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The Truth About Superbugs

When you hear from your daycare provider in the middle of the day, you can almost always assume some run-of-the-mill bad news -- a sudden fever, a split lip, vomiting, the usual. When Missy Pearce, 25, got the call about her 17-month-old son last October, she assumed much the same. And then the center's owner told Pearce she thought Andy might have a staph infection. Staph is a common bacteria that lives on the skin and in the nose and throat but can cause illness if it gains access to the body through a scratch. Pearce had noticed a tiny pimple above Andy's left hip six days earlier, and her husband had even tried to pop it. Though it had gotten bigger, they still weren't too worried. "Andy has eczema and sensitive skin," says Pearce, who lives in Providence Forge, Virginia. "We thought it was an allergy to his diapers." That's an easy mistake to make given that staph infections often present as inflamed skin with one or more pimples, and in babies, the diaper area is often affected.

The call unsettled Pearce, so both she and her husband left work to take Andy to his doctor right away. By then, the pimple had swelled to the size of a boil. The pediatrician took one look and said Andy seemed to have classic MRSA (methicillin-resistant Staphylococcus aureus), a type of staph that's resistant to many common first-line antibiotics, including methicillin.

They were shocked. "The only thing I knew about MRSA was that a teenage boy in a nearby town had recently died from it, and that terrified me," says Pearce. Andy's pediatrician knew lab tests to confirm her diagnosis would take a couple of days (a rapid test has since been approved); not wanting to lose any time, she treated him for MRSA in the interim, prescribing both oral and topical antibiotics. But even though the doctor's instincts were right, her quick action wasn't enough. Over the next two days, Andy became much, much sicker. "The infected area had spread to his abdomen and all the way down to his groin," says Pearce. They brought him back to the doctor, who advised them to take Andy immediately to the emergency room. The baby had surgery to remove the infection the next night.

Pearce didn't sleep during the torturous wait. "I was in survival mode. Plus, they told me he'd be able to go home after the procedure," she says. "When the doctor came out and told us we might have to stay for a while, I just fell apart and cried." Over the next five days, Andy received another antibiotic intravenously. When he was finally released, Pearce believed her family's battle with staph was over. But as she discovered all too soon, this bug knows how to fight back. a growing threat to babies MRSA hit the headlines last fall when a shocking report from the Centers for Disease Control and Prevention (CDC), in Atlanta, revealed that the organism was associated with 19,000 American deaths in 2005 -- more than AIDS -- and caused serious infections in another 94,000.

Infants have a unique risk because their immune systems are immature. And because babies have the highest rates of antibiotic use, they tend to have the highest rates of drug-resistant infections. Moreover, additional research suggests that MRSA may actually be on the rise in babies. Doctors at Texas Children's Hospital in Houston found that the proportion of infections in infants caused by resistant staph rose from 50 percent in 2001 to 83 percent in 2005. Even more worrisome, they found that the number of infections in newborns caused by the community form of the disease (as opposed to the types that circulate in hospitals) also increased every year between 2001 and 2005. This finding is particularly alarming because it can be nearly impossible to know where the child picked it up. The bug is easily transmitted by simple skin-to-skin contact in homes, daycare centers, places of worship, and stores.

Like Andy's parents, Scott Smith and his wife have no idea how their 14-month-old son, Bryce, caught a form of MRSA that attacked his lungs in 2005.

"At first we thought, 'Wow, he's over a year old and this is his first cold,'" says Smith, 45. But then they noticed his breathing had become rapid, and he spiked a high fever.

Instead of a cold, Bryce had developed resistant pneumonia, and he spent 55 days in the hospital before finally being cured with vancomycin, known as the drug of last resort. "We were always very careful," says Smith, who lives in San Diego. "You just never think about the real danger from a microscopic bug like this." And MRSA is far from the only drug-resistant bug that can affect babies.

A host of ailments, including ear infections, tuberculosis, and foodborne illnesses like salmonella, have evolved strains that can survive treatment with common antibiotics. Last year, the Journal of the American Medical Association (JAMA) published a report on nine children who couldn't be cured of persistent ear infections with any child-approved drug (that's 18 antibiotics) or ear tubes. The germ could only be beat with a drug approved for adults.

Deep breath.

Although the news thus far is enough to turn the most casual parents into sanitizer-toting germaphobes, most doctors say there's little reason to turn concern into panic. "People are getting more frightened than necessary," says Robert Frenck, Jr., M.D., professor of pediatrics at Cincinnati Children's Hospital Medical Center. That's because MRSA and most resistant infections are still vulnerable to at least some antibiotics, says Dr. Frenck. Our job is to help keep it that way.

How Resistance Happens:

Since their introduction in the 1940s, antibiotics have saved millions of lives. But as soon as bacteria had their first fight against the drugs, they began adapting ways to outsmart them.

How It Works:

You start life with a bunch of different kinds of bacteria on your skin and in your gastrointestinal tract, and most of them are sensitive to antibiotics. But a few are not, says Elizabeth Bancroft, M.D., a medical epidemiologist with the Los Angeles County Department of Public Health. As we kill off the vulnerable bugs with drugs, we begin to tilt the bacterial balance in the body: Any resistant germs now have a clear playing field. "They can start dividing and become the dominant strain in your body," she says. That's not the only trick bacteria have. They can also mutate and develop changes in their DNA that make them invulnerable to the antibiotics they've been exposed to before; and they can acquire resistance genes by swapping genetic material with other bacteria. Pearce found out just how adaptable and persistent bacteria can be when she noticed a new pimple on the back of Andy's thigh in January. Not only was the MRSA back, but the new infection was resistant to clindamycin, the medicine that had cured him before. "From the moment I realized what was going on, I was a wreck," she says.

Fortunately, the infection responded well to Bactrim, another antibiotic. But doctors warned the Pearces that Andy is probably colonized with resistant staph, meaning he permanently carries the bugs in his nose or on his skin, and they could trigger another infection at any time (an estimated 2.3 million Americans are MRSA carriers). "The fact that we're going to be dealing with this for the rest of his life is overwhelming," says Pearce.

8 Ways to Fight Your Fears

Hearing about babies like Andy and Bryce can be paralyzing for new parents, who are already grappling with so many anxieties. Our hope is that their experiences will inspire you to take charge of those fears and turn your worry into action. After all, there is a lot you can do to protect your family.

1. Stay sane about staying clean.
"A lot of parents think you have to be dirty to get an infection like this, and that it's their fault if their child develops one," says Stephanie Boyd, project coordinator at the Alliance for the Prudent Use of Antibiotics, in Boston. But that's just not true. "Yes, you can reduce your risk with hand washing and other strategies, but that's true of colds, too. You're not dirty if you catch a cold."

A few simple rules suffice: Anyone who touches your baby should first wash her hands for 20 seconds with soap or use a hand sanitizer containing at least 60 percent alcohol, rubbing for that same 20 seconds; the "swipe and wipe" won't do it. And because some germs can live on surfaces, wiping down cart handles, fast-food tables, and other shared surfaces when you're out can't hurt.

2. Check your daycare's hygiene policies.
Because outbreaks of MRSA have been traced to daycare centers, find out what their sanitizing, diaper-changing, and hand-washing procedures are, as well as how skin infections are handled (infections should be tightly bandaged, taped down on all sides). You'll want to know that caregivers wash their hands and the children's often, especially before eating and after using the bathroom; the toys and equipment should be visibly clean and washed daily. Diaper stations should be in a separate area, have disposable cover sheets, and be cleaned after every use.

3. Take care of yourself.
It's the advice new parents most often ignore, but exercise, healthy eating, drinking plenty of water, and getting as much sleep as possible will bolster your immunity, which means fewer health risks to your baby. Your baby will catch colds and other viruses and pass them to you, and if you're run-down and develop other infections, you can then pass them back to your baby like a game of family-disease Ping-Pong. "You have a better chance of avoiding secondary bacterial infections if your body can fight viruses," says Stuart Levy, M.D., professor of molecular biology and microbiology and medicine at Tufts University, in Boston.

4. Be diligent about vaccines.
Immunizing against viral diseases such as measles and chicken pox reduces your baby's chances of getting secondary bacterial infections while his immune system is weakened. The same goes for you and the flu shot, so roll up your sleeve every year.

5. Avoid pressuring your doc for antibiotics.
Unfortunately, in our enthusiasm to save children from pain and suffering, doctors and parents have played a role in the rise of resis- tance by improperly using antibiotics to treat viral infections; remember, every time the bacteria are exposed, they have another chance to learn how to outsmart the drug. A JAMA study found that more than 50 percent of children with a sore throat received antibiotics. Given that the vast majority of throat infections are viral and only half of the children who received drugs were tested, millions of antibiotics were unnecessarily unleashed. The truth is, physicians are people, too, and vulnerable to pleading, says Dr. Levy. Researchers at the University of California at Los Angeles found that doctors prescribed antibiotics 65 percent of the time if parents expected them, but only 12 percent of the time if they didn't.

6. Get confirmation.
Always ask your doctor to confirm her diagnosis with a culture. That's the only way to know if antibiotics are truly necessary. Scott Smith says he wishes he'd known to ask for a culture when he first brought his son to the doctor. A few days later, the baby was rushed to the hospital with MRSA pneumonia, which left him with lung damage.

7. Follow instructions precisely.
Give every prescribed dose of an antibiotic, and don't stockpile extras. Taking a couple of doses of an antibiotic whenever you or your child feels sick will not make you better, but it can kill off weaker bacteria, leaving the resistant strains alive and well.

8. Get involved.
Most of the large drug companies have stopped developing new antibiotics because they don't generate much profit -- people take them sporadically for short periods of time, not daily for years like treatments for asthma, high cholesterol, and high blood pressure. Now there's a bill before Congress called the STAAR Act that would provide incentives for antibiotic research and increase monitoring and information on resistant infections. (See *** to learn how to voice your support for the bill.) The thing to remember from all of this is that although germs can adapt, people can, too.

Both the Pearces and the Smiths are still rocked by their encounters with resistant staph, but they're moving forward. Andy's back in daycare, and his parents now use Bactroban cream on him whenever they see a new pimple pop up. And after a year of keeping their son away from crowds, the Smith family is almost back to normal. "We watch Bryce very closely, but we take him to parks and other places," says Scott Smith. "We're learning slowly that we have to let him be a little boy again."

Melanie Howard lives in Alexandria, Virginia, with her husband and two children.