Methicillin Resistant Staph Aureus

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Methicillin Resistant Staph Aureus
Dr. David J. Holcombe

Almost everyone has heard of Methicillin Resistant Staph Aureus (MRSA) these days.  As a source of boils in high school or college athletes or the cause of devastating complications in hospitalized patients, MRSA seems to be everywhere.

 

In fact, Staphylococcus aureus is a germ that lives on the skin of over 30% of healthy people.  It, like many other bacteria, was once universally sensitive to penicillin.  Within a few years, however, it had already developed resistance in some strains.  Other antibiotics were invented, including methicillin in 1960; but by 1963, resistance to methicillin had also developed.  Resistance continued to extend to other antibiotics until multi-resistant Staphylococcus became a world-wide epidemic.  By 2010, over 60% of all hospital strains of Staphylococcus were MRSA, and many had become resistant to vancomycin, one of the mainstays of treatment.

 

MRSA is not only widespread in hospitals, but has gradually spilled out into the general community.  Staphylococcal strains are now divided into HA-MRSA (Hospital Associated) and CA-MRSA (Community Associated).  The latter was further divided into strains associated with healthcare institutions (nursing homes, for example) and those that appear spontaneously in the community.  Wherever MRSA comes from and however it manifests itself, it represents a terrific medical challenge.

 

In Louisiana, about 1.5 million people (30% of the populations) are colonized with Staphylococcus, while only about 1% (or 45,000) carries MRSA.  This still results in countless outpatient medical visits for those unlucky enough to develop boils, cellulitis, folliculitis, or more invasive infections including pneumonia or sepsis.  Although such major complications are rare in the community, over 125,000 people will develop Hospital Associated MRSA each year in the U.S., and over 5,000 will die.  MRSA complications in the hospital add over 9 days to the average stay, $20,000 to the individual bill and over 4 billion dollars in aggregate costs.  It is estimated that all costs associated with MRSA, both in and out of the hospital, exceed 34 billion dollars each year.

 

So how can we prevent ourselves from this modern day scourge?  Since Staphylococcus aureus is everywhere, we can start by reducing the 5 C’s:  Contact, Crowding, sharing Contaminated items, covering Compromised skin (open lesions) and promoting Cleanliness.  In the hospital, hand washing prior to entering and when leaving a patient’s room is essential.  Hospitals are very much attuned to the human and economic costs of MRSA (and other hospital-acquired infections).  Each hospital has an Infection Control Officer who tracks and reports such infections, reporting certain types of infections to the National Healthcare Safety Network (NHSN).  There are also active programs of bacterial surveillance and isolation associated with cases in the hospital setting.   Strict adherence to such programs dramatically reduces hospital acquired MRSA case.

 

On an individual level, the importance of hand washing cannot be overstated.  Use of soap and water (or alcohol-based hand sanitizers) reduces bacterial contamination by over 90%.  Never share personal hygiene items and cover open wounds.  Staphylococcus is here to stay and has outwitted our best attempts to develop antibiotics.  This being said, judicious use of antibiotics reduces the development of resistant strains of all bacteria.  If you do not really need antibiotics, don’t insist on their use.  Doctors, patients, hospitals, pharmaceutical companies and the general public all share the responsibility for reducing the terrible cost of this omnipresent enemy.