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Drug-resistant staph on rise

JoNel Aleccia
Staff writer
July 22, 2007

At age 85, Louise Geisbush suffered a cerebral hemorrhage after a hard fall last March in her north Spokane home.

But it’s not the head injury that idled the avid gardener or put her in a hospital bed early on a Friday morning.

Geisbush was sidelined by a more insidious and increasingly common enemy: a drug-resistant staph germ that has settled in one of her artificial knees – and requires medicine’s biggest guns just to keep it at bay.

Every other day, Geisbush must show up at Holy Family Hospital to receive a hefty dose of high-powered antibiotics to fend off MRSA – Methicillin-resistant Staphylococcus auerus – a so-called superbug linked to hundreds of deaths in Washington state.

“It’s scary,” said Joanne Poss, 62, one of Geisbush’s eight children. “It can strike hard, and it can strike fast. And most people don’t even know about it.”

Although her mother became quite ill from the sudden infection, Poss understands the situation could have been much worse.

Nearly 500 people in Washington may have died with or because of MRSA between 2003 and 2005, according to a new review of state death certificate records conducted at the request of The Spokesman-Review.

Analysis by Ann Lima, a state health department researcher, showed that possibly 145 people died in 2003, followed by 169 in 2004 and 168 in 2005 from antibiotic-resistant staph infections, including MRSA.

While state health and medical experts cautioned that the figures have not been validated, they also noted that they may provide a rare glimpse of the mortality associated with MRSA, which is not classified as a reportable infection.

“It’s not clear to me how reliable those figures are,” said Dr. Tim Dellit, medical director for infection control at Harborview Medical Center in Seattle, who had not examined Lima’s research. “But even with that aside, we know people die from MRSA infection and that it’s a very serious problem.”

Although no one keeps specific statistics on MRSA infection, surveillance studies have indicated that the drug-resistant bacterium has increased exponentially in the past decade, doubling to about 50 percent of staph cases tested in Washington.

It’s at least 10 times as common as once estimated, infecting nearly 5 percent of all patients in hospitals and nursing homes, according to a comprehensive national study released last month by APIC, the Association for Professionals in Infection Control and Epidemiology.

Recently, the problem has become so serious that Spokane’s Pathology Associates Medical Laboratories – PAML – is finalizing a faster, cheaper test to detect MRSA so that the sickest infected patients can be isolated more quickly. Starting in September, all adult patients who enter the intensive care unit at Sacred Heart Medical Center and elsewhere will be tested for MRSA.

“Once you find out a patient is positive, then you’ve got to implement contact precautions,” said Ann Robinson, director of virology and microbiology at PAML, which serves more than 100 regional hospitals.

The precautions include isolating patients and requiring masks and gloves for all contacts.

The new tests – which provide results in one day instead of three and for a cost of about $25 instead of as much as three times that amount – are at the heart of a heated national debate about the best way to contain MRSA infections.

Once confined primarily to hospitals and long-term care centers, MRSA is now showing up in patients with no previous medical contact. Community-acquired MRSA often starts as a small lesion, cut or boil that fails to heal and then gets progressively worse. Both hospital-acquired and community-acquired MRSA can lead to life-threatening pneumonia or blood infections.

Some experts argue that testing high-risk populations or even all patients for MRSA – a practice known as “active surveillance” – is the best way to understand and treat it.

“The surveillance allows you at least to know the size of the problem,” said Dellit.

Others, however, claim that MRSA has become so common and so virulent that efforts should focus on prevention instead of detection.

“It’s gotten past the point of rational thought,” said Robinson, who favors strong efforts to increase knowledge of basic hygiene.

“It all comes down to hand-washing,” she said. “If we could just get everybody to wash their hands.”

Increased awareness about the overuse of antibiotics is also crucial, state health experts said.

“The prodigious use of antibiotics is part of the problem,” said Jude VanBuren, assistant secretary for epidemiology with the state health department. “A physician has to be pretty vigilant about not giving out antibiotics and then giving out the right antibiotics.”

For those who’ve contracted MRSA infections, however, the situation calls for more than a warning about soap and water and limiting antibiotics.

Albert “Butch” Beaver, 54, of Spokane Valley, said he still can’t believe he went into Sacred Heart Medical Center for neck surgery in April 2006 – and came out with a life-threatening infection.

“He hadn’t even been home a week and he had to go back in the hospital,” said Cindy Beaver, 51, his wife.

The wound on Butch Beaver’s neck refused to heal, eventually requiring surgery to remove an egg-sized chunk of infected flesh. “It was nasty,” recalled Cindy Beaver.

Doctors finally told the couple the infection was caused by MRSA, and that it may remain a problem for the rest of his life, she said. The Beavers considered suing to recover about $2,500 in out-of-pocket medical bills, but lawyers told them MRSA was so common, they wouldn’t take the case.

“It shouldn’t be a risk you should have to take in the hospital,” said Butch Beaver. “That’s baloney.”

Louise Geisbush and her family never considered taking legal action when the family matriarch contracted MRSA after her head injury. For one thing, it wasn’t clear where she acquired the infection that left her knee “red-hot and beet red,” according to daughter Joanne Poss.

“They said she could have gotten it from brushing her teeth or picking her nose,” Poss said, to protests from her mother.

To the family, it was clear the infection that settled in her knee joint was acquired in the hospital or during her weeks-long stay at a rehabilitation center. But the source didn’t matter as much as the solution, Poss said.

“I was livid because she was in so much pain,” Poss recalled.

Oral antibiotics left Geisbush nauseated, but she needed medication strong enough to keep the infection at bay. Doctors finally inserted a “pick” line that delivers vancomycin to her heart every other day.

“She’ll have to be on antibiotics for the rest of her life,” Poss said.

To Geisbush and her children, MRSA is frightening not only because it’s so dangerous, but because it’s so common – and so unknown.

“People don’t know about MRSA. We didn’t know about it,” Poss said. “It’s scary. It’s right up there with HIV. It’s a killer.”

Reach JoNel Aleccia at (509) 459-5460 or by e-mail at jonela@spokesman.com.

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