Hawaii sees rise
in ‘super’ bacteria

Drug-resistant germs trigger
more staph infection cases here

Doctors in Hawaii and across the nation say they are alarmed by an increase in cases of a drug-resistant bacteria that has caused fatal pneumonia or life-threatening heart infections.

These so-called "super bugs" -- strains of Staphylococcus aureus unfazed by the entire penicillin family and other first-line drugs -- are worrying infectious disease experts, who say the problem will only get worse.

In Hawaii, health officials say, the incidence of drug-resistant staph aureus appears to be higher than elsewhere. But there are no statewide or national statistics to prove their suspicions.

"There seems to be as much or more of a problem of this strain (in Hawaii) than many other places," said Dr. Alan Tice, associate professor at the University of Hawaii medical school and a consultant in infectious disease at the Queen Emma Clinics. "That may be related to the warm, sort of tropical environment, which allows this organism to perpetuate better than usual."

A study of four health-care facilities in Hawaii between July 2001 and June 2003 showed that drug-resistant staph aureus appeared in the lab cultures of 1,389 patients. Some 389 patients, 51 percent of whom were native Hawaiians or Pacific Islanders, "had illness consistent" with or symptoms of the disease, according to the Centers for Disease Control and Prevention study released Monday.

"Unless we do something about it, the rates are going to continue to rise," said state Department of Health chief epidemiologist Dr. Paul Effler.

He said the Health Department is stepping up programs to deal with the infections, and recently asked hospitals to start reporting cases of drug-resistant staph so that more accurate statewide statistics are available. Also, the agency is working with the Kapiolani Medical Center for Women & Children to do another study on staph aureus.

The CDC report, which Effler helped write, did not say how patients fared after treatment. Also, he said it is still unclear why native Hawaiians and Pacific Islanders had a higher incidence of infections in the study.

"We are concerned" about the incidence of infections, Effler said. "It's just part of an increased trend nationwide."

Until about five years ago, drug-resistant staph infections were unheard of except in hospital patients, prison inmates and the chronically ill. But doctors across the country say they are now seeing staph in healthy children, athletes and others.

"This is a new bug," said Dr. John Bartlett, who chairs the committee on antibiotic resistance at the Infectious Diseases Society of America. "It's a different strain than in the hospital ... more dangerous than other staph."

Bartlett, a professor at Johns Hopkins University School of Medicine, treated three young Baltimore-area women this year who got pneumonia from community-acquired resistant staph. All had to be put on breathing machines, and one died, he said.

Scientists nationwide are also concerned about an emerging form of the so-called "flesh-eating bacteria," or Group A streptococcus infection, which is related to staph aureus. Tice said there have been cases in the islands in which patients have had both Group A strep and staph aureus, which is highly unusual.

Both infections will be a hot topic at the society's annual meeting, which starts today in Boston. The group says doctors should be more aware of the infections so that they can try to treat patients early on, and drug companies need to start developing new antibiotics to avert a crisis.

Tice, who is attending the conference, said last night in a telephone interview from Boston that staph aureus primarily causes skin infections, including abscesses, boils and pustules, "which can be very painful and can be a significant problem."

In more serious cases, he said, the bacteria "will go on and invade the body," causing pneumonia and heart infections.

Dr. Dan Jernigan, a CDC epidemiologist, said athletes, children and military recruits are at higher risk for staph. They are more likely to have cuts and scrapes, he said, and share close quarters, as well as towels and soap. Another factor is overuse of antibiotics, which tends to kill weak bacteria and help hardier ones develop resistance.

The CDC has reported on numerous infection clusters across the nation, including Colorado fencing club members, college football players in Pennsylvania and Los Angeles, and high school wrestlers in Indiana. Many patients were hospitalized, including most of the athletes. At least two outbreaks have occurred among native Alaskans since 1996, with many cases linked to steam baths.

One of the case reports to be discussed at the society's infectious disease conference is that of Driscoll Children's Hospital in Corpus Christi, Texas, where doctors saw fewer than 10 cases a year of community-acquired resistant staph infections in the 1990s, then saw 459 in 2003.

Ninety percent were healthy children. Half were admitted to the hospital to get intravenous antibiotics; a few developed life-threatening lung and heart infections or toxic shock syndrome.