LGBT Medical Association Comments on Drug-Resistant Staph Infections
Putting Methicillin-Resistant Staphylococcus Aureus (MRSA) in Perspective
March 31, 2003
-- Recent reports in the lay press of outbreaks of drug resistant staph infection in gay men's health clinics in San Francisco and Los Angeles have caused many in the gay community to recall the first days of the AIDS epidemic. These case reports need to be put into a broader perspective, according to Kenneth Haller, MD, President of the Gay and Lesbian Medical Association (GLMA).
Haller says that there have been increasing reports of infections with Methicillin-Resistant Staphylococcus aureus (MRSA) acquired in community settings. While some of these accounts have come from clinics serving gay men and HIV-positive clients, clusters of skin infections caused by MRSA have also been described among injecting drug-users, Aboriginals in Canada, New Zealand or Australia, Native Americans in the United States, incarcerated persons, players of close-contact sports, children in day-care settings, and other populations, according to the Centers for Disease Control (CDC).
"For years physicians have seen rising rates of antibiotic resistance in the hospital setting," said Haller. "In settings like those, where bacteria are repeatedly exposed to multiple antibiotics, this kind of resistance is expected."
What's changed, according to Haller, is that over the years, as more medical treatment is done in outpatient and home settings, bacteria have been exposed to varied and powerful antibiotics in community settings as well.
"In the 1940s Staph aureus was exquisitely sensitive to penicillin," Haller said. "Today, virtually all strains are resistant to penicillin. Over the years new antibiotics have been developed to treats bacterial infections. While some evolution in the resistance of staph and other bacteria to antibiotics is inevitable, much of this has been accelerated by antibiotic misuse and overuse."
These exposures may be the result of antibiotics being prescribed in cases of viral illness, like flu or colds, where they will be of no help, or as a result of antibiotic use in livestock, such as beef or poultry, to promote growth. In fact, GLMA has endorsed U.S. Senate bill 2508, "Preservation of Antibiotics for Human Treatment Act of 2002," currently in committee, which would restrict use of antibiotics as a growth-enhancer in farm animals.
"Bacteria will naturally evolve and adapt to new antibiotics, and antibiotic misuse just accelerates this effect. We can't assume that we can keep developing new antibiotics that will stay ahead of this process," said Haller.
He suggests that it is also important to know that Staph aureus is commonly found in the nose and on the skin. Approximately 25 to 30 percent of the population, for example, is colonized in the nose with staph bacteria at any given time. When the skin and membranes of the nose are intact, it is rare for staph to cause a significant problem, and MRSA is not more likely to cause an infection than any other strain of staph colonizing the skin or nose.
Staph bacteria can cause many different kinds of illness, including skin infections, bone infections, pneumonia, severe life-threatening bloodstream infections, and others. Since MRSA is a staph bacterium, it can cause the same kinds of infection as staph in general.
Staph bacteria, including MRSA, can spread among people having close contact with infected or colonized people. MRSA is almost always spread by direct physical contact, and not through the air. Spread may also occur through indirect contact by touching objects (i.e., towels, sheets, wound dressings, clothes, workout areas, sports equipment) contaminated by the infected skin of a person with MRSA or other staph bacteria.
Persons can prevent staph infections by practicing good hygiene, by remembering to:
"We should not think of MRSA as either some type of super-staph infection or as a specifically gay health issue. Where it becomes a problem, particularly for HIV-positive persons, is if the wrong antibiotic is given to treat a staph infection. If the first medicine is ineffective, that could allow the infection to become much deeper and more severe," according to Haller.
Haller's advice for patients is: "If your doctor thinks you have a staph infection, he or she should NOT just start you on antibiotics. Your doctor should first get a test called a Culture and Sensitivity of the infection before starting antibiotics. That way, if the bacteria are not sensitive to the first antibiotic you've been given, your doctor will have information within a day or two to change your treatment to an antibiotic that will work."
This article was provided by Gay and Lesbian Medical Association.