Methicillin-Resistant Staphylococus Aureus

Taken from Mayo Clinic Proceedings, showing an external and internal S. aureus infection.

This is the second time I'm hitting on this subject, the last time was in Why Are We So Bent Over Bird Flu? where I wondered why it is we're so excited about bird flu, which even now has killed less than a couple of hundred folks world wide, yet so sanguine, apparently, about MRSA, the acronym for the title to this blog. In the Nov 3 issue of The Economist, specifically in MRSA : The struggle against superbugs we're informed about MSRA and that it kills about 90,000 Americans a year. This week you can read in U.S. News & World Report another article, Bugs behaving Badly: Antibiotics are aging, and bacteria are learning to fight them off about very much the same thing, in fact the 90,000 fatalities number is also given. U.S. News takes it a step further by telling us that it's more than Staph. a. that we need to be concerned about, indeed we can add to the list clostridium difficile, acinetobacter baumannii, and neisseria gonorrhoeae. These were all bacteria that were very treatable with general antibiotics in the past and are now resistant and, obviously, life threatening; the list is only going to grow. So in short, with S. aureus if it doesn't kill you it can do a serious number on your body and the list of deadly bacterial companions continues to grow (additional information specifically regarding MRSA can be obtained from Kent County Health Dept. Fact Sheet.)

With Stap. A. we have a bug that not only can kill you, and does so to the tune of 90,000 folks a year, but can disfigure as well, and there's no national program to address this issue, no major ruckus by our politicians to fund a program to educate the public and to provide incentives to drug companies to make it worth their time and money to actually focus on new antibiotics that could get ahead of drug resistant strains of common bacteria. Just as a reminder, S. aureus is quite common, having a preference for hanging out in mucous membranes so it's fairly commonly found in the nose, and even on our skin.

There are a few things that can be done to help ameliorate if not solve this problem:

1. As far as things to be done are concerned, what should top the list is the government providing monetary incentives to drug companies to come up with new antibiotics. It's not as if we can't come up with them, i.e. the bugs aren't getting beyond antibiotics in general, but rather that there's little money to be made in antibiotics and in turn few drug companies put much effort into them. So throwing some incentives at drug companies for new antibiotics and new strategies to fight these bugs would indeed be a public health service worthy of just about as much money as we're throwing at bird flu, or about a week's worth of occupation in Iraq. When the government looks to spends hundreds of millions on bird flu vaccines they're throwing money at drug companies to induce them to produce an equally low-profit item, doing so for MSRA and antibiotic resistance in general would be a definite public service.

2. Doctors need to stop over-prescribing antibiotics. I appreciate that a parent with a child that's screaming its head off from a viral infection wants something to fix the problem, but we all know (ok, we don't all know ...) that antibiotics don't work on viral infections and otherwise help to build up antibiotic resistance in the bugs that inhabit our body. Doctors more and more don't have the time to tell their patients this so it's easier to prescribe an antibiotic and be done with it, but this definitely fuels the problem and it needs to stop. A patient screaming for percodan shouldn't get them, why should someone screaming for antibiotics? Well, the fact is the doctor doesn't go to jail for over-prescribing antibiotics ...

3. Doctors and hospitals need to be clean freaks. In Denmark, Finland, and the Netherlands the incidence of MRSA infections are much lower than in other countries, and the main difference seems to be cleanliness protocols. Doctors need to wash their hands before, after, and in between every patient, but really, who wants to be bothered with that with so little time?
Hospitals need to be scrupulously clean, but with HMOs looking for those cost saving measures where do you find the staff to keep things clean? Well we have to figure out how to up the priority on this as the number of people dying from resistant bugs bred in hospital environments such that it's hard to picture any possible justified cost-savings in not doing so, though cost-cutting mentalities are all too often stovepiped such that they don't see the potential harm done by being too niggardly when it comes to cleaning supplies.

4. Antibiotics are used in huge numbers in the livestock industry for a couple of reasons. First, and the one the industry will most often give as a reason, is to reduce infections in the livestock population. Now of course this flies in the face of the prophylactic use of antibiotics with humans where it's been found that the only thing it does is eventually build up a resistant strain of the bugs you're trying to avoid. Second, and the main reason antibiotics in animal feed is so attractive, is that for reasons I'm not clear on, I'm not sure anyone is, livestock bulk up on antibiotics up to 10%, so of course that cow in the feedlot is now worth 10% more if it has some antibiotic munchies in its corn feed. So we're fattening our cattle and helping to create antibiotic resistant strains of bugs that the cattle live with, and somehow that's supposed to be good us ... oh boy.

5. People in general, to include people who certainly should know better, need to understand and appreciate the difference between viral and bacterial infections. Of course I understand much this may be to expect for a country where so many have a hard time with evolution much less understanding the difference between viruses and bacteria, but we really need to try. The U.S. News article cited above has some a good article attached to it entitled Want to help? Just say "Whoa" which provides some good information on how not to abuse antibiotics and a number of good links, to include: 1. an animation from the U.S. FDA center for veterinary medicine explaining how bacteria becomes resistant (Animation of Antimicrobial Resistance), 2. some info from the CDC's Get Smart campaign, Spotlight: Snort. Sniffle. Sneeze. No Antibiotics, Please!, and finally we have 3. Tuft University's APUA: Alliance for the Prudent Use of Antibiotics which provides information for consumers & patients, healthcare providers, and researchers, as well as information on antibiotics in the ecology and the international problem with antibiotics.

Lastly, it always helps if you raise a stink with your local national representatives, by letter if possible (they tend to take letters a bit more seriously than simply emails, and they take calls even more seriously), to let them know that you think this is an issue you think the federal government should be doing more about. I'm not a believer in the government, any government having all the answers. But right now throwing some hundreds of millions of dollars at bird flu when we already have a catastrophe (really, how else would you describe 90,000 people dying from something every year?) running rampant through this country, is a ridiculous focus of resources (I won't even get into the war in Iraq) and does more to endanger Americans in the long term than just about anything else you can point a finger at.