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Hospitals Report Increase in Drug-Resistant Staph Infections

Times Staff Writer

Deadly drug-resistant staph infections -- rarely seen in patients a decade ago -- have become the leading type of skin infections treated in emergency rooms, scientists reported Wednesday.

The study in the New England Journal of Medicine was the first to demonstrate the extent to which drug-resistant Staphylococcus aureus has spread throughout the U.S.

The bacterium accounted for 59% of skin infections in the study, researchers said, with ranges of 15% in New York City to 74% in Kansas City, Mo. In Los Angeles, drug-resistant staph accounted for 51% of skin infections, researchers said.

“The message for doctors is to recognize how prevalent these infections are,” said Dr. Gregory J. Moran of Olive View-UCLA Medical Center, lead author of the study.

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The drug-resistant strain was found to cause painful skin lesions that resemble infected spider bites. It also can cause necrotizing pneumonia, a deadly lung disease, and toxic-shock syndrome -- a type of blood poisoning that can be fatal.

Not long ago, doctors could prescribe tried-and-true antibiotics for skin infections, but Moran said that was no longer the case. At his hospital, “we assume the infection is resistant and treat it accordingly” with a different set of drugs, Moran said.

What triggered the spread of drug-resistant staph isn’t known. Some years ago, researchers started finding infections in jail inmates, sexually active gay men and professional athletes. Last year, infections were reported among the general population in Atlanta, Baltimore and Minnesota.

The study, conducted by researchers from UCLA, the Centers for Disease Control and Prevention, and several other institutions, looked at 422 patients treated for skin and soft-tissue infections during August 2004.

The patients were seen in university-affiliated emergency rooms in 11 U.S. cities.

The staph was resistant to antibiotics routinely used to treat skin and soft-tissue infections, such as erythromycin; cephalexin, sold as Keflex; and dicloxacillin, sold as Diclocil, scientists said.

Most of the infections were more or less susceptible to other antibiotics, including clindamycin, tetracycline, rifampin, and sulfa drugs. In addition, the study said, many drug-resistant infections can be cured by surgically lancing and draining them.

In an accompanying editorial, Dr. M. Lindsay Grayson, an infectious disease expert at the University of Melbourne in Australia, said surgical drainage should become “the priority intervention” because the effectiveness of drug treatments varied.

A separate study in the same edition of the journal said that daptomycin, sold as Cubicin, appeared to work better than standard antibiotics against bloodstream infections caused by drug-resistant staph in a clinical trial, but the results weren’t significant on a statistical basis.

The study was paid for by Cubist Pharmaceuticals Inc., which markets Cubicin. Grayson wrote that the drug might be useful for a small number of patients with bloodstream infections.


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