Backing away from the MRSA crisis
Last month, public health researchers reported that six Canadians -- one in Ontario, five in Saskatchewan -- were infected with methicillin-resistant Staphylococcus aureus, or MRSA, drug-resistant staph. That may not sound unusual, but there was something odd about their illnesses: They were caused by a strain that during the last few years has spread through livestock and farm workers in Europe and North America. But the Canadians made sick by the bacterium had no contact with animals or farming; one of them, an elderly woman, had been housebound for several years.
FOR THE RECORD:
Infection: An Op-Ed article Sunday said that 61% of children in the intensive care unit of Johns Hopkins Hospital carried the community strain of MRSA staph infection. It should have said 6% of children carried MRSA infections, and 61% of them carried the community strain. —
Last week, epidemiologists at Johns Hopkins Hospital revealed that 61% of the children in their pediatric intensive care unit -- kids enduring advanced cancers, organ transplants and tricky infusions of stem cells -- were carrying MRSA, but not the usual hospital strains. Instead, the kids had a strain that predominates outside healthcare and is more transmissible, more virulent and harder to detect than the hospital variety. While they were counting the cases, one child developed a serious bloodstream infection from the community bug, something that would never have happened just a few years ago.
Reports like these are warning bells, and there have been many of them ringing, mostly unheard, for a decade now. Collectively they signal that drug-resistant staph has changed in startling and threatening ways, and that our control efforts, and even our ability to detect it, have not kept up.
Most people think of MRSA as a healthcare infection, and it is: It is a risk for patients who are elderly or immune-compromised, and for those who are taking many antibiotics or are pierced by lines and catheters that breach the immune protection of their skin. We hear of it less frequently outside the walls of hospitals, and then primarily as an irritant that shades occasionally into illness, as when skin infections bedeviled the USC Trojans and the Cleveland Browns.
But MRSA is not just an irritant, and it is far from occasional. It is a consistent global epidemic, stretching over more than 50 years. And though it began in hospitals, it has now moved into the everyday world, where it has found a niche in industrial-scale farming, in the close quarters of gyms and prisons and in professional and school sports. It is an everyday complaint in emergency rooms nationwide, and it is the spark for infections that can destroy a child’s lungs before an ambulance can get to his door.
Its comprehensive assault has gone largely unnoticed, because some of MRSA’s victims are patients in nursing homes, some are kids seen in pediatric offices, and some are pets or livestock animals that are cared for by veterinarians -- and none of those sectors of medicine and public health routinely talk to each other.
But if you follow the breadcrumbs of MRSA’s emergence through the many silos of medicine, here is what you find: Almost 19,000 deaths a year in the United States from the bacterium’s most invasive forms. Almost 370,000 hospitalizations. At least 7 million visits, probably more, to doctors’ offices and emergency rooms. And a bill for additional healthcare spending that is in the billions, with estimates as high as $8 billion, and in one projection $38 billion, in a year.
How did it get this bad? MRSA managed its advance in part because we were not paying attention, and in part because a bacterium that produces a new generation every 20 minutes will always outpace pharmaceutical companies that take a decade, on average, to bring a new drug to market.
But it also escaped our control because we created the conditions that allowed it to. Patients expect prescriptions when they’re ill, and doctors have been too quick to prescribe antibiotics even when they might not be necessary. We’ve crammed prisons beyond their capacities without taking into account that bugs bred in a prison will walk out with inmates when they are released and with correctional officers at the end of every day.
More than anything, the crisis was bred of our craving for cheap protein, which led to industrial-scale farms that consume 70% of the antibiotics used in the U.S. each year. We failed to realize in time that antibiotic-resistant bacteria would leave those farms not only in the animals that received the drugs, but in their manure, in groundwater and in dust on the wind.
In hospitals now, infectious disease physicians talk somberly about a return to the era before antibiotics, to the possibility that there will be infections for which there are no longer any drugs that work. They are not exaggerating. MRSA is the leading organism in an international epidemic of antibiotic resistance. It is the most important healthcare-associated infection in the world.
We can walk MRSA back from this crisis if we take actions that other countries have implemented. We can look for it more aggressively and keep more precise statistics about its spread. We can call on healthcare to exert more leadership in combating infections in hospitals. We can tell primary care, and veterinary care, to use antibiotics more conservatively. Most of all, we can begin paying attention to antibiotic resistance, before it advances to a point at which no control strategies will succeed.
Maryn McKenna is a Minneapolis journalist and the author of “Superbug: The Fatal Menace of MRSA.”
