Are We Taking a Step Back in Staph?

Staphylococcus aureus is one of those bacteria that’re becoming all too common so, despite the seriousness of these infections, they don’t seem to cause as much of a stir when we hear about cases or outbreaks. But the facts remain: Staph infections are easily spread, increasingly common, and the methicillin-resistant Staphylococcus aureus (MRSA) strains are only becoming more widespread in the community. But attention tends to focus on the newer resistant infections, like those with the MCR-1 genes, which are surely an issue in the struggle against antimicrobial resistance, but lack the commonality of staph infections. Now, a new report from the US Centers for Disease Control and Prevention (CDC) has revealed some unsettling findings about this somewhat forgotten bug.

Staph infections can either be methicillin-resistant or methicillin-sensitive (MSSA) but, overall, staph is the leading cause of infections in US hospitals. Infection preventionists have been zeroing in on MRSA for decades in the health care industry, working tirelessly to stop the spread. Unfortunately, according to the CDC, progress in curbing MRSA has slowed, and findings indicate that MSSA rates are also not declining. One theory is that the opioid crisis may be connected, as 9% of all serious staph infections in 2016 occurred in patients who used injection drugs, a statistic that represented an increase from 4% in 2011. Consider this—right now, nearly 1 in 10 staph infections that occur are in people who use intravenous drugs.

The CDC also reports that in 2017, there were more than 119,000 bloodstream infections caused by staph, leading to the deaths of 20,000 people. Patients who have surgery or inpatient hospitalizations, have implanted medical devices, or who come into contact with others who have staph are at an increased risk for infection. Sure, we’ve made progress against MRSA, with US rates of hospital-onset infections dropping 17% each year until 2013, when things started to slow. This slowing progress and findings that MSSA is rising in various communities have people worried. Mostly because we know what to do; we know that using Contact Precautions for MRSA infections helps stop the spread. We know to screen high-risk patients and we know the decolonizing methods for high-risk periods, such as stays in the intensive care units or surgeries.

Moreover, the CDC notes that appropriate and rapid treatment practices, as well as educating patients can be preventive. The patient-education piece also goes a long way, in fact, as I have repeatedly seen, from the infection prevention angle, patients with staph infections are not taught to watch for signs of wound infections, or told to avoid sharing items that frequently come into contact with skin (razors, needles, towels), or advised to communicate a history of staph infections with other medical providers.

CDC principal deputy director Anne Schuchat, MD, stated in a telebriefing that “the bottom line is this: We have prevented many staph infections, but while we've made important progress, the data show that more needs to be done to stop all types of staph infection.” As the CDC reports, we are struggling against these common bacterial infections and, despite having evidence-based prevention strategies, there is much work to be done.