. But it can be deadly. In 1999 the Centers for Disease Control and Prevention reported that four children, ranging in age from 12 months to 13 years, had died from severe MRSA infections acquired outside the hospital setting. Since then, there have been occasional news reports about professional athletes suffering from MRSA-related infections. It is likely, however, that what has reached the media is just the tip of the iceberg.

Community-associated MRSA infections are increasing worldwide among military personnel, prisoners, those engaged in weight lifting, varsity and professional sports, and other healthy young adults. Recently there was an outbreak of community-derived MRSA among 235 military recruits in Virginia, and between 2001 and 2003, some 12,000 infections were reported in the prison systems in Georgia, California and Texas. According to a CDC report on the prevalence of MRSA during 2001 and 2002 in the United States, more than 2 million people were estimated to have nasal colonizations of MRSA bacteria, and current numbers are likely to be higher.

What can be done? Among the recognized risk factors are having an open wound and being in close contact with an infected individual, frequent treatment with antibiotics and use of poorly decontaminated whirlpools. Preventive measures, therefore, would include covering wounds when interpersonal contact is expected, not sharing personal items in locker rooms, taking daily baths, cleaning shared whirlpools and saunas thoroughly and prescribing antibiotics more judiciously. Finally, routine hand-washing and the use of alcohol-based disinfectants are key elements in breaking the cycle of transmission. We all share the burden of prevention.

John Francis // Division of Infectious Diseases

Karen Carroll // Division of Medical Microbiology 
Johns Hopkins Hospital, Baltimore


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