By now there’s a good chance you have been flipping through the morning paper as you sip your coffee and happened upon one of the frightening headlines about MRSA, an antibiotic-resistant bacterium that can cause a variety of serious infections. According to a study conducted by the Centers for Disease Control and Prevention (CDC) and published in the Journal of the American Medical Association (JAMA), more people died from MRSA in 2005 than from AIDS. Now doctors are concerned because not only is the previously recognized hospital strain of MRSA on the rise, there has been a tremendous increase in the incidence of community-associated MRSA (CA-MRSA). Are the facts getting overblown by the media to hold readers' attention, or should you be concerned too?
MRSA stands for methicillin-resistant Staphylococcus aureus, a type of staph infection that is resistant to methicillin and other common Beta-lactam antibiotics, including penicillin, amoxicillin and oxacillin. In general, Staph bacteria are very common, and can be found just about everywhere, says Gregory Moran, M.D., professor of medicine in the Department of Emergency Medicine and Division of Infectious Diseases at Olive View-UCLA Medical Center, Sylmar, Calif. These bacteria live on surfaces in our homes, and are also commonly found living on the skin and in the nose or throat. The CDC states that approximately 25-30 percent of the population is colonized (when bacteria are present, but do no harm) in the nose with staph bacteria; however, sometimes staph can cause an infection.
Most of these skin infections (which often look like a mosquito bite, boil or pimple with red, painful, swollen and/or hot skin) are minor and can even be treated without antimicrobials or antibacterials, but sometimes they can cause serious infections, such as surgical wound infections, pneumonia and, more rarely, bloodstream infections, says Richard P. Wenzel, M.D., chairman of the Department of Internal Medicine at Virginia Commonwealth University, Richmond, Va. MRSA strains in particular (which account for one-percent of Staph colonization) are resistant to the kinds of antibiotics that have traditionally been used to treat Staph infections, which then gives them a damaging advantage.
But while the healthcare variety, which often spreads during medical procedures such as dialysis, surgery or catheter or feeding tube insertion, has been causing increasing problems for over two decades, Wenzel says, it is the aggressive emergence of CA-MRSA in the last decade that is causing real concern. "This was something that we never saw at all until the early 2000's, and now it has become the most common cause of skin infections in the U.S.," Moran says. In fact, 60-70-percent of the MRSA cases doctors are now dealing with, are the community-acquired variety, adds Wenzel. While these infections are typically mild in nature, the CDC has reported clusters of CA-MRSA skin infections among athletes, military recruits and prisoners, and the average age of those who are infected is far younger than those who typically acquire MRSA in a healthcare setting – 23 as compared to 68, according to a study published in JAMA.
But while this unprecedented shift in the environment for MRSA incidence is cause for increased awareness and commitment to proper hygiene, Moran feels that the age-factor has been somewhat misrepresented in the media, due in part to a few high-profile cases in which healthy kids got serious MRSA infections at school.
"But in truth, the majority of people who die from MRSA infections are old, sick in the hospital, and would have probably died shortly from something else if the MRSA infection hadn't killed them first," Moran says. "The probability of a young, healthy person dying from MRSA is very low."
Regardless, the best prescription for good health is avoidance. MRSA is spread by direct contact, both in the hospital and out of the hospital, so the best way to avoid getting it or spreading it is by frequent hand washing, says Moran. Make sure to thoroughly clean any shared equipment (towels, sports equipment, etc.), and lube up with lotion daily to avoid the dry, cracked skin that could allow MRSA to enter. If you have a cut or skin infection, keep it covered and wash your hands frequently. Be especially careful in body shaving or waxing and piercing situations as well, warns Wenzel, as they can lead to small cuts and abrasions that open the door to infection. And if you are a patient in the hospital, you should feel entirely comfortable with asking staff to wash their hands before they touch you.
"Although all hospital personnel know we need to wash our hands frequently, in practice people sometimes forget," says Moran. "A simple question, 'Did you wash your hands' before they touch you may help remind them."
If people proactively step up on their hygiene, collectively they can prevent the headlines from getting any worse.
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