Patients, many of them children, tell the same story: Tiny red bumps pop up on their skin. They look like bug bites. But eventually, these bumps grow into deep, painful abscesses.
The stubborn abscesses are telltale signs of the antibiotic-resistant strain of staph that has ravaged bed-bound hospital patients for nearly two decades. But pediatricians across North Carolina now say nearly 80 percent of the skin wound cases found in healthy children are caused by this bacterial scourge, known by the acronym MRSA.
It's a sign that the infection is stepping out of the hospital ward and into the general population, doctors say.
"We're seeing a transition from MRSA being an infection largely of chronically ill and hospitalized patients, to one of healthy children," said Dr. Mark Piehl, medical director of WakeMed Children's Hospital. "There's no question that the bacteria is more prevalent in the community now."
Dr. Mary-Cassie Shaw, apediatrician at Oberlin Road Pediatrics, said the rise has been so dramatic that when she sees a skin infection, MRSA is often the first thing she considers.
"It's a smart bug," she said. "Before, we saw it in people who were fairly sick. But just popping up in Joe Blow is a new phenomenon of the last several years."
Though doctors agree community-acquired MRSA cases are on the rise, there's no consensus on the best ways to combat the infection.
Starts out harmless
MRSA, which stands for methicillin-resistant Staphylococcus aureus, is found in the nose and on the skin of about one in three people.
"We all carry bacteria all over the outside and inside of our bodies, and it's normal," Piehl said.
MRSA evolved when staph picked up mutations in its genetic code that equipped the germ with powerful resistance to antibiotics. Its evolution was propelled by a history of use and overuse of antibiotics.
It works like this: When an antibiotic is prescribed, it knocks out most - but not all - of its tiny bacterial targets. The few survivors are the ones armed with certain genetic mutations that enabled them to escape detection. When these survivors reproduce, a new, resistant strain emerges.
The MRSA strain primarily affected patients in hospitals and other health care settings until a second version popped up in the mid-1990s, striking even healthy people.
Still, the broader MRSA strain doesn't cause a problem in many people.
"I don't want to give an impression that it's this big, awful epidemic. It's just out there, people have it, and sometimes it causes infection," Piehl said.
Infection happens when bacteria burrow into the skin through wounds or cuts. They make skin red, warm and tender to the touch, "like any skin infection would look like," Shaw said.
Who's at risk
The tricky thing about bacteria is that while they might be harmless to one person, they can cause infection in another.
The bug spreads easily, by skin-to-skin contact or sharing objects such as towels or razors.
As a result, infection is more common among groups in close quarters, such as athletes on sports teams, prisoners and military personnel.
Children are also commonly affected. They're more vulnerable simply because they're worse at basic hygiene measures.
"They don't have the germ phobia that the rest of us do," said Dr. Adam Shapiro, a pediatrician at UNC Hospitals.
Rely on good hygiene
When the bumps mature into boils and abscesses,many can be removed with drainage, without the use of antibiotics.
"We're using antibiotics more correctly now, and not just prescribing them automatically," said Shapiro.
While we may be smarter at knowing when to use antibiotics, there's still no agreement about the best way to treat MRSA.
"There's controversy about prevention because there have been no studies," Shaw said. "There's a lot of anecdotal evidence. But science likes a nice study to tell you what works and what doesn't."
One piece of anecdotal evidence, for example, is bleach baths.
Shaw says that when she sees whole families with the same infection, she puts everyone on the therapy regimen that involves adding one teaspoon of bleach per gallon of bathwater to try to knock MRSA off the skin.
"We're not going to eradicate it. It's ubiquitous," she said. "But I believe there's some merit in trying to get the household burden of that bacteria down."
But others are more skeptical about cures that haven't been proven.
Piehl and Shapiro say that in the absence of organized data, the best precautions are those general hygiene measures advocated by the Centers for Disease Control and Prevention, which include good hand washing, covering wounds, and not sharing personal items.
"It comes down to basic, common sense hygiene," Shapiro said.
