The Staph of Death

Sulfa drugs and antibiotics have worked miracles against most kinds of germs, but with one species, Staphylococcus aureus, their too-liberal use has backfired. Last week US. physicians were pondering massive evidence in the A.M.A. Journal showing that 1) infections acquired in hospitals are a deadly and growing peril; and 2) antiseptic methods are as important as ever.

"Staph," as medical men nickname the germs, cause the commonest and most minor bacterial infections--but also the most dangerous. They are found in boils and in the pus of infected wounds. They may cause pus-filled blisters all over the body of the newborn, and fast-spreading diarrhea. From the eyes (conjunctivitis) they can spread to bone (osteomyelitis). If staph spread to the inner surface of the heart chambers, they can cause heart failure and death. In the lungs they are a potent source of pneumonia; many of the pneumonia deaths following Asian flu are laid to staph.

Where They Come From. Why has the staph menace grown so great? Part of it is relative: other germs, once equally common and deadly, have been tamed. Part of it is that physicians, surgeons and hospital staffs have become too confident: relying on their antibiotics, they are careless about general cleanliness and even surgical asepsis (TIME, April 1). But most of the trouble is in the nature of the beast itself: Staphylococcus aureus has the greatest capacity of any known disease germ for developing strains that are resistant to one antibiotic after another.*

These resistant strains, the Journal authors agree, are now firmly entrenched in hospitals. Epidemics usually begin in the nurseries. Since the babies do not bring them into the nursery, where do they come from? Usually, the investigators found, from nurses. In some hospitals, as many as 80% of personnel have been found to carry staph in their nasal passages (without apparent illness). The proportion who carry the resistant strains, causing disease outbreaks, may be only 4% to 12%, but once a wave of infections starts rolling, it is hard to stop. Healthy adults have a high degree of immunity, but its nature is not yet understood, and no vaccine is in sight. The newborn and very old are especially susceptible, and so are patients recovering from surgery.

What to Do? Most of the dangerous staph are immediately found to be resistant to penicillin and streptomycin. They show descending orders of resistance to the tetracyclines (Aureomycin, Terramycin, Achromycin) and chloramphenicol (Chloromycetin). Strains have emerged that show varying resistance to still newer antibiotics. Strangely, nobody knows exactly how severe the problem is because most deaths caused by staph are not so listed. If a patient admitted for heart surgery dies of a staph infection, his death is attributed to the original heart trouble. Example: in Seattle and surrounding King County, only four deaths (out of 7,837) in 1956 were listed as caused by staph. But Dr. Reimert T. Ravenholt estimates in the American Journal of Public Health that fully 100 and perhaps more than 200 deaths should have been so listed.

On what to do to fight the staph, the authorities give unanimous advice: P: Clean up the hospitals. P: Make doctors and nurses scrub up better, use heavier masks, take far more care in many details--e.g., changing their shoes when moving between surgical and nonsurgical areas.

P: Sterilize instruments and bedding far more rigorously; staph can live, snug in blankets and mattresses, for months. P: Do not give antibiotics haphazardly, and never in small "preventive" doses, which probably serve mainly to encourage resistant staph strains. P: When an infection apparently caused by a defiant strain is detected, treat it with full doses of the most promising antibiotic. At the same time, culture the germs in the lab, and confirm (by complex tests) that the right drug is being used. Isolate the patient as far as possible.

*Microbiologists are about equally divided on whether the resistant strains arise by mutation, or are present from the beginning and multiply to dominate the field only after the more sensitive strains are killed off by the drugs.

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