The bug most drugs can’t cure

Drug options shrinking
Physicians lack experience with the remaining antibiotics that do work against CA-MRSA. “Are they not very effective, or are they just as good? I don’t think we know,” says Henry Chambers, M.D., chief of infectious diseases at San Francisco General Hospital. And that menu of alternate drugs may be shrinking. Several recent studies suggest that community MRSA, which originally could be distinguished from the hospital variety because it was vulnerable to more drugs than the hospital strain, is losing that vulnerability. And even as existing drugs cease to work, few new antibiotics are being developed. “The pipeline is just skimpy,” says John Bartlett, M.D., of Johns Hopkins University School of Medicine in Baltimore. “We are already starting to use drugs that we shelved because they were too toxic.”

Adding to their concern is a troubling discovery that researchers have only recently pieced together. More and more, CA-MRSA infections nationwide are caused by a single strain, known as USA 300, which emerged in 2001 and has become linked with horrific infections, including flesh-eating disease. As it spreads, USA 300 is squeezing out other MRSA strains, including the long-standing hospital variety—a sign, researchers say, that a pathogen already demonstrating a talent for survival of the fittest may have become super fit.

CA-MRSA’s emergence as a potent health problem is so new that authorities are scrambling to get the message out about it. The CDC has launched an educational campaign and convened a caucus of experts to discuss strategies for physicians to follow. Among the experts’ recommendations: Doctors should be aware of the extent of MRSA in their communities. A skin infection that staph might have caused should always be cultured to see which drugs will work against it. Complaints of spider bites should always rate a second look. “It is a change in practice,” admits Rachel Gorwitz, M.D., a CDC epidemiologist who tracks CA-MRSA. “We are asking them to do something that they may not have done before.”

Physicians with experience treating MRSA urge patients to act in their own defense. Simple precautions such as washing your hands, covering any wounds and showering immediately after contact sports can help ward off germs. If a suspicious boil does pop up, never be afraid to ask a doctor to culture it. Be especially concerned about skin problems that rise or spread rapidly or become red, swollen and painful. But doctors also concede reluctantly that the public may have to learn a hard lesson: For many infections, the time of easy, uncomplicated treatment is over.

Mollie Logan has already come to that realization. She was declared free of CA-MRSA in May 2006, after three sets of tests to prove it had been eliminated. She has had no more recurrences, and Isabella—who turned 2 years old last August—remains healthy. The family is moving on: Logan will give birth this spring to their second child. As she nears her due date in April, her obstetrician will test her again, and if she comes up positive, she will get antibiotics during labor and delivery. “But I don’t know if they really know what will happen,” she says. “It is very scary.” Meanwhile, the family continues to shower weekly with antiseptic soap, keeps a supply of prescription antibiotic ointment on hand and takes nothing for granted.

In what may eventually be the postantibiotic era, that is the only sensible attitude, says Darcy Jones, the physician’s assistant who cared for Mollie Logan at Infectious Disease Associates. “Hopefully, we have eradicated the MRSA from her, but it is not something that will last forever,” she says. “She could get this again. Any of us could.”

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