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Contagious and
often dangerous
Richard Feldman Antibiotic-resistant Staphylococcus aureus, known as MRSA, isn't new, but recent publicized infections have increased public awareness and generated anxiety. Rightfully so. MRSA now causes 70 percent of serious skin and soft-tissue infections. Ninety-four-thousand serious or life-threatening MRSA infections occur yearly, resulting in nearly 19,000 deaths. Seventy years ago, Staph aureus was universally sensitive to a new antibiotic called penicillin. It quickly gained resistance to penicillin and progressively became resistant to newer antibiotics. Bacteria aren't dumb. They skillfully mutate in response to threats against their existence and overcome the effects of antibiotics. By the 1980s, MRSA had spread globally and now increasingly resistant strains are reported. MRSA once primarily resided in hospitals and other health care institutions. Hospitals are especially vulnerable to these resistant organisms since they care for sick people who may have weakened immune systems, open wounds or who are subjected to surgical procedures, invaded with tubes and catheters, and intensively treated with antibiotics. MRSA now represents about 25 to 40 percent of Staph aureus infections in hospitals. We have traditionally worried about the strain known as "hospital-acquired MRSA." That specific strain is a moderately growing problem in hospitals and represents a constant challenge to their infection-control programs. Hospital-acquired MRSA has spilled some into communities but is not a major issue. Now we hear of a completely different bug called "community-acquired MRSA." It is genetically distinct from the hospital-acquired variety and originated outside of the hospital environment about 10 years ago. Indeed, when we look at the risk factors of outpatients with these infections, there are generally no hospital-related associations. This is clearly an infection that is spread within the community, particularly in schools, day care centers, sports teams and prisons, and finds its way into hospitals as patients require treatment. Community-acquired MRSA is more virulent than the garden variety of Staph aureus and is apt to cause more severe infections. Some may be life threatening, occurring in the bloodstream, various organ systems and body sites. Fortunately, the vast majority of infections are localized skin and soft-tissue infections, and more serious infections are the exception. The recommended intravenous antibiotic options for MRSA are expensive and limited. Community-acquired MRSA is susceptible to only a few oral antibiotics, and one is outrageously expensive. If, or maybe more appropriately, when these bacteria become resistant to oral antibiotics, we may be in profound trouble. Only a few new MRSA antibiotics are under development and all are for intravenous use. MRSA is everywhere. About 1 percent of Americans carry the bug asymptomatically, one-half of which is the community-acquired type. A recent New England Journal of Medicine study of emergency department patients with skin and soft-tissue infections found that 78 percent of the infections were caused by MRSA and that virtually all were of the community-acquired type. This is a mounting community problem. The Indiana State Department of Health task force developed to combat MRSA through public education is right on target. Schools, institutions, sports teams, athletic clubs and day care centers must further their efforts to institute basic sanitation and disinfection measures. Individuals must become more aware of the importance of s avoidance of sharing personal items, appropriate hand-washing, and covering wounds. Doctors must avoid needlessly using antibiotics, better recognize early Staph infections, and know which antibiotics are reliably effective for MRSA. Indiana hospitals have already formed several initiatives intensifying their efforts in fundamental infection control, using newer surveillance systems, and exploring new protocols and products that will discourage bacterial spread. Ultimately, new antibiotics must be developed to treat MRSA and efforts continued to successfully develop a vaccine. Nationally, some policymakers have mistakenly branded hospitals as the culprit. Legislative, regulatory and public health efforts overly focused on health-care institutions will miss the mark. The true target should be our communities and all of us who live there.
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