The bug most drugs can’t cure

Thrasher’s physician, James Buckmaster, M.D., had seen CA-MRSA before. He told her there was no way to know how she had acquired it; all he could do was send off a sample to be cultured for the bacteria and start her on the right drugs. The bug demonstrated its tenaciousness: Thrasher, her husband, Jobee, and her 11-year-old son, Clint, all popped up with boils before antibiotics brought things under control.

'I was terrified'
Or so she thought. Two weeks after Thanksgiving, she woke up at midnight unable to move the left side of her face. She was alone in the house, as Jobee had taken the children to visit family. “My father had just had a stroke, and now I thought I was having one,” she says. “I was terrified.” She called her best friend, a nurse, who rushed her to the emergency room. Doctors there suspected her illness was an especially serious sinus infection, and a CAT scan revealed that about 70 percent of her sinuses were blocked. “I remember saying to the doctor, ‘I feel so bad coming in for just a cold,’” Thrasher says. “And he said, ‘Oh, sweetheart, you have so much more than a cold. You are probably the sickest person we have seen today.’”

The hospital put her on the strongest IV antibiotics and placed her in strict isolation. Her family had to don masks, gowns and gloves before entering her room. But after four days, the drugs weren’t helping. Doctors punctured and drained her sinuses in surgery, which finally revealed the cause of the blockage: a CA-MRSA abscess. After Thrasher recovered, it took four rounds of strict decolonization, including twice-daily showers with antiseptic soap and weekly baths in water laced with bleach, before the family quelled the outbreak.

Thrasher says the experience left her family with medical bills of more than $50,000—about $5,000 of it not covered by insurance—along with an awestruck respect for germs. “For our family,” she says, “it was life-altering.”

The Logan family, meanwhile, thought their ordeal was over by the spring of 2006. They had slogged through the punishing decolonization process twice, enduring itchy skin, endless laundry and the ever-present faint scent of bleach. Isabella’s body was containing her infection: Periodically her bottom would swell with angry-looking pimples, but they would subside without breaking open or making the toddler ill.

And then, last March, Logan found a boil low on her abdomen. She hoped it was an ingrown hair—but fearing for Isabella and Brian, she showed it to her primary care doctor. He lanced the swelling, ordered a culture and sent her back to Infectious Disease Associates. They delivered the bad news: It was CA-MRSA once again. The prescription was 30 more days of decolonization, along with a 30-day course of two stronger antibiotics. “We went so many months without an outbreak,” Logan says. “Now I’m wondering, What is the magic number?”

The virulence of community- associated MRSA has troubled the physicians who are aware of its advance, in part because they’ve feared that many of their fellow doctors are not. In a study coauthored by Dr. Blumberg in Atlanta, about two thirds of the patients with CA-MRSA in one hospital had initially been given one of the antibiotics that no longer work against the bug. That is not surprising, says Elizabeth Bancroft, M.D., a medical epidemiologist with the Los Angeles County Department of Public Health, who has investigated MRSA outbreaks. Diagnosing the infection correctly requires ordering a bacterial culture to find which drug will work against it, but doctors are not accustomed to routinely culturing skin infections because the standard drugs worked so well for so long. “In my mind, this is similar to what happened when HIV was first discovered,” Dr. Bancroft says. “A new bug comes to town, and people at first do not think of it when they are making diagnoses.”

Because CA-MRSA can destroy tissue so rapidly, the consequences of starting treatment with the wrong drug can be dramatic. Dee Dee Wallace, a 46-year-old mother of two in Nashotah, Wisconsin, discovered that in late 2004. She noticed a painful boil on her rear end in the midst of an 800-mile Thanksgiving car trip. When she saw her primary care doctor the following week, she was given a common penicillin-based antibiotic. The infection seemed to heal, but then recurred on her left knee around New Year’s Day. By the time it was cultured, identified as CA-MRSA and targeted with the correct drugs, it had developed into necrotizing fasciitis. To clean out the infection, surgeons had to remove more than five square inches of flesh from the inside of Wallace’s knee. Two years later, after an ICU stay, skin-graft surgery and months of recovery, she still lacks full use of her leg. “I had never heard of MRSA,” she says. “Until my husband got online and looked it up, I had no idea how serious it was.”

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