Sunday, January 07, 2007

The entrenchment of MRSA
Jan. 5, 2007

More than 1,000 people in our region will catch a terrible infection this year that no antibiotic will easily defeat. The worst cases will be fatal, but even the ones that aren’t will still be dangerous, unpleasant and extremely difficult to clear up.
Once upon a time, an infection like the one taking root right now was a problem only for very specific populations. A few isolated tribes of Australian aborigines. People living on the streets. Athletes playing contact sports. Military recruits.
Not anymore. The staph infections showing up in our community lately are occurring in people with no known risk factors. “We are the epicentre of the country,” local infection specialist Dr. Pamela Kibsey said this week.
Human beings have been grappling with staphylococcus infections for millennia, of course. No small wonder penicillin was given a hero’s welcome upon its invention in the 1940s, considering how many people had been killed by infection up to that point.
Alas, you can’t keep a bad bug down. From the emergence of penicillin-resistant staph barely a decade after penicillin’s discovery, to the multi-resistant “superbugs” of today, we have yet to vanquish a very old foe.
Bacteria are clever beasts, and likely would have given us a run for our money no matter what strategy we took for surviving their onslaughts. Staph bacteria have reached the point of being able to mutate almost as fast as the latest wonder drug is being rushed to market.
But we’ve also aided the bugs’ cause immensely by doing just about everything wrong in terms of infection control. It starts with years of gulping antibiotics like candy and continues through a long series of health-care and social policy changes made for reasons of economy rather than disease management.
And now we’ve all got a problem.
The latest version of staph has a big name: Community-acquired Methicillin Resistant Staphylococcus Aureus. The experts call it CA-MRSA.
In this region, we’ve been living with HA-MRSA - the kind you get in hospital - for almost a decade. What’s going on now is basically the result of the same bug, except you don’t have to go to the hospital anymore to end up infected.
My dad had the dubious honour in the late 1990s of being one of the first hospital patients in the region to acquire MRSA. The bacteria got into a surgical wound. The ensuing infection almost killed him, and the heavy-duty antibiotics he had to be on took almost as serious a toll.
More pertinently to those beyond his immediate family, he cost the system a fortune. He was in isolation in hospital for five months, on an antibiotic drip that cost more than $150 a day.
The intensity of his illness definitely would have pushed up his nursing costs. And every day he was in hospital meant another day of risk for everyone else who was in there, because staphylococcus aureas spreads like crazy among the sick and weak.
Add eight years of inflation and the spiralling costs of pharmaceuticals, and you can figure out how much this same scenario would cost today. If my dad had been in his working years and not yet retired, the financial hit he’d have taken from being laid up for five months would have been disastrous on a whole other level for my family.
Not all of the 1,000 cases of MRSA in the coming year will be as dramatic, of course. Staph presents differently in everybody, from relatively minor boils to ravaged lungs. A few of us live with MRSA in our bodies all the time, and never get sick.
Still, the entrenchment of MRSA over time is the alarming part. I used to think the trick was to stay away from antibiotics and hospitals, but now it seems that even those ramparts have been breached. The world is growing ill enough that individual efforts to stay healthy are no longer a guarantee.
Why the rise in infection? Pick your theory. We now have ghettos of street people being left to sicken in our downtowns. We’ve seen huge changes in health care. Our food supply is downright alarming, saturated in antibiotics.
Start with an increasingly privatized and mobile health-care force that travels from site to site, inadvertently spreading infection. Mix in ever-shorter hospital stays, heightening the risk that someone is released into the community before their brewing infection is even noticed. Then there’s the overcrowded emergency rooms, stacked with those sickly victims of the street and everybody jammed together for hours.
We eat meat and eggs from antibiotic-laden animals, the poor sods would not survive the miserable conditions of factory farming without the drugs. We overuse antibiotics ourselves, continuing to take them for the wrong things, at the wrong time, in the wrong way.
It doesn’t have to be this way. But for as long as it is, brace yourself for the consequences.

1 comment:

sboyle@peds.bsd.uchicago.edu said...

HI. I work with community acquired (CA)-MRSA in my everyday research. ANd have been comparing the community and Hospital acquired strains at the genetic level. One of the most popular misconceptions is that the source of CA-MRSA is from hospital-acquired MRSA that have "escaped" from the hospital. One of the things we and a lot of other researchers have found is that CA-MRSA strains are unique to the Community setting. In the U.S., there is one predominant strain in the community and a different predominated strain in hospitals. So the community strains are not simply strains that "escaped" from the hospital and have nothing to do with hospital infection control. The source of the community MRSA strains is from methicillin suscpetible Staph aureus (or MSSA) that have managed to pick up the gene that confers resistance to methicillin. Another tidbit about the CA-MRSA strains- and it is a bit of goiod news- is that, in contrast to hospital acquired strains, the CA-MRSA are susceptible to many antibitoics that could be effective. However, the CA-MRSA strains often produce a toxin (Called PVL) that is not present in HA-MRSA and it is thought that this toxin makes the community strains of bacteria potentially more deadly. We do not know what is causing MSSA to evolvem into MRSA in the community but already 25-30% of healthy people are carrying MSSA bacteria on their bodies so all you would need is a selective pressure and the resistance genes. Since the resistance gene is already present in Staph epidermidis, a nonthreatening species of staph that inhabits the skin of all human beings, this is where the gene might be coming from.