Darriel Fleming thought he had a spider bite.

As the boil swelled painfully on his stomach, the 28-year-old Marietta man went to a nearby emergency room. A doctor drained the wound and sent Fleming home with a prescription for antibiotics.

Allen Sullivan/AJC (ENLARGE)

Still grieving over her daughter Chelsie's death, Melissa Mize-Elder has preserved the girl's bedroom much as it was in February 2007. Memorials to 'angel' Chelsie have been added to the walls. Mize-Elder named her infant son Chelton, in honor of Chelsie.

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Three weeks later, Fleming was dead, killed last July by a drug-resistant form of staph bacteria called MRSA.

MRSA, or methicillin-resistant Staphylococcus aureus, for decades was an infection confined to hospitals and nursing homes. But MRSA strains are increasingly infecting people in the community, outside of health care settings.

In Georgia, more than 1,700 people have been hospitalized in the past three years with severe MRSA infections caught in the community, according to reports filed with the state health department. At least 62 have died — including several children with a deadly form of MRSA pneumonia.

Local and federal health officials are working to educate doctors and the public about the rise in these drug-resistant infections — best evaluated and treated early — and on ways people can protect themselves. They emphasize that the vast majority of community MRSA infections are treatable skin boils and abscesses.

Sometimes, for reasons unclear to scientists, the bacteria invade a person's bloodstream or wreak havoc with internal organs.

Researchers are studying who gets these serious community MRSA infections and examining the bacteria for clues about why they live on some people without causing infection — yet kill others.

"We want people to understand that potentially, even though it's very uncommon, these community MRSA cases can be very serious and even fatal," said Dr. Rachel Gorwitz, epidemiologist at the Centers for Disease Control and Prevention.

Community vs. hospital MRSA

Staph bacteria, even those that aren't resistant to antibiotics, have long caused serious infections.

In the 1960s, the first reports surfaced of staph infections that had stopped responding to the antibiotic methicillin. Over the decades, those strains have spread, and the germs have developed resistance to other drugs, largely in hospitals where they infect patients weakened by disease or made vulnerable through surgical wounds and catheters.

Even today, MRSA poses the greatest threat in hospitals, where strains are usually genetically different and, because of antibiotic use, more difficult to kill than those circulating out in the community. About 85 percent of life-threatening, invasive MRSA infections involve people who have been hospitalized, lived in a nursing home or been treated in some other health care facility, the CDC estimates.

During the 1980s, doctors began finding cases of MRSA in people who hadn't spent time in health care settings.

Unlike hospital strains, MRSA in the community tended to cause skin infections — pus-filled pimples and boils.

Unlike their hospital cousins, community MRSA still responds to a wider range of antibiotics, experts said. It's unusual for community infections to become life-threatening.

Panic and MRSA

Still, MRSA made headlines last fall — and caused the panicked closure of some schools in Georgia and across the nation — in the wake of publicity about a new study estimating that more life-threatening infections occur than previously thought.

The study, which involved CDC and Emory University researchers, estimated invasive MRSA infections — in both health care facilities and the community — killed nearly 19,000 Americans in 2005. Another 94,000 had life-threatening infections.

In Atlanta, the study said, the incidence of invasive MRSA has increased 71 percent in recent years — from 19.3 infections per 100,000 people in 2001-02 to 33 infections in 2005, the most recent data analyzed.

About the same time, news reports played up the MRSA death of a Virginia teen. As public awareness and concern grew, schools in Georgia and elsewhere sent home notes alerting parents when a child had a routine, treatable MRSA boil. Some schools closed for disinfection.

Lost in the furor was the study's main finding: Most life-threatening MRSA infections — 85 percent — involve people who have been infected while hospitalized or living in a nursing home. Only about 15 percent happened in the community.

People 65 and older were most likely to suffer invasive MRSA infections of all types, the study found. Black people had invasive MRSA at nearly twice the rate of whites, which researchers speculate could be due to higher rates of chronic illnesses that may make them more vulnerable.

Contrary to public perception during last fall's panic, school-age children aren't at greatest risk for serious MRSA infections — nor is scrubbing surfaces an effective way of preventing transmission of bacteria spread by skin-to-skin contact or by sharing intimate items, such as towels, razors or sports equipment.

Awareness, not panic

Dr. Susan Ray, an associate professor of medicine at Emory and a co-author of the study, said the public needs to be aware that MRSA is in the community — but not become panicked by it.

"Most people who have a skin infection with staph germs have a boil that comes and goes and they may never have seen a doctor," Ray said.

Those who seek help from a doctor usually are successfully treated.

Dr. Amy Kim, an Atlanta dermatologist, says she sees about one or two MRSA cases every week out of about 150 patients. Usually, the patients are in their 20s or 30s, and they're seeking treatment for boils, abscesses or inflamed pus-filled pimples around their hair follicles.

The diagnosis isn't what patients want to hear.

"People are pretty freaked out about it," Kim said. She tries to reassure them that, while MRSA is resistant to some antibiotics, it's still very treatable with others. Nearly all her patients' infections have cleared up within 10 days. In rare cases, however, the bacteria can enter the bloodstream — with deadly consequences. Being elderly, having skin problems or in poor health may be contributing factors for invasive infections.

Experts don't know why MRSA ravages some people and not others.

"That's the $64,000 question," said Ray. "We don't know."

Grief and frustration

That such a young man like Darriel Fleming would die so suddenly left his wife reeling with grief and unanswered questions.

Although records show doctors reported Fleming's community-associated MRSA death to the state, his widow said she never knew the bacteria killed her husband until contacted by The Atlanta Journal-Constitution.

"I'm just so frustrated," said Cynthia Fleming. "I'm just trying to come to grips with this."

Hospital records, obtained by the AJC with Cynthia Fleming's authorization, show her husband's infection was caused by MRSA.

She wonders whether her husband could have been saved if he had been diagnosed earlier with MRSA.

Darriel Fleming, who had heart disease and was a diabetic at risk of skin problems, went to WellStar Cobb Hospital in Austell on June 17 after a painful boil grew on his stomach. In the emergency room, the doctor lanced the abscess and packed it with gauze.

The doctor didn't say what it was, said Cynthia Fleming, who went to the hospital with Darriel that day. "My husband kept saying it was a spider bite. I kept saying it doesn't look like a spider bite to me," she said.

Darriel Fleming was sent home with a prescription for Bactrim, an antibiotic, although no lab tests were done on the abscess to determine what organism caused it, hospital records show.

About three weeks later, on July 5, Fleming developed a fever of 104 degrees. The next day, he went back to the hospital. While a chest X-ray was ordered, again the hospital didn't run any blood tests to look for an infection, hospital and insurance records show. The hospital sent him home with instructions to take Tylenol and drink fluids.

Less than 24 hours later, Fleming was extremely ill and back at the emergency room. Despite being put on powerful, intravenous antibiotics, including vancomycin, Fleming's condition declined rapidly.

He was put on a ventilator in the hospital's intensive care unit, but died at 3:14 a.m. on July 8.

Final blood culture results, which came back after Fleming died, showed the Marietta man's bloodstream infection was caused by MRSA. A separate culture of his abdominal wound — taken less than an hour before he died — found MRSA there as well, hospital records show.

The tests indicated the MRSA bacteria infecting Fleming should have been susceptible to being killed by Bactrim, the antibiotic he was prescribed June 17. Why it didn't work may never be known.

Hospital officials refused to discuss Fleming's case, even with his widow's permission.

In general, emergency room doctors assume that abscesses involve MRSA, said Dr. Gerald Bortolazzo, chairman of ApolloMD, the firm that employs the hospital's ER doctors. Patients are given Bactrim, the preferred antibiotic for strains circulating in Atlanta.

Searching for answers

At the CDC's campus on Clifton Road in Atlanta, scientists in the national Staphylococcus reference laboratory examine samples of MRSA from people like Darriel Fleming.

They grow the bacteria in large incubators, then determine what antibiotics will and won't kill them. They also run tests to identify the bacteria's genetic fingerprints and whether they are producing certain toxins.

A lot remains unknown about MRSA — especially why it lives on some people without infecting them, and why in some cases it kills.

"That's really an important question for us to learn more about," said Gorwitz, the CDC epidemiologist.

It may involve differences within MRSA strains, a person's genetics or delays in seeking care, she said.

Until scientists have more answers, experts said, the public's best protection is to practice good hygiene and get skin problems checked out by a doctor.

Researcher Sharon Gaus contributed to this report.