Health: Drug-Resistant Staph Germ

The Washington Post's Rob Stein was online Wednesday, Oct. 17 at 2 p.m. ET to discuss a dangerous germ that has been spreading around the country and causing more life-threatening infections than public health authorities had thought.

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Read the story: Drug-Resistant Staph Germ's Toll Is Higher Than Thought.

A transcript follows.

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Rob Stein: Hi everyone. Thanks very much for joining this discussion. We'll be discussing the report that was published today about a "superbug" known as MRSA, which the CDC says is causing more life-threatening infetions and deaths than had been thought. Looking forward to your questions.

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North McLean, Va.: What an important, and scary, article. I am concerned that Staph isn't getting the attention it deserves. Is it because Staph infections just aren't, and I am struggling with the right term here, as "glamorous" as other diseases?

Rob Stein: Although concern about MRSA has been rising in recent years, part of the problem was that before today's report there had been no national estimates about the full scope of the threat.

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Hartford, Conn.: Last year my son, a soccer player, was hospitalized with MRSA and a turning point in his treatment came when his doctor persuaded insurance to authorize a $1,000 drug regimen. The name escapes me, but does the report address the cost/benefit aspects of moderate vs. more aggressive treatments?

Rob Stein: This report does not adddress that issue. But doctors tend to treat this very aggressively once it has been diagnosed to minimize the risk of serious complications.

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Baltimore, Md.: It seems like everywhere you look these days there's a new antibacterial product. Bodywash, air fresheners, Windex, mattresses. ... Why aren't more consumers, and more importantly, the federal government, demanding that manufacturers stop this dangerous practice? It scares me that our unneccessary overuse of these products is causing these bacteria to evolve and our medications to become ineffective against fighting common illnesses.

Rob Stein: Yes, there is concern about this. Experts say that people can minimize their risk for these resistant infections, and actually all kinds of infections, by take simple common-sense steps, such as washing their hands frequently, avoiding close contact with people known to be infected and avoiding sharing personal items such as razors and towels.

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Denver, Colo.: Hello, It appears the drug companies are focusing research effort and money on development of drugs people take daily rather than on antibiotics. Can you comment on current research and development efforts to produce new antibiotics aimed at these "superbugs"?

Rob Stein: One of the concerns about these drug-resistant microbes is that there aren't enough new antibiotics in the pipeline. That said, there are at least a couple of new antibiotics that appear effective against MRSA pending before the Food and Drug Administration, and at least several more in the pipeline. Experts are particularly worried that there aren't enough new antibiotics in the pipeline for so-called "gram-negative" infections, such as one called Acinetobacter that's become a big problem among wounded soldiers in Iraq.

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Ohio: My newborn daughter, who was born when we were living in DC, contracted MRSA through a tiny cut on her finger when we were still in the hospital (my husband and I then both got it from contact with her). Once it was diagnosed (2 weeks later) she was treated with very strong intravenous antibiotics and survived with no ill effects. She is now 2 and a 1/2. Her pediatricians in DC and now in Ohio claim that she should suffer no future adverse effects based on her early battle with MRSA. However, she has had many ear infections and at least a couple of the milder antibiotics do nothing for her. Have you uncovered any evidence that people who had MRSA either (a) are more susceptible to future infection; or (b) are hard to treat with commonly used antibiotics?

Rob Stein: I haven't run across any information about that. But the report published today about MRSA was accompanied about another report about the emergence a drug-resistant strain of the bacterium that causes ear infections. All those cases were reported in the Rochester, N.Y., area so it's unclear how widespread that resistant strain might be.

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Baltimore, MD: Commericals for Clorox, Febreeze, and Lysol imply that not using these products is akin to inviting disease into your home. We're told to spray Febreeze all over our bedlinens (yuck!) and Lysol on pretty much everything. What ever happened to removing odor-causing bacteria by actually cleaning your house the old-fashioned way? If something doesn't smell good, its probably needs a good scrubbing down. Vinegar and plain dishsoap work. I would much rather sleep in freshly laundered sheets than half a bottle of chemicals any day. My grandmother's house always looks and smells amazing, and I haven't seen a single bottle of febreeze in the place.

Rob Stein: Yes, health experts say that simple common-sense personal hygiene -- hand-washing being the most important one -- are usually more than enough to reduce the risk.

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Silver Spring, Md.: Can you elaborate on what a person should watch for and how these infections are spread? And how widespread are staph infections outside of hospitals?

Rob Stein: MRSA infections can cause skins infections that may start as small red pumps that may resemble a pimple or boil. They then often become red, swollen, painful, or have pus or other drainage. In the research published today, 85 percent were associated with health care settings.

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Follow Up from Ohio...: Did this report consider the question of whether MRSA can remain in the body, in the nose, for example, without adverse effects and then cause a future infection? I've read and heard mixed things on this topic.

Rob Stein: It is possible to have a MRSA skin infection come back after it is cured. Experts say the best way to prevent that is the same way to prevent initial infection -- wash hands a lot, keep cuts and scrapes clean and covered until healed.

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Anonymous: Rob :

In November, 2003 I had what was most likely MRSA although at that time the doctors couldn't figure out what I had -- I had to have an operation where they collapsed my lung and vacuumed out the puss from my pleura -- still have reduced lung capacity and painful internal scarring.

When did the medical community realize what they were dealing with and do you think the large amounts of antibiotics in our food supply is partially responsible for this type of resistant disease ?

Rob Stein: Awareness about MRSA has been rising over the last few years, especially as the number of cases in hospital and outbreaks outside the hospital have been reported with greater frequency.

Public health experts have become increasingly concern that overuse of antibiotics in farm animals may be contributing to the risk of antibiotic-resistant infections in people.

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Arlington, Va.: The biggest concern I have is that this illness, which has been around for a long time, has not been tracked by the CDC. Are they going to make it a reportable disease? The boy that died in Va. earlier this week should not have. Seemed doctors were just too willing to say it wasn't anything serious without really looking into his symptoms too much.

Rob Stein: The CDC has been working more closely with state and local health departments to assess the frequency of antibiotic resistant infections such as MRSA. Today's report is part of that effort.

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Laredo, Tex.: Something else that just occured to me is whether or not the MRSA strain is more virulent than garden variety Staph infections. In other words, is it more likely to make you sick than anyother strain in the absence of treatment?

Rob Stein: Yes, MRSA is much more likely to cause serious illness, and much more difficult to treat.

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Reston, Va.: Who pays for an infection contracted at a hospital or doctor's office. Are the hospitals not responsible for infection control?

Rob Stein: Yes, hospitals are responsible for infection control, and there's been a big focus in recent years on trying to reduce the number of hospital-acquired infections, including MRSA. Some hospitals, obviously, do better than others.

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Fairfax, Va.: My son works at a residential facility for children and adolescents. They emphasize cleanliness, washing, etc. Should he be worried about MRSA?

Rob Stein: Well, hospitals, nursing homes and other health-care facilities are a major source and location of such infections. But cleanliness measures, such as frequent hand-washing, are a good way to reduce the risk.

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Dallas: Do you think our overuse of antibiotics has caused this? As someone who is deadly allergic to almost all antibiotics, I rarely get sick and it is not because I avoid exposure; I am on a commercial plane every week. I would like to believe it is due to a "safe" exposure level that has built my immune system up.

Rob Stein: Overuse of antibiotics is definitely a major factor in the emergence of these resistant microbes.

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Washington, D.C.: Both of my grandparents died of infections back in the 1930s, before antibiotics were available for things like pneumonia and nephritis. They were in their 40s then, hardly elderly. Are we heading into an era where more people are just going to die of infectious diseases because we won't be able to do anything about them?

Rob Stein: That's definitely one of the big concerns. The development of antibiotics is considered one of the most significant developments in modern medicine that turned what had been some of the biggest killers into treatable diseases. That's something a lot of us take for granted these days.

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Arlington, Va.: You may have missed the point of my question. Doctors must report incidences of "reportable diseases", such as flu, rabies, etc, to the state health department that in turn reports them to the CDC. This infection has not been tracked very well...what about other diseases such as Bird Flu? Seems that there should be much more coordination between the various parties here...before a pandemic is upon us! It sounds like it may already be among us!

Rob Stein: Yes, that's a complaint that I've heard before -- that better efforts need to be made to track these diseases.

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Germantown, Md.:"One of the concerns about these drug-resistant microbes is that there aren't enough new antibiotics in the pipeline."

It seems to me that even if we develop new antibiotics, these organisms are going to develop resistance against them, and do so rather quickly. They will then be even more dangerous. What else can be done other than spend untold millions on something that will be little more than a Band-aid?

Rob Stein: Well, preventing the spread of these microbes is also very important. And again, personal hygiene is the best way to do that.

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Sun City Hilton Head, S.C.: Is this the same Rob Stein who attended Bullis School in Potomac, MD? I coached a Robbie Stein in tennis in grades 7 & 8 there, and I have since retired from teaching and moved south. Bill Smith

Rob Stein: Sorry, different "Rob Stein."

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Silver Spring, Md.: My mother in law contracted MRSA in a hospital and actually had it internally -- She was only cured by us taking her to Cleveland to an amazing doctor who was able to identify and remove all of the diseased tissue. This was after two years of increasingly aggressive antibiotic tratments failed. We were told that it could all have been avoided if the original hospital personnel had just adequately washed between patients. The suprising thing to me is that the lawyers haven't gotten into the act!

Rob Stein: Yes, that's why there's been a major focus in recent years on getting hospitals to improve their infection control measures.

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Arlington, Va.: Prevention: We've all read the "exposes" about people not washing their hands. I'm sure this extends to the medical profession, too. It seems we need to return to primary school and learn to WASH OUR HANDS. Why do we have this weird dichotomy where we are disinfecting every surface with noxious chemicals and breeding superbugs while the basic most important thing is ignored?

Rob Stein: It does seem like an obvious contradiction, doesn't it. Study after study shows people don't wash their hands, including some studies of health care professionals.

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College Park, Md.: I am about to have a colonoscopy. Should I be questioning the medical center about the precautions they are taking to prevent this disease?

Rob Stein: It certainly couldn't hurt. At the very least, it might remind the individual health care providers you are encountering to follow standard infection control procedures.

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Laredo, Tex.: Vaccination has been shown to drastically reduce ear infections caused by pneumococcus in children. Has there been any attempt to produce a Staphylococcus vaccine, or are the various strains too diverse? In light of this report and the fact that most of the resistant strains are found in hospitals, has there been intensification of the push to restrict the use of antibiotics to those cases where they actually are likely to do some good?

Rob Stein: Not sure what's happening on the vaccine front. But there has been a big push to reduce the unnecessary use of antibiotics, which is contributing to the rise of antibiotic resistance.

Rob Stein: Also, I just got an email from an expert in this area, who says that there is working going on to develop a vaccine. Earlier efforts did not work out well, and the new work is still very early.

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albuquerque, NM: My grandson lived in NYC. He attended a daycare when he was 7 months old. Despite many infections, including boils on his head, he was misdiagnosed by his pediatrician. He was finally treated correctly when he came down to visit us in NM. We believed that he was infected through his daycare center where kids are always sick and touching each other.

I was told that MRSA is not only in hospitals but can be found in the community as well. Have you heard much about this?

Rob Stein: Definitely. MRSA cases are increasingly being reported in the community, often times with no connection to any health care setting. That's one of the aspects of this that is setting off alarms.

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Baltimore: I had two bouts of this disease, and both times my skin looked as if it was being eaten away. Im wondering how much of this bacteria can be transfered in sexual contact?

Rob Stein: It can definitely be spread through close physical contact.

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Rob Stein: Thanks everyone for your interest, and lots of very good questions.

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