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Methicillin-resistant Staphylococcus aureus infections, which are potentially deadly, are now responsible for an estimated 12 million outpatient visits each year for skin infections, said Jeff Hageman, of the U.S. Centers for Disease Control and Prevention.
Hageman blamed the increase on rising numbers of infections -- a trend that has probably been under way for several years -- and greater awareness of the problem.
"MRSA is epidemic in some regions of the country," he said. "The highest rates are in the southern parts of the U.S., including Atlanta, Los Angeles and Texas. We first began noticing MRSA in 1999 when there were four child deaths in Minnesota and North Dakota."
"Most of these infections are minor and go away without any medical treatment," Hageman said. "It's not clear why some progress to life-threatening disease."
While most MSRA infections occur in hospitals, the number and severity of infections in the community appears to be increasing. "Some 30 percent of people have staph bacteria on their skin," Hageman said. "The extent to which it is growing in the community is just being defined."
Hageman's assessment of the problem follows publication this week of a study in the Journal of the American Medical Association that found that MRSA staph infections are more common, both in and out of hospitals, than experts had once thought. More people died in 2005 from MRSA infections in the United States than from AIDS, the journal noted.
And it follows news reports that students in school districts in at least six states have been infected with MRSA, and three of the children have died. Ashton Bonds, 17, of Bedford, Va., died Monday as a result of infection. Preschooler Catherine Bentley of Salisbury, N.H., and Shae Kiernan, 11, of Vancleave, Miss., both died from infections last week, Fox News reported.
Also, six football players at one North Carolina high school, seven students at three West Virginia schools and two teens in Connecticut have been diagnosed with MRSA infections.
MRSA infections are the leading cause of skin and soft tissue infections among hospital patients, and can result in severe and even fatal disease. These infections account for almost 19,000 deaths and more than 94,000 life-threatening illnesses each year in the United States.
Dr. Pascal James Imperato, chairman of the department of preventive medicine and community health at the State University of New York Downstate Medical Center in New York City, said there's a growing awareness of MRSA infections, particularly those occurring outside of hospitals.
"But there is also an increase in the number of cases, especially in the community," Imperato said. "That has come about because of changes that have occurred in MRSA in the community where, at the biological level, the organism had mutated and can cause serious illness, whereas before it didn't."
Many people carry the MRSA bacteria on their skin. But it has only become a problem since the increased use of antibiotics, which has caused the bacteria to mutate into a drug-resistant form, according to the CDC.
MRSA is resistant to methicillin, which includes several types of penicillin. MRSA infections are treated with newer antibiotics, such as vancomycin, teicoplanin and glycopeptide, although newer strains of the bacteria are becoming resistant to these antibiotics as well. This is one reason health officials warn against the over use of antibiotics, the CDC said.
The best protection from MRSA is good hygiene, including frequent hand washing, particularly for health-care workers and their patients.
For MRSA infections of the skin, the usual treatment is to have the site drained of puss and bandaged. Most of these infections do not require antibiotic treatment.
In the JAMA study, researchers found that 58.4 percent of MRSA infections from July 2004 through December 2005 were found in community health-care settings; 26.6 percent were in hospitals; 13.7 percent were infections not associated with health-care facilities; and 1.3 percent could not be classified.
Hageman said transmission of MRSA infection typically occurs in crowded areas where there's an opportunity for people to come into contact with infected items and then spread the infection to others. "These are most likely athletic settings, prisons and the military," he noted.
Imperato said young athletes are particularly vulnerable to MRSA infections.
"The reason they are more vulnerable is because [when] playing contact sports, abrasions, lacerations and contusions of the skin are common. And if their skin is colonized with MRSA it then has an easy portal of entry," he said. "In addition, they are sweating, which facilitates penetration of the organism."
Also, they're wearing and sharing equipment on which MRSA can survive, Imperato said. To prevent this form of transmission, he thinks equipment should be sterilized on a regular basis.
Imperato said young athletes should shower after each practice or game, and not share towels. "If one implements simple, sound measures -- particularly in locker rooms, gyms and among players -- it will go a long way to reducing community-acquired MRSA infections," he said.
SOURCES: Jeff Hageman, M.H.S., epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; Pascal James Imperato, M.D., distinguished service professor and chairman, department of preventive medicine and community health, and director, master of public health program, State University of New York Downstate Medical Center, New York City
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