Amid the recent hype surrounding a sometimes deadly form of staph infection — cases of which the media have reported in New Haven schools within the past week — Yale University Health Services officials said they will continue to diagnose skin infections with the bacterium in mind.
“At this point, if we have a patient coming in with a sore or boil or some kind of skin infection, we culture it rather than assume it can be treated empirically,” YUHS director Paul Genecin said, describing a practice the University has adhered to since the antibiotic-resistant strain evolved years ago.
Awareness about MRSA — the common but potentially fatal methicillin-resistant staphylococcus aureus bacterium — has increased during the past week after an article published last Wednesday in the Journal of the American Medical Association indicated that the infection is responsible for more deaths each year in the United States than HIV/AIDS and homicide.
The study, authored by researchers at the Centers for Disease Control and Prevention, reported the number of MRSA infections may be twice as high as previously thought.
The national discussion about MRSA has been accompanied by a growing number of MRSA cases reported in the media — in gyms, day care centers and schools, including public schools in Connecticut.
Since MRSA is antibiotic-resistant, Genecin said rather than first turning to antibiotics when a patient has an infection, UHS tests to see if the bacteria causing the infection is MRSA.
“We can no longer assume that anybody with a skin infection has a sensitive staph infection,” Genecin said. “We now assume until proven otherwise that people have [community associated] MRSA.”
Genecin said the University has been vigilant about testing and treating skin infections in recent years because there have been a number of MRSA cases at Yale. Following the release of the CDC study, he said YUHS will continue to increase attention to MRSA and particularly community-associated MRSA — a strain of MRSA which can be passed between otherwise healthy persons through poor hygiene or open wounds and which makes up about 14 percent of total MRSA cases, according to the JAMA study.
Genecin said the University’s department of athletics, the Office of Environmental Health and Safety and the Office of Athletic Medicine have been collaborating on a campaign to minimize risk and raise awareness about MRSA among athletes.
At New Haven public schools, parents are being given information about MRSA and ways to prevent it from spreading, New Haven public schools spokeswoman Catherine Sullivan-DeCarlo said in an e-mail.
In a Friday statement, Governor Jodi M. Rell said the state is continuing to track the number of local MRSA cases, which currently averages about 900 a year, according to the Connecticut Department of Public Health.
Like all staph infections, MRSA rests harmlessly in either the skin or nasal passage until it is transferred to a wound or to another person. Staph is far more common than one might expect, Kerstin Calia, a professor of infectious disease at the Yale School of Medicine, said.
As long as it does not enter the body directly, the bacteria is harmless, she said.
“More than half of this whole population is colonized with some kind of staph,” Calia said. “As long as it’s just sitting on the surface and it doesn’t get into you, you’ll never know about it.”
But if the bacteria enters the body, through a wound or other means, it can lead to complications such as pneumonia or bacteremia — commonly known as blood poisoning — which left untreated, this could be fatal, she said.
Several doctors interviewed said MRSA is passed most often through skin-to-skin contact but can also be passed through the sharing of any personal items such as towels, razors or athletic equipment.
MRSA infections usually appear in the form of a skin boil, Calia said. As they grow, the boils must be incised and drained by a surgeon. MRSA is unlike most staph infections because it is antibiotic-resistant and therefore requires a unique approach to treatment, she said.
“We have to go back to thinking about it the way we did before we had antibiotics,” Calia said. “In some cases, antibiotics alone are not enough. Draining it alone might be the only therapy that a person needs.”
Some students said the recent MRSA incidents have not increased their concern about the infection, because they have always been aware of the problem.
“I myself am not very concerned about MRSA only because this isn’t necessarily a new phenomenon,” Lauren Taylor ’08 EPH ’09 said. “I think it only becomes particularly dangerous when it goes untreated.”
Patrick Ruwe ’83 MD ’87, Orthopedic Consultant for Yale’s Athletic Teams, said the athletic department has always been aware of the risks community associated MRSA poses to student athletes, taking preventative measures including the promotion of good hygiene, washing of all equipment and uniforms daily, monitoring and covering all wounds and deterring students from sharing their personal equipment.
Doctors said all Yale students, not just athletes, should keep these types of good habits in mind to prevent the spread of MRSA.
“It doesn’t have to be on the field of play — lots of young people in close contact can cause the same issues,” Ruwe said. “The risk is enhanced when you take these kids and start running them into each other.”
Melinda Pettigrew, an assistant professor specializing in epidemiology in the School of Public Health, said the bacteria’s constant ability to adapt has made it difficult to eradicate.
“It is very unlikely that CA-MRSA will just go away — bacteria are constantly evolving and always seem to be one step ahead of us,” Pettigrew said in an e-mail.
Calia said students should know when to seek medical help, and they should get inflamed boils tested for MRSA — instead of trying to pop them at home.