Years ago, the superbug MRSA was found only in hospitals and other health care facilities, where it preyed on the old and the sick. And still, that's where it is deadliest, responsible for more than 70 percent of all hospital staph infections and killing some 20,000 Americans annually.
MRSA started turning up outside hospitals in the late 1990s in schools, gyms and military barracks, evolving into community-associated MRSA, or CA-MRSA. Now a new study published this month says that strain is bouncing back into hospitals, increasing the infection risk to the most vulnerable people.
But as 18-year-old Jordan Fry knows, this is a bug that is dangerous even if you're a healthy young athlete.
In fact, the college student from Valrico learned all about it as a high school football player, from a coach who preached prevention measures to his team.
So in August, when a week of worsening leg pain sent him to the hospital, Fry wasn't surprised to learn it was MRSA.
Others, however, could easily have missed the signs.
"You couldn't see anything on my skin at first. It just felt like a bruise," he said, "Then it turned red and swollen and warm to the touch. I knew. I had all the signs."
A generational divide
The Centers for Disease Control and Prevention estimates that 14 percent of people with MRSA have the community-associated strain. Many are young. A Minnesota study found that the average age of a CA-MRSA patient is 23, compared to 68 for other MRSA patients.
Starting in the late 1990s, most cases of CA-MRSA were linked to places like gyms and schools where people are in close proximity and might share exercise equipment, bathroom and shower facilities, razors, towels, uniforms and other clothing.
Athletes in high-contact sports such as football and wrestling were found to be at particular risk, but so were people who failed to wipe down shared surfaces in gyms like weight benches, bike seats and padded mats for floor exercises. The bacteria can survive on damp towels and surfaces for days or weeks.
More troubling, CA-MRSA seems to have invaded hospitals. A study in the December issue of Emerging Infectious Diseases suggests health care workers, who often move between outpatient clinics and in-patient hospital rooms, may be dragging the bacteria with them and infecting hospitalized patients.
But not everyone agrees with that conclusion. "I think that's overblown," says Dr. John Sinnott, director of infectious disease at the University of South Florida and Tampa General Hospital. "It could be brought into hospitals by family members or the patients themselves.
"But MRSA is very prevalent, so it's not surprising that the community-acquired strain has found its way into hospitals."
It's 'all around us'
Any opening in the skin can be a point of entry for the bacteria: cuts, scrapes, a foot ulcer, a torn cuticle, even a hair follicle. It takes direct contact with infected skin or with something that has touched infected skin to pick up the bacteria.
In most cases MRSA skin infections look like a pimple or boil and the surrounding area may become red, swollen, filled with pus or appear to be draining fluid.
But the pain can be so great that patients end up in the hospital emergency department looking for relief.
Fry was treated and sent home from the hospital with oral antibiotics. After two days with no improvement, he returned to the hospital and was admitted for three days of stronger, intravenous medications.
He still doesn't know how he picked up the bacteria.
"It was just bad luck,'' said Sinnott, the specialist who treated Fry during his hospitalization. "Staph germs are all around us and they got in Jordan."
Fry is fully recovered now, but he has an indented, penny-sized scar on his left leg where the infection started and had to be surgically drained, a souvenir of his MRSA ordeal.
Irene Maher can be reached at firstname.lastname@example.org or (813) 226-3416.