-Caveat Lector- http://www.boston.com/dailyglobe2/061/metro/Resistant_bacteria_report s_cause_alarm+.shtml Resistant-bacteria reports cause alarm
Five cases are seen in Boston patients By Stephen Smith, Globe Staff, 3/2/2003 Five men in Boston have been infected with a powerful, drug-resistant bacteria, strikingly similar to larger outbreaks in Los Angeles and San Francisco. Beginning last fall, doctors at the Fenway Community Health Center started seeing patients with pneumonia, sinus infections, and skin conditions caused by methicillin- resistant Staphylococcus aureus -- a germ normally caught only in hospitals by patients already seriously ill from other diseases. The germ, known as MRSA, can elude a whole class of antibiotics, making the illness significantly more difficult to treat. Its appearance in the general community has alarmed health authorities. All five of the men have been treated and recovered without lasting complications, but doctors are worried about the broader emergence of bacteria so wily that they can outrun the best drugs that medicine can produce. ''It's of great concern,'' said Dr. Scott Fridkin, a medical epidemiologist at the US Centers for Disease Control and Prevention. ''The reports are becoming more frequent, and it appears to be a growing problem.'' Fenway physicians alerted the CDC about the cluster of cases, and the Massachusetts Department of Public Health has begun an investigation, hoping to establish whether the cases are linked and, if so, to identify a common source of infection. The men are all HIV-positive, but neither physicians providing treatment nor disease investigators can say with certainty that the patients' HIV status had anything to do with the bacterial infection. ''There's no clear, obvious link that we can pick up with this,'' said Dr. Stephen L. Boswell, executive director of the Fenway center. ''It could take months before we know what's going on here.'' Drug-resistant bacteria are especially perilous because people infected with them typically don't know -- and neither do their doctors. That means they're often started on main-line antibiotics, which do not work because the bacteria has found a way to get around that drug. In the meantime, the patients get sicker as the bacteria advances, until doctors find an antibiotic that will work. And the threat is not limited to the patient with the original infection. That resistant bug can spread to other people, which can ignite a cascade of illness only treatable by more powerful pills or even antibiotics given intravenously. Drug-resistant bacteria arrived in Boston in the late 1960s and early 1970s in hospital wards, said Dr. Alfred DeMaria, state director of communicable disease control, and they have remained chiefly a problem in hospitals. That's because patients are already sick, and many have undergone surgery, leaving them with incisions vulnerable to infection. ''What's really new is the degree to which they are turning up in community- acquired settings,'' DeMaria said. ''But I suppose it was sort of inevitable.'' On the West Coast, outbreaks of similar staph infections have stricken hundreds of patients, with 928 reported in Los Angeles County jails during 2002. And earlier this year, public health agencies in LA and San Francisco both reported clusters of antibiotic- resistant bacterial infections in those cities' gay communities. Staph bacteria are pervasive, typically causing few problems. But if they invade a cut or other opening in the skin, they can cause painful skin infections, bone infections, pneumonia, and life-threatening blood conditions. In the past, staph cases in the community have been treated with first-line antibiotics, such as Keflex. But it is exactly those sorts of drugs that some strains of the bacteria are outwitting. ''It's something we need to be on the outlook for and get better data on,'' said Dr. Anita Barry, director of communicable disease control at the Boston Public Health Commission. To prevent further spread of antibiotic-resistant staph, specialists recommend many of the same measures used to stop other infections, including rigorous hand-washing. Patients with persistent skin infections are encouraged to contact their doctors, and they are urged to make sure that any sores are properly covered. ''The whole issue of antibiotic resistance is a huge problem for all of us,'' Fenway's Boswell said. ''And it's a problem that really needs to be addressed because it has huge public health implications.'' Stephen Smith can be reached at [EMAIL PROTECTED] This story ran on page B1 of the Boston Globe on 3/2/2003. © Copyright 2003 Globe Newspaper Company. Forwarded for your information. 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