SIMPLY HEALTH: Bad Bugs, Drugs and MRSA

posted 11/03/2008
Colds and respiratory illnesses are more frequent this time of year, and many people ask for antibiotics hoping to "catch it early". The huge majority of these infections are viral and do not respond to antibiotics. It might seem like the antibiotic worked, but it usually coincides with when your symptoms were going to get better anyway. So instead of curing your illness, you are giving the bacteria in your body another opportunity to develop resistance to that drug. With dozens of frequently overused antibiotics available nowadays, the stage has been set for "superbugs" like MRSA (Methicillin Resistant Staph Aureus).

Bacteria have been with mankind for millennia. Antibiotics have been around for less than a hundred years and for all the good they have accomplished, they are also triggering worrisome changes in the world of bacteria. Penicillin was developed in 1928 and sulfa antibiotics in the early 1930s.

Bacterial resistance started developing a mere twenty years later and by the 1970s, "super bugs" like MRSA evolved demonstrating resistance to multiple kinds of antibiotics. At first these infections were confined to extremely ill patients who were given multiple antibiotics in hospitals. Then, about five years ago, MRSA started showing up in the community among healthy children and adults. The incidence has rapidly risen since.

It is estimated that there are over 90,000 deaths per year in the U.S. due to MRSA. That is more deaths than due to HIV-AIDS. Most of these deaths occur in elderly people, the very young, those with some compromise of their immune system, or debilitated by chronic illness. However in the last year or two, there has been a lethal pairing of influenza and MRSA pneumonia. Young healthy children and teens are often those that succumb to this duo, going from well to mortally ill within four days. Getting a flu shot protects against this deadly combo.

What is MRSA?

Staph bacteria resistant to multiple antibiotics
Secretes a toxin that kills normal tissue
Starts with a small "spider bite" appearance
Rapidly forms abscess requiring drainage
If invasive, may cause life-threatening disease
Easily spread among household contacts
Commonly found in schools, sports teams
Healthy persons may carry and spread the bacteria from the nose.

Why is this bug so nasty? Infection often starts out on the skin, looking like an exuberant reaction to a spider bite. (MRSA is not caused by insect bites) Within a few days, there is a raging abscess usually requiring drainage to resolve. These staph bacteria produce a toxin that causes necrosis or death of the surrounding tissues. Sometimes, the bacteria become invasive and enter the lungs causing life threatening pneumonia, or they may enter the bloodstream infecting the bone, blood and heart. The death rate from these invasive infections is twenty percent.

How common is it? Sixty percent of skin infections and abscesses seen in the emergency room are caused by MRSA. Many family practice offices see several patients a day with abscessed infections. In the intensive care unit, if a staph infection developed, the likelihood of it being a MRSA infection in 1974 was two percent, in 1995 it was 22 percent, and by 2004 the rate was up to 64 percent.

The bacteria are spread from person to person via handshake, touching objects or using towels of infected people. Some individuals are carriers of MRSA with the bacteria living in the nostrils, not causing disease, but acting as a reservoir of bacteria to infect others with an innocent touch. It is easily spread among household contacts, schoolchildren, those playing contact sports, in dormitories, nursing homes and other group living situations.

Some communities are doing outreach in the schools to educate how to prevent the spread of the bacteria among children and athletes. Hand washing with soap and water continues to be the cornerstone of prevention. Waterless antiseptic cleaners are another option. Disposable paper towels are safer than community use of hand towels. A dilute bleach solution (1 Tbsp to 1 qt. water) or disinfecting wipes can be used to keep home and workplace surfaces free of the bacteria.

How to Protect Yourself from MRSA

Wash your hands frequently
Use your own pen at check-out counters
Wipe grocery cart handle with disinfectant
Only take antibiotics when appropriate
Bathe daily
Keep fingernails trimmed short
Don't share towels, clothing, or personal items
Launder sheets and towels regularly

MRSA can be difficult to eradicate and it is common to have recurrent skin abscesses. People can be carriers for years. For excellent information on "Living with MRSA" developed by the Tacoma-Pierce County Health Department see www.tpchd.org, go to the top ten most viewed pages and select MRSA.

Research into non-drug treatment of MRSA is also underway. A paint that releases titanium dioxide when exposed to fluorescent lights may someday help keep bacteria counts down in hospitals. A green dye currently being tested in wounds, gives off a toxic molecule that when activated with infrared light, disables the bacteria and stops infection. These measures are under study but may well replace the role of antibiotics to control MRSA in the near future. For now though, hand washing, hygiene and judicious use of antibiotics are a must.

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