Bug Puts Hospitals On Edge, On Guard

'Nasty' Bacterium Resists Antibiotics, Forces New Actions

Hospitals across the Washington region are mounting increasingly aggressive defenses against a virulent bacterium resistant to antibiotics that turns seemingly minor skin abrasions, cuts and sores into serious, even life-threatening, infections.

At Franklin Square Hospital Center in Baltimore, clergy wipe down their Bibles after visiting patients' rooms so as to spread only the Word. Medical charts are tucked into plastic pouches to minimize the chance of germs being transported with people heading to tests or therapy.

At the University of Maryland Medical Center, more than a third of all patients are tested upon admission, discharge and frequently in between for what the infection control director labels "a nasty bug." Using nasal swabs and molecular technology, doctors learn within hours whether someone is carrying the bacterium.

Like facilities elsewhere in the country, the hospitals have experienced a sharp rise in the incidence of methicillin-resistant staphylococcus aureus, known as MRSA, coming from the community into their emergency rooms and patient wards. In the District, where a task force is considering a citywide response, this strain of microorganism appears responsible for a jump in hospitalizations since 2004.

The challenge is not just treating people exhibiting the red, swollen skin abscess or painful skin inflammation that are classic warning signs. Millions of Americans are unknowingly "colonized" with MRSA but show no symptoms. They pose a different issue: How can hospitals immediately identify and separate them when they're admitted for whatever medical reason?

"We need to do more. Just how much more to be effective is not clear," acknowledged Harold Standiford, who heads infection control at the University of Maryland Medical Center. The 669-bed institution recently expanded its testing surveillance to all nine intensive care units, at a cost of hundreds of thousands of dollars.

The pathogen commonly resides in nasal passages or on skin and can be transmitted easily by casual contact with another person or a contaminated surface. Whether on a bedside table or an X-ray machine, a stethoscope or Bible, it can survive for days.

Hospitals have long battled internal staph infections that could fight off the usual antibiotics. The patients most at risk were those with weakened immune systems or those recovering from surgery or in intensive care.

Then several years ago, a variant emerged in communities across the United States. It spread rapidly, garnering attention because its victims were generally younger, healthy people. Some were professional athletes whose seasons or careers were derailed.

A Virginia Health Department conference Friday in Richmond will include Bubba Tyer, director of sports medicine for the Washington Redskins, who will talk about the team's half-dozen MRSA cases since 2004. The meeting will bring together government officials, physicians and hospital administrators to discuss a comprehensive counterattack to the threat.

One concern is that the new strain could become entrenched in hospitals. "We are starting to see outbreaks," Donald Goldmann, an infectious disease expert at Children's Hospital in Boston, told a national audio conference this year.

Some data also suggest the bacterium is becoming less susceptible to the alternate drugs prescribed as treatment. Given federal estimates that antibiotic-resistant staph infections are responsible for about 130,000 U.S. hospitalizations and for 17,000 deaths annually, the ramifications could be daunting.