Dr. Mark Anderson

These days, if someone shows up in an emergency room with a bug bite that won’t heal, doctors immediately become suspicious.

“When people come in the ERs and say, ‘Hey, I have this spider bite,’ I think most practitioners now automatically think, ‘We probably got some MRSA going on,’” said Chuck Reece, quality vice president at Parkridge Medical Center.

MRSA stands for methicillin-resistant Staphylococcus aureus. If contracted outside a hospital, MRSA (pronounced “mersa”), typically appear in the form of a skin infection resembling a bug bite, Mr. Reece said.

“It is not rare for us to see these community-acquired infections coming through the ERs, (in patients such as) young athletes, healthy people,” he said.

Though doctors still have a number of antibiotics that are effective in stamping out the disease, if left untreated MRSA can be fatal.

After gonorrhea and chlamydia, invasive MRSA is the third most-common reportable communicable disease in Tennessee, said Dr. Marion Kainer, medical epidemiologist with the Tennessee Department of Health.

Staph infections with resistance to some antibiotics have occcurred in health care facilities since the 1960s, but public health officials are watching a growing tide of a strain that is contracted outside hospital settings — in schools, locker rooms and jails.

PRECAUTIONS IN SCHOOLS

“Just having a few cases raises a concern because you see that it is a community problem,” said Sheryl Rogers, director of school health programs for Hamilton County Schools. “We try to beef up our cleaning; we try to stress personal hygiene and make sure (infected students) get treated properly.”

Within Hamilton County schools, cases of MRSA have been sporadic, Ms. Rogers said, totaling probably under 100 cases over the past five years or so and ranging from elementary school students to high school athletes.

Schools are implementing changes in cleaning equipment in locker rooms and reminding athletes about hygiene protocol. After two football players at Lookout Valley High School came down with MRSA two years ago, the athletics department stepped up its focus on keeping equipment clean and deterring the spread of bacteria, said football coach Tony Webb.

“We (emphasized) with the kids to not share each others’ equipment,” said Mr. Webb, noting that the team had no MRSA cases last year. “We hopefully nipped it in the bud a little bit.”

DISEASE SURVEILLANCE

In Tennessee, community-acquired MRSA first emerged in 2000, but the disease did not show up in Chattanooga until about 2004, said Dr. Mark Anderson, local infectious disease specialist and part-time chief quality officer at Memorial Hospital.

The state Department of Health made invasive MRSA cases a reportable condition in mid-2004, and the total number of cases statewide has hovered close to 1,800 each year from 2005 to 2007, Dr. Kainer said.

Invasive MRSA — severe cases in which the infection has entered a patient’s bloodstream, bones, joints, heart or brain fluid — make up only about 7 percent to 10 percent of MRSA cases, Dr. Kainer said.

“The risk to an individual is so very, very low, in terms of having a bad outcome,” she said.

Community-acquired MRSA infections initially manifest in skin boils or pimples, and the disease is more virulent than the hospital-acquired strain, Dr. Anderson said.

“It colonizes much better, binds to human skin much better and is extremely difficult to get rid of,” he said.

Still, the community-based cases garnering the most media attention make up only about 15 percent of the invasive MRSA cases reported to the health department, with hospital-acquired cases comprising the bulk of them, state health officials said.

TREATMENT OPTIONS

The good news, Dr. Anderson said, is that older, relatively cheap drugs are effective in treating the drug-resistant staph infections. Recurrent skin boils also can be treated using a Hibiclens antimicrobial wash, he said. In health care facilities, doctors generally use the antibiotic vancomycin.

But infectious disease experts are continually on the lookout for the disease developing resistance to antibiotics that have so far been effective in treating it, Dr. Anderson said.

“It’s a great concern. I’m constantly looking at the cultures of this to see if it’s become resistant to those drugs,” he said. “That could make the care of this frightfully more expensive.”

Early diagnosis is key since a case of MRSA can go from bad to worse pretty quickly, said Parkridge’s Mr. Reece. Last year, his niece came down with MRSA and within days ended up in the hospital, he said.

“She had a (what looked like) a pimple on her forehead, and in two days she looked like the Elephant Man and ended up in the hospital on IV antibiotics,” he said. She recovered fully and graduated college a couple weeks later, he said.

RISE IN CASES

In its data collection, the health department does not differentiate between community-acquired or hospital-acquired invasive MRSA, but public health officials here said anecdotally that it looks like the number of community-based MRSA cases are rising.

MRSA is more common among blacks, in part due to higher rates of diabetes and dialysis among the population, Dr. Kainer said. The risk for MRSA for a person on dialysis is between 100 to 200 times greater than the general population, due to the breach of the skin barrier and weakened immune defenses, she said.

Although media attention has focused on schools with MRSA cases, more commonly, cases crop up on athletic teams and in correctional facilities, Dr. Kainer said.

At Hamilton County Jail, nurse manager Beverly Cooper said the jail began culturing inmates’ skin wounds to test for infections in 2006 when the number of apparent spider bites became unusual.

“We kept saying, ‘Spider bites, spider bites, spider bites,’ ” she said. “We just had too many people coming up with the wounds.”

Since 2006, only two cases of MRSA in the jail were severe enough to require hospitalization, and both inmates recovered, Ms. Cooper said.

PREVENTION EFFORTS

Hospitals here have doubled their emphasis on hand-washing and infection control, officials said.

Erlanger, Parkridge and Memorial have hand-washing monitors to ensure that physicians and nurses are washing hands before and after touching a patient.

“We have people kind of snooping around, watching,” said Coretha Weaver, coordinator for infection control at Erlanger hospital. She said the hospital is encouraging nurses and patients to remind physicians to wash their hands, though some are reluctant to speak up.

“That’s kind of like telling somebody in a restaurant, ‘Take this coffee back, it’s not good.’ You don’t know what you might get back,” she said. “But we have signs in the room that say, ‘It’s OK to remind your health care provider to clean their hands.’”

Hospitals here also are conducting MRSA screenings on patients who are most vulnerable to infections, including patients on dialysis, those coming from long-term care facilities, those entering ICU departments or those undergoing cardiac or spinal surgeries, infection control coordinators here said.

Patients who test positive for MRSA are placed on strict contact precautions, Mr. Reece said.