No need to run scared; staph is an old bug
|No need to run scared; staph is an old bug
By Dr. Marc Siegel
December 19, 2008
Bacteria are only a few microns in size, invisible to the naked eye. So it is easy to either forget about them entirely or become overly fearful of them, imagining that they are about to attack. This lack of perspective, amplified by media reports, is the reason for the sudden widespread worry over MRSA, or methicillin-resistant staphylococcus aureus, a skin bacteria that's been a chronic problem in American hospitals for years.
A new report by the Centers for Disease Control and Prevention published in the Journal of the American Medical Association - documenting 94,000 cases of serious MRSA infections nationwide with 19,000 deaths in 2005 - coupled with the dramatic death of a high school student in Virginia, has fueled a nationwide hunt for the so-called superbug. Ten cases have been found at Iona College in Westchester County, and so far one case has been reported on Long Island, at Baldwin High School.
Each state has been reporting minor skin infections as though they were war wounds. Millions of healthy people who had never heard of this bacteria two weeks ago are now concerned it could kill them. The worry is not justified.
Though MRSA has appeared in gyms and schools over the past several years, it is still primarily a hospital pathogen, with more than 85 percent of the cases occurring in health facilities, according to the CDC. Most of the cases occur in patients who are already severely sick with chronic diseases, such as emphysema and cancer, but most are also completely treatable - not by penicillin-based drugs, but by other antibiotics. It's not known asthe superbug in hospitals where it is found; it is simply called the colonizer.
But thanks to widespread media coverage of the CDC report, people are worried. Last week many of my patients called me with fresh concerns over their usual pimples and boils, and a frightened neighbor refused to shake my hand, pointing out that because I worked in a hospital I might be in contact with the superbug.
Such hypervigilance will do nothing to eradicate MRSA. Quite the contrary, in fact. Excessive concerns over rare bacteria lead patients to pressure physicians for antibiotics to treat the slightest sniffle or scratch. Though more than 90 percent of upper respiratory infections are viral and don't respond to antibiotics, and though most skin bumps go away on their own, physicians are nevertheless quick to overprescribe oral antibiotics. This bad habit leads to more impervious bacteria, which develop resistance to existing treatment.
And whereas frequent hand washing is a good habit and decreases the amount of bacteria passed back and forth, overuse of alcohol-based antibacterial hand wipes and sanitizers can also create drug resistance, not to mention cause dry, cracked skin that allows more bacteria to propagate.
So what actually should be done? The focus on superbugs is drawing more attention to the problem, but worry and obsession do more harm than good. Fear is a strong emotion, and when people are overly emotional they tend to be easily distracted, taking fewer precautions than they should. A calm, rational approach, by comparison, can lead to containment.
Since MRSA is still much more common in the hospital than in the community, the hospital is where the greatest measures should be taken. Resistant bugs such as MRSA emerge when sterile techniques are inadequate and the staff doesn't follow proper infection-control precautions, including regular glove use and hand washing. Cleaning sports equipment in schools, one precaution that's been recommended, is always a good idea, but it's unlikely to make a significant impact on MRSA.
In the 1970s and '80s many new antibiotics were developed to keep pace with the emergence of drug resistance and to compensate for inadequate prevention, but unfortunately the pipeline for new antibiotics has slowed to a crawl over the past two decades. There are only a few drugs that reliably treat MRSA, and the most effective treatment, Vancomycin, is only given intravenously. It costs a drug company more than a billion dollars to develop a new drug, and antibiotics do not yield nearly as high a return on investment as do chemotherapy for cancer or retroviral therapies for HIV.
Plus, whenever an unexpected side effect occurs, as happened last year with the antibiotic Ketek and liver failure, the resultant public relations nightmare, and the associated legal costs, must be factored into the cost of developing future antibiotics. This trickle-down effect on future drug development is not considered when a drug company is being publicly vilified. Perhaps it should be.
Without an explosion of new drugs to reassure us, we cannot afford to overreact to existing infectious threats. We must see the risk in perspective. MRSA is an old problem. It is not sexy, as the media have falsely tried to portray it, and it is not swarming. Calling it a superbug, though most of the time it is indolent and limited to hospitalized patients who are already sick, is neither good public health nor responsible journalism.
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