Superbug defies antibiotics

[okarol]

Superbug defies antibiotics
Doctors, lawmakers argue over what to do about MRSA

By Dennis O'Brien

Sun reporter

March 1, 2008

For Kerri Cardello McKoy, mother of four, a trip to the hospital to treat a broken nose in 2003 seemed routine. But what followed wasn't: a raging MRSA infection that cost her both legs below the knee, a collapsed lung and four months in a hospital bed, much of it in a drug-induced coma.

"When I think about it, it makes me want to cry," she says.

Almost five years later, public health officials, hospitals and legislators are still arguing over the best way to curb MRSA, the drug-resistant bug that cost the Annapolis woman her legs and could be killing up to 19,000 people a year nationwide.

Experts can't agree on whether hospitals are doing enough to address the growing number of MRSA infections - or whether government should make them take action.

Advocates say the recent defeat of two MRSA bills in Annapolis leaves thousands of hospital and nursing home patients more vulnerable to the deadly pathogen.

"It doesn't make any sense. The data, the science, the evidence, everything we know about this says that we have to act now," said Michael Bennett, who as director of the Coalition for Patients Rights has fought unsuccessfully for MRSA legislation in Maryland for three years.

Methicillin-resistant Staphylococcus aureus (MRSA's official name) is a bacterium that can live harmlessly in the skin or nasal cavities but attacks wounds and causes life-threatening infections, including pneumonia and blood poisoning.

Over the years, it has evolved into a superbug that resists the most common antibiotics. Random testing in Chicago hospitals has shown that about 10 percent of patients are positive for MRSA when they're admitted.

The federal Centers for Disease Control and Prevention has identified at least 12 subtypes of MRSA, including a new variant - at large in the community - that killed a Virginia youth last fall and can spread in gyms, locker rooms and community settings.

Last fall, CDC researchers estimated that MRSA could kill more than 19,000 people a year in the United States. Their report, in the Journal of the American Medical Association, showed Baltimore with the highest infection rate of nine regions studied - but experts noted that Baltimore was also the most urbanized region.

The 8,987 cases of invasive MRSA that CDC discovered translated to 31.8 cases per 100,000 people. That was about twice as high as the previous estimate, with infection rates highest among people older than 65 (127.7 per 100,000) and African-Americans (66.5 per 100,000). Of those infected, almost 1,600 died, about 18 percent.

Given the scope of the crisis, lawmakers might have to act, some experts say.

"It's staggering how much MRSA there is, and it's indefensible to not do anything," said Dr. Carlene Muto, an infectious disease specialist at the University of Pittsburgh Medical Center. "Not everyone is going to do it because it's the right thing to do."

New Jersey, New York and the Department of Veterans Affairs recently began requiring hospitals to test patients for MRSA when they're admitted. Pennsylvania and Illinois have begun testing patients considered at high risk of infection, such as those previously hospitalized or cared for in nursing homes. Connecticut has also introduced legislation that would require hospitals to test high-risk patients.

Bennett argues that Maryland should begin requiring hospitals to report MRSA cases to state health authorities and to test high-risk patients. But bills that would have stepped up MRSA surveillance in Maryland's hospitals were killed in the Senate Finance Committee on Feb. 25.

"I'm just shocked, befuddled and dismayed at the duplicity of the health care leadership and how they're responding to this crisis," said Bennett.

According to the Maryland Hospital Association, the legislation was flawed. "It would have taken clinical guidelines and made them into law, and that's never a good idea," said Nancy Fielder, the group's spokeswoman. MHA is planning a series of public forums on MRSA at hospitals around the state this month.

Sen. Lisa A. Gladden, the Baltimore Democrat who sponsored the measures, vowed to introduce them again next year.

"It's clear to me hospitals don't want to be told this is the way to go," she said. "But we'll bring it back until we get a resolution."

State health officials also say that they are taking steps to eradicate MRSA - and that the best safeguards are still evolving.

"The jury is still out on how aggressive the steps to control MRSA have to be," said Dr. Rex Cowdry, executive director of the Maryland Health Care Commission, which regulates hospitals.

The commission plans to require hospitals to screen intensive-care patients for MRSA and track the number of MRSA cases that turn up among surgical patients and those who develop "central line" bloodstream infections, Cowdry said.

Some experts argue that the problem is too complicated for a state law's "one-size-fits-all" approach. MRSA might be a serious threat in some hospitals, but universal testing would waste resources at facilities where infections are rare and could "hamstring efforts" to tailor better solutions, said Kathy Warye, chief executive officer of the Association for Professionals in Infection Control & Epidemiology, which represents 12,000 infection-control experts.

"I think what all the experts are recognizing is that there's no single silver bullet approach to this problem," said Dr. John Jernigan, the CDC's chief expert on hospital-acquired MRSA.

McKoy, 37, the Annapolis woman infected by MRSA, believes a state law could prevent the spread of MRSA. She went to the hospital after her 13-year-old daughter kicked her while they were playing in a bunk bed.

That began an odyssey to Anne Arundel Medical Center and then to North Arundel Hospital, which was renamed Washington Baltimore Medical Center in 2005.

Officials at both hospitals declined to comment on McKoy's case, but they said they have initiated rigorous MRSA surveillance and prevention. They test patients suspected of infection and isolate those with MRSA.

McKoy is unsure where she was infected, but doctors say the bug robbed her of most of her lung capacity and makes her susceptible to lung infections. She has testified in support of Gladden's bills in hopes of preventing others from being infected.

"I'm thankful for every day because it means another day with my kids," she said.

dennis.obrien@baltsun.com

www.baltimoresun.com/news/nation/bal-te.mrsa01mar01,0,7895358.story