SEASIDE - Doctors at Seaside Urgent Care are not immune to the prevalence of deadly drug-resistant staph bacteria.
Lately, they've seen up to eight cases a day, often because of the bacteria's quick spread through families and across the community.
That's a big concern raised in a federal study published last week in the Journal of the American Medical Association, which says methicillin-resistant Staphylococcus aureus, a superstrain of staph bacteria, poses a major public health problem.
The study also suggests that MRSA infections are far more widespread than anyone realized - about twice as common. The bacteria were linked to almost 19,000 deaths in 2005 nationwide, according to researchers for the U.S. Centers for Disease Control and Prevention.
While the majority of cases are still reported from patients in nursing homes, hospitals and other health-care centers, infections are increasingly cropping up in schools and other community settings, in people otherwise young and healthy.
And they can have devastating consequences.
A 17-year-old football player in Virginia died last week after a MRSA infection spread throughout his body; two other students at his school were successfully treated after contracting the so-called "superbug" the month before. Additional cases have been noted in Maryland and elsewhere, including one at Long Beach (Wash.) Elementary School last week. Earlier this month, a 4-year-old New Hampshire girl died of complications from a staph infection, according to news reports.
But how many community-spread staph cases are being diagnosed in doctors' offices across Clatsop County?
"Incredible amounts," said Dr. Joann Stefanelli at Seaside Urgent Care. "This is a huge problem in our communities, but people don't know it. We see so many people with it who have never heard of it. Their children and whole families are colonized."
Staph bacteria colonize the noses of 25 percent to 30 percent of the U.S. population, but only about 1 percent carry the more-dangerous MRSA, which doesn't respond to penicillin or other commonly prescribed antibiotics. According to the CDC, many of these people won't suffer any problems as a result, because they have no open cuts to allow the bacteria into their bodies. But they can still spread staph to others.
The bacteria spread rapidly through person-to-person contact or by indirect contact with infected surfaces, such as sports equipment at schools.
Astoria High School confirmed one case on the cross country team this fall. Principal Larry Lockett credits an aggressive student hygiene policy with preventing additional infections.
"We work really, really hard on this," Locket said, noting the school nurse is especially rigorous in maintaining a clean indoor environment. "She inspects areas every single week, she goes in and takes cultures and makes cleaning recommendations."
Staff members scrub down locker rooms and weight-room equipment daily, sanitizing solution is available in every classroom and students are required to disinfect mats before yoga classes. Athletes are told not to share personal items, they're required to shower "as soon as possible after every athletic event," and any rash or other skin irritation must be reported to a coach or nurse as soon as it's detected.
The policy was implemented after a staph scare in recreation facilities last year, when several students became sick. "We really took an aggressive approach," Lockett said.
Southwestern Oregon Community College in Coos Bay also worked fast to stem a potential outbreak after a student displayed symptoms of MRSA. The student, who lived in on-campus housing, was quarantined last week; lab tests confirmed the case Monday. As a precaution, the college is continuing to disinfect any areas that could be contaminated and has instructed students, staff and faculty to routinely wash their hands, shower and wear clean clothes.
Although MRSA is resistant to certain drugs, it is treatable, especially by IV, said Clatsop County Health and Human Services Director Joell Archibald. Another preventive measure involves curbing overuse of antibiotics.
"We now have strains of bugs that aren't susceptible to normal kinds of antibiotics because of that practice of prescribing too frequently," Archibald said. "It has been a pattern in medical practices over the years and it has come to be an expectation of the consumer."
While hospitals are required to track staph cases among their patients, community-spread infections are not subject to mandatory reporting, making it difficult to monitor cases and detect potential outbreaks, she said.
"Because this is not a mandatory reportable disease, the only information we have is anecdotal information we receive from people," she said. "There is no good way for our community or any community to capture the amount of this that is happening."
But the federal report released last week - the government's first sweeping estimate of invasive staph infections - may help shed new light on the situation.
"What has been determined is that this is far more prevalent than thought," Archibald said. "What we're seeing here in Clatsop County mirrors that."
By KARA HANSEN
The Daily Astorian
Although most health care providers have no mechanism for reporting cases of methicillin-resistant Staphylococcus aureus, hospitals are required to monitor MRSA rates - not just cases contracted in hospitals, but those spread through communities.
Local health care clinics have reported seeing widespread infections from the deadly "superbug" MRSA, a strain of staph bacteria that doesn't respond to penicillin or other commonly prescribed antibiotics.
The bacteria are spread rapidly through person-to-person contact or by indirect contact with contaminated surfaces.
Meanwhile, while MRSA incidence rates climbed annually for years, they've recently leveled off at Columbia Memorial Hospital, said Kendra Gohl, infection control practitioner at the hospital.
Still, the virulent strain of staph continues to pose problems in Clatsop County and nationwide, in hospitals but also in schools, daycare centers and nursing homes.
"In Clatsop County we run on the upper range for our MRSA, but there's no explanation for it," said Gohl. "All across the country we're all dealing with the same thing in infection control."
But potential risk factors related to the infections vary by community across the country, she said, leading Columbia Memorial to conduct a study of local characteristics tied to drug-resistant staph.
The hospital will soon begin a study to identify county-specific risk factors associated with drug-resistant staph. These risk factors will be used to develop guidelines for screening patients as they're admitted, which would accelerate moving someone at risk for MRSA into isolation until tests are completed and prevent the disease's spread, said Gohl.
"Our hope is that we're going to screen all patients admitted and develop risk factors from that, so we can really get a feel and not just guess at what are our higher risk groups," she said.
In a study earlier this year aiming to improve clinical management of community-acquired MRSA, doctors at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center determined there were no reliable risk factors distinguishing patients with drug-resistant staph infections from those suffering the more common, less dangerous form. Their report, published in the journal Clinical Infectious Diseases, suggests that in areas where MRSA is common, all patients with suspected staph infections should be isolated from outside contact.
Other agencies and medical groups cite risks ranging from playing contact sports to living in crowded conditions, to using drugs. Some studies have noted connections between frequent antibiotic use and patients who contracted MRSA infections.
Columbia Memorial Hospital's study could begin as soon as Jan. 1, 2008.