Taking aim at staph A

With Hawaii's rate tops in the U.S., doctors seek ways to prevent it

Hawaii had the highest prevalence of drug-resistant Staphylococcus aureus in the nation last fall when 1,200 hospitals, long-term care and rehabilitation facilities were surveyed across the country.

The study covered 187,058 patients in the facilities, of whom 8,654 either were infected or "colonized" with methicillin- resistant staph A, said Susan Slavish, infection prevention and control coordinator at the Queen's Medical Center.

In participating Hawaii facilities, 91 patients were identified with the superbug out of every 1,000, compared with 46 per 1,000 patients in the study overall, she said.

Although she has seen drug-resistant staph increasing here over the years, Slavish said, "I think I was surprised we were No. 1."

Other high superbug states were Maine, New York and South Carolina, which had more than 60 patients with the drug-resistant bug per every 1,000 patients.

The comprehensive study was reported at the annual meeting of the Association for Professionals in Infection Control and Epidemiology June 25-28 in San Jose, Calif. Participating facilities were not identified, but more information will be available when the study is published, said Slavish, who attended the meeting.

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Many people carry the bacteria around in their nose and on their skin and never know it -- but it can be deadly.

It's methicillin-resistant Staphylococcus aureus, an organism Dr. Alan Tice likens to the Army's Bradley fighting vehicle -- fully armed to do damage.

Prevention Tips To prevent methicillin-resistant Staphylococcus aureus infections: » Wash your hands thoroughly and often with soap and water. » Do not pick your nose. » Wash cuts and scrapes and cover them with dressing until healed. » Avoid contact with other people's wounds or objects contaminated by an infected person such as clothing, towels or sheets. » See your doctor if you have boils or abscesses. Source: Summer Staph Institute To Learn More Islanders who want to learn more about Staphylococcus aureus may attend Summer Staph Institute meetings from 4 to 5:30 p.m. Fridays at the University of Hawaii John A. Burns School of Medicine, 651 Ilalo St., Honolulu. Local and mainland authorities discuss different aspects of the bacteria and its impact on the community.

It is known simply as the superbug.

The bacteria's resistance to common antibiotics "is causing more and more problems for Hawaii," Tice, an infectious disease specialist, said in an interview.

A study that was announced on June 28 at the annual meeting of the Association for Professionals in Infection Control and Epidemiology found at least 30,000 patients in U.S. hospitals could have the drug-resistant bacteria at any given time.

The rate is 8 to 11 times greater than previous estimates, said Susan Slavish, infection prevention and control coordinator at the Queen's Medical Center, who attended the meeting in San Jose, Calif.

Slavish, who has been doing infection control here for 35 years, said she has seen drug-resistant staph increase every year. But it was a surprise that Hawaii led the nation with the highest prevalence of patients with the superbug in the survey, she said.

"The alarm is out," said Tice, a part-time University of Hawaii professor who tries to promote awareness of infectious diseases. "Probably 5 to 10 percent of hospital beds are filled with people with staph infections, especially MRSA."

Methicillin-resistant Staphylococcus aureus is a term used to describe strains that are also resistant to amoxicillin, penicillin and oxacillin.

Studies indicate one-third and possibly as many as one-half of apparently healthy people carry the staph A bacteria, Tice said.

"It hangs out in the nose area. We suggest people don't pick or scratch the rim of their nose because it's probably a way to spread it, not only to other parts of the body, but to other people as well.

"It's an escalating battle," Tice said, explaining at least half of infections seen in the emergency room occur among homeless and indigent people. Pacific Islanders and native Hawaiians also have more problems with staph than other racial groups, he said.

It is a human organism that is easily spread from person to person or from contaminated surfaces or objects, he said.

Many people who have staph A are never affected, while others might have skin infestations as the primary symptom, Tice said. A little scratch that gets infected could cause a boil or abscess.

Sometimes the organisms get into the bloodstream or lungs and cause more serious and potentially fatal illnesses, such as heart and lung infections, toxic shock syndrome or pneumonia, he said.

Tice, who has a private practice and volunteers at clinics, is attacking Hawaii's staph problem through a Summer Staph Institute for research and education to help people understand the organism.

His partners are Dr. Steven Seifried, UH associate professor of cell and molecular biology, and Dr. Matt Bankowski, vice president and director for clinical microbial infectious disease at Diagnostic Laboratory Services and an associate professor in the medical school.

The Honolulu Medical Group Foundation provided funding to support student education and employment in the institute, Tice said.

The program involves sampling sea water for the organism near Waikiki and Ala Moana, looking for alternate forms of treatment such as topical antibiotics and developing new detection systems for bad strains of staph.

Seifried is developing techniques to detect staph A in water and generally characterize the strains. He is looking at how antibiotic-resistant they are and how they relate to genes. "We're developing what we think will be more reliable, less expensive, gene-based detection of these organisms," he said.

"One thing I've already determined: We have a huge variety of different types of staph, mainly because airlines keep bringing all these tourists in."

More than 100 different strains of staph A have been found in samples from Hawaii's beaches, including drug-resistant strains, Tice said. But he does not think sea water is a threat, noting he surfs on Sundays when he has time and has not been affected.

"It's a really interesting organism because it's friend and foe at the same time," Tice said, explaining it might have some benefits as far as stimulating the neurosystem.

Bankowski said his laboratory sees 20 to 30 staph A cultures a day from hospitals -- skin wounds, blood, spinal fluids and tissues. About 10 to 15 are resistant -- "quite a lot," he said.

He is growing staph colonies in the lab to use for developing drugs and molecular detection techniques for infection control. With molecular tests, he said, "Instead of 1 1/2 days, we could in a few hours have not only identification of staph aureus, but resistant genes and types of virulent genes."

The spreading germ has a big economic impact, Tice pointed out. Hospital costs are about $1,200 or more per day, and intravenous antibiotics needed daily range from $20 to $100 a day, he said.

The staph institute team has been testing some general antibiotics in the search for new drugs for resistant bacteria, Tice said. They are also trying to develop more effective drugs to apply to the skin, which Tice said is safer than intravenous therapy or a pill and preserves the effects of antibiotics.

Staphylococcus aureus has no outward symptoms, Seifried said. "It's only when these things transition to an infection that things are dangerous."

It is a growing problem nationally because the organism "continues to improve its arsenal against what we try to fight it with," he added.