The bug most drugs can’t cure

Unnerving infection
The drug-defying bug that attacked Mollie and Isabella Logan unnerves researchers perhaps more than any other. In less than 10 years, CA-MRSA has soared from a barely noticeable blip on disease charts to a major cause of widespread, devastating and sometimes fatal infections. A strain of it has been linked to rare illnesses that were almost never caused by old-fashioned, nonresistant staph: severe infections of the bloodstream that cause multiorgan failure, for instance, and pneumonia that kills by destroying the tissue of the lungs. It has even triggered necrotizing fasciitis, the “flesh-eating” infection associated with several types of bacteria.

Some CA-MRSA victims had preexisting health problems that might have made them vulnerable to the bacterium, such as a paraplegic woman in Fort Worth, Texas, who may have been infected during a salon pedicure and who died after complications from the infection triggered a heart attack. But others were strikingly healthy: Emory University in Atlanta has been battling an outbreak in its athletic department for the past two years; four female athletes, including swimmers and volleyball players, were among those mysteriously infected.

A study published last August in The New England Journal of Medicine made clear how aggressively MRSA has proliferated in communities: Nearly 60 percent of people who came to emergency departments in 11 different cities with skin infections had it. Cases have sprung up in every area of the country, and most of them cannot be linked to a larger CA-MRSA outbreak. “This is widespread,” says Henry M. Blumberg, M.D., professor of medicine in the division of infectious diseases at Emory University School of Medicine in Atlanta. “And everybody is potentially at risk.”

Isabella’s early brush with illness deeply frightened her parents. Once she came home from the hospital, they agreed that Brian would go back to work as an auto mechanic, but Mollie, who had been working as a nanny, would become a stay-at-home mom. The origin of the family’s infection remained a mystery: Isabella had clearly contracted the bug from her mother at birth, but doctors could not identify the source of Logan’s infection. Because she had the community version of MRSA, not the type confined to hospitals, it was impossible to know for sure where she picked it up.

To her parents’ relief, Isabella thrived—she had no more signs of illness and no indications that the potent drugs had affected her. But in November 2005, 15 months after her first scare, Logan found a hard, red pimple on her own right breast. Oh no, she thought. I know what this is.

Tests confirmed her suspicions. The bacteria had lurked somewhere in or on her body and recurred. A second set of doctors, from Infectious Disease Associates of Omaha, ordered lab tests to make sure the bug was vulnerable to the kind of antibiotics that can be taken at home in pill form—the very strongest tend to be given only by IV—and put her on a 20-day course of pills. Then they recommended a grueling 30-day cleansing called decolonization, which would wipe out any staph lingering on the Logans’ bodies or in their home.

Logan changed their sheets and towels every day, laundering each batch with a cup of bleach, which kills bacteria. She bought new hairbrushes, toothbrushes and combs. All three of them washed daily with Hibiclens, a harsh antibacterial soap used in hospitals. After they showered, Mollie and Brian sprayed the bathroom with Lysol; they did the same thing after either one of them used the toilet. They regularly wiped down every surface in the house with Clorox Disinfecting Wipes. And three times a day, they painted the inside of their nostrils with Bactroban, a thick antibacterial ointment. “If this was what we had to do to make sure our daughter didn’t have to fight for her life again, we were going to do it,” Logan says.

New tests showed that Mollie and Brian were clear of infection. But baby Isabella was carrying CA-MRSA in her rectum. Neither drugs nor the decolonization ritual had knocked it out. She could reinfect herself, or them, at any time.

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