Recent Death, New Research, Point to Community Presence of Invasive Strains

After a weeklong hospitalization, Ashton Bonds, a high school student from Bedford, Va., died Monday after a mysterious infection had spread to his kidneys, liver, lungs and the muscles around his heart.

The infection turned out to be a drug-defying bug called methicillin-resistant staphylococcus aureus, otherwise known as MRSA.

What makes this case shocking is the fact that Bonds was seemingly healthy just weeks ago.

And the case seems to underscore another concern about the deadly infection -- once only a hospital-based concern, MRSA has spread its wings within the community setting as well.

A study released Tuesday by the Journal of the American Medical Association shows that out of the 8,987 cases of invasive MRSA reported over an 18-month period in nine states between 2004 and 2005, 58 percent -- more than half -- were associated with health care. This means that most such cases arose in places like hospitals and other medical care centers.

But even more surprising is that 14 percent of the cases originated in the community, highlighting the fact that while MRSA is a major public health problem that is primarily related to healthcare, it is no longer confined to the hospital setting.

Moreover, certain populations -- including those older than 65, blacks and males -- were disproportionately affected.

But disease experts say anyone can be affected by the disease.

"I have seen children with severe and fatal pneumonia from presumed -- or known -- community-acquired MRSA," said Dr. Jerome Klein, professor of pediatrics at the Boston University School of Medicine.

"Although children and adults with underlying diseases are at risk, much of the community-acquired MRSA disease occurs in children without known risk factors."

Infection from the Outside In

Traditionally, staphylococcus aureus has been considered to be primarily a skin infection. However, the new research shows that the invasive form of the bug -- the one that enters the body and wreaks havoc within -- is becoming a bigger threat.

"We are in the middle of something explosive," says Dr. Stuart Levy, professor of medicine and microbiology at the Tufts University School of Medicine in Boston, Mass., and author of the book The Antibiotic Paradox.

"The country is not what it was 20 years ago," he says. "[The study] shows us that MRSA originates in the community, not just in the hospital."

The findings, however, did not come as a surprise to all doctors. Dr. Gary Simon, director of the division of infectious diseases at The George Washington University in Washington, D.C., says he feels the study presents old data, since researchers have known about community-acquired MRSA for several years.

Still, Dr. William Schaffner, chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine, says the research brings new information to light.

"Contrary to previous studies with individual hospitals or small groups of hospitals, this is a rigorous surveillance, population-based in nine states," he says. "Now we can compare the impact of invasive MRSA with other diseases; it is more than several of these other diseases added together.

"This paper is the 'cap' on a lot of other studies. It reinforces them."

Have We Created a Monster?

The presence of MRSA in the community setting may also serve as a grim reminder of how the overuse of antibiotics can facilitate the spread of this deadly infection.

"The widespread use of antibiotics has likely created an environment where this community-associated strain has spread," Schaffner says.

Dr. Neil Fishman chair of antimicrobial Resistance Working Group of the Infectious Disease Society of America, agrees.

"The initial development of the organism may be related to antibiotic use, but the transmission -- the spread -- of the organism is the way that it has expanded," he says. "We have a big problem with resistance in the United States, not only in hospitals, but also in the community. We have to focus on it as a nation."

Part of this focus may center on restraint. Levy says he is concerned that MRSA fears may lead some to demand high-powered antibiotics from their doctors, a situation that could lead to unnecessary antibiotic use.

Curbing such antibiotic use may be part of the solution to keeping MRSA at bay. And Fishman adds that another important facet of MRSA control is to apply appropriate measures for detection of the bug -- and isolation of infected individuals, if necessary.

But as there is little that can be done about the advanced stages of the disease, public health efforts will likely continue to focus on prevention -- in other words, proper hygiene and sanitation.

"Unfortunately, public health has little to offer other than good hygiene," Schaffner states. "But athletics in high schools, colleges and the pros should encourage good hygiene in the locker room -- frequently washing towels, and not sharing razors."

MRSA infections in locker rooms and gyms may be made even more likely by the fact that these are places where athletes, perhaps suffering from cuts or abrasions, share space and sports equipment. As for Bonds, the student played football with the school team last year, but was not playing this season.

But aside from avoiding places the bacteria may thrive, those in the public can offer themselves some degree of protection through such low-tech means as soap and water or alcohol-based sanitizers.

"We don't want to scare the public, but rather to encourage them to improve their hygiene," Levy says. But he adds that people may do well to stay away from soaps with anti-bacterial additives, noting that these cleansers "may change the microbiology" of these germs.