Los Angeles Times

Mom lives in fear of a lethal germ

No matter what doctors did, the baby's oxygen levels kept dropping.

Drug-resistant bacteria were eating holes in the lungs of 7-week-old Madeline Reimer of Batavia. The most powerful antibiotics available could not stop them.

The baby died four years ago this week, succumbing to an infection that flared at home after birth. Angry and grieving, Beth Reimer called publicly for better efforts to control the bacterium that killed her daughter: methicillin-resistant Staphylococcus aureus, or MRSA.

It was a threat the 37-year-old woman would meet again, with horror and disbelief.

Longing for another child, Reimer eventually set aside her anxiety and gave birth to a girl in April. But days after Emma was born, hospital staff discovered the infant carried MRSA on her body, putting her at a much higher risk of infection.

"What are the odds of this happening twice, in the same family?" Reimer said recently in her kitchen as a healthy Emma napped quietly in her lap.

"We had the whole fear we were going to bury another child," said her husband, Ken Reimer.

The Reimers' story is highly unusual; MRSA doesn't strike newborns very often. But it underscores the continuing spread of this potentially dangerous bacterium in hospitals and the community -- and the difficulty of keeping it at bay.

The methicillin-resistant form of the bacterium commonly known as staph was identified in the 1970s, in hospitals. By the 1980s, it had surfaced across the world. A decade later, University of Chicago researchers identified a community form of the germ that is now circulating widely in day-care centers, gyms and schools.

Up to 1.2 million MRSA infections occur in hospitals each year in the U.S., and invasive MRSA infections kill more than 19,000 people each year, according to estimates. Reliable data about trends aren't available because MRSA isn't tracked nationally, unlike mumps or HIV/AIDS.

The bacterium sometimes causes life-threatening infections, but people often are "colonized" without becoming ill and carry it for years in or on their body. To avoid transmission in the community, experts urge people not to share towels or clothing in gyms, to clean wounds and keep them covered, and to wash hands frequently. Active infections can be treated with vancomycin, a top-of-the-line antibiotic.

In the past several years, hospitals across the country have mounted aggressive campaigns against MRSA, stressing hand-washing by staff and thorough cleaning of rooms and equipment with disinfectants. Yet many U.S. hospitals are cutting infection control budgets amid the current economic downturn, according to a survey released last month by the Association for Professionals in Infection Control and Epidemiology.

Two years ago, Illinois became the first state to mandate that hospitals screen all at-risk patients for MRSA and take measures to stop the bacterium's spread. People considered at risk include frail seniors transferred from nursing homes and all patients in intensive care. This fall, Illinois will begin reporting data about MRSA infections in hospitals.

Nationally, legislation introduced last month in Congress would require hospitals to screen patients for MRSA and report the number of infections publicly.

Where the bacteria that entered Emma's body came from remains a mystery that haunts the Reimers.

"The hospital had Emma in isolation. How does a newborn get something like this?" Ken Reimer asked.

Not from her mother, apparently: Beth Reimer also had a MRSA test after giving birth in April and the results were negative.

Dr. Jeffrey Loughead, director of neonatal intensive care at Central DuPage Hospital in Winfield, where Emma was born, said, "It's highly unlikely" she contracted the germ from a health-care worker.

"We don't have MRSA in labor and delivery, the [neonatal intensive care], the [pediatric intensive care] or the nursery," Loughead said.

Some neonatal intensive care units and nurseries at area hospitals have persistent problems with MRSA, but Central DuPage is not among them, he said.

Among pregnant women, 2.1 percent to 3.5 percent are colonized with MRSA, according to several small research studies cited by Dr. Laura Riley, an expert on the subject and director of labor and delivery at Massachusetts General Hospital in Boston. Transmission from mother to baby during childbirth is not common, she said, but MRSA can be passed through breast milk. Riley and other physicians report increasing numbers of mothers with breast infections involving the bacterium.

When MRSA was discovered on Emma, prompt diagnosis and treatment eliminated it from her body. Today, at 3 months old, she is fine, but her mother lives with anxiety and dread.

Every time Emma coughs, Reimer remembers the dry cough that was the first symptom Madeline was ill. Every person who comes into the house represents another opportunity for MRSA to be carried in on Reimer's hands or clothes.

At home, she sterilizes toys regularly for Emma and Luke, Madeline's twin brother, age 4. Hand-washing is mandatory, several times a day. When anyone in the family becomes sick, everyone uses paper towels. The couple also have an 18-year-old son from Ken Reimer's first marriage.

Beth Reimer's persistent fear is that her baby will become infected and she will learn too late. That is what happened with Madeline.

At 4 pounds 10 ounces, Madeline was the smaller of the twins born at 32 weeks in June 2005 after Reimer had an emergency Caesarean section at Edward Hospital in Naperville.

"She seemed to be healthier; she never needed oxygen," Reimer said. In all, Madeline spent 2½ weeks in the neonatal intensive care unit.

Edward Hospital spokesman Keith Hartenberger said the medical center investigated the case in 2005 and determined the baby's MRSA was acquired outside the hospital.

Madeline was a sweet baby with petite features and big blue eyes that seemed to look right through whoever was holding her, her mother remembers. Two days after Madeline started coughing and a doctor diagnosed a likely viral infection, Reimer found her limp and blue in the middle of the night when she went to pick her up for a feeding.

An ambulance rushed Madeline to Rush-Copley Medical Center in Aurora with suspected meningitis. After several tests, she was airlifted to Loyola University Medical Center in Maywood in critical condition. Doctors there put Madeline on a ventilator and diagnosed sepsis and a virulent pneumonia that was destroying her lungs. Cultures showed the culprit was MRSA.

Dr. Kathleen Webster, a pediatric critical care physician at Loyola, cared for Madeline for 11 days before the baby died. She described a roller coaster course of illness: a touch-and-go situation in the first 24 hours, growing optimism as the infant's condition appeared to stabilize, then acute crisis as her lungs collapsed.

Often, Madeline's grandfather sat beside her, urging her not to give up, the doctor remembered. Every night, Beth Reimer slept at her daughter's side -- except once, the night before Madeline died, when Reimer went to the Ronald McDonald House near Loyola. The next morning, Webster recalled, Reimer walked into the hospital and said: "She's not going to get better."

"She knew before we did," Webster said.

All day, nothing the doctors tried prevented the baby's oxygen from dropping. Madeline died that night, surrounded by family and the physicians who had cared for her, including Webster, who had come in on her day off, Ken Reimer said.

"You spend the next weeks and months thinking, 'Is there something I could have done?' " Webster said.

After the funeral, the Reimers learned the entire family had some form of MRSA. Beth Reimer was colonized with the bacterium and was crushed by guilt, thinking she might have passed MRSA to Madeline. Luke, who was admitted to neonatal intensive care the day after Madeline died, also was carrying MRSA. A boil on Ken Reimer's hip was lanced and tested positive for the bacterium. The family was treated until the bacterium disappeared.

The Reimers' experience highlights the unpredictability of MRSA.

"Why do some people exposed to MRSA get severe infections -- like Madeline -- and others have no or mild infections, like Luke?" Webster asked. "That's the million-dollar question and we don't have an answer."

jegraham@tribune.com

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