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    Saturday, November 03, 2007

    A Word About MRSA: I've been fielding a lot of doorknob questions about MRSA lately. (Doorknob questions= questions thrown out just as my hand reaches the doorknob to leave the room.) Little wonder. It's been in the news again and again, and has even prompted the closing of schools and cancelling of football games. Despite what some editorialists say, it is being framed as a threat to our children. Here's an example of the typical coverage:

    A 16-year-old Springfield High School junior remained in serious condition Friday in the intensive-care unit of Akron Children's Hospital with a drug-resistant staph infection. Michael Forester of Lakemore was hospitalized Oct. 24 and was to undergo surgery Friday, said his mother, Mary Baxter. "The more prayers I can get, the better," Baxter said Friday at the hospital.

    On Wednesday, Springfield School Superintendent William Stauffer, in a letter sent to parents, acknowledged that a student had become ill and was admitted to the hospital. The superintendent said rumors that the student has a contagious disease that puts other students at risk and that the high school has an ongoing problem with staph infections are not true. Stauffer could not be reached for comment Friday.

    What is this MRSA? A better question might be "What is SA"? The "SA" in MRSA is Staphylococcus aureus, a bacteria that resides in our nasal passages and skin. That is its habitat. Normally, it causes us no problem, but if conditions are right, it can make us quite ill. It's often the culprit behind boils and styes and cellulitis and urinary tract infections. It can also cause more serious infections such as pneumonia (as in the case of the young man in the linked to article above), meningitis, sepsis, endocartditis, and osteomyelitis. It is one of the most common causes of sepsis. Penicillin conquered Staph infections for a little while, but the bacteria acquired resistance within a few years of the antibiotic's introduction. When penicillin became widely used in the community, the population of Staph aureus living in noses and on skin shifted toward those containing an enzyme that could cut the betalactam ring on penicillin, rendering it ineffective. New antibiotics were developed to get around this. One of those antibiotics was methicillin, which brings us to the "MR" part of "MRSA".

    We don't use methicillin any longer. We use drugs like Augmentin instead. But, when we say that a Staph aureus infection is "methicillin resistant" we mean that it's resistant to all penicillins, even those that were developed to get around the betalactam-eating defenses of the Staph aureus population. This doesn't mean that it's resistant to all antibiotics, however, just the ones that we typically use for a Staph infections. In the hospital, we often use vancomycin for MRSA infections. In the outpatient setting, we use drugs like Bactrim and clindamycin. In most cases, the infections respond nicely to these drugs. There is, however, concern that the bacteria may one day develop resistance to these, too, as we use them more to treat the growing resistant population of Staph.

    So here are the take home points about MRSA:

    1) It isn't running amok in our schools like the blob or killer tomatoes. It's living on our skin and nasal passages just as it always has before it developed resistance to penicillin and its cousins.

    2) One of the reasons bacteria acquire resistance is because we expose them to antibiotics when we don't need to. Don't insist on an antibiotic for every runny nose, even if the snot is yellow. And don't insist on one of the special antibiotics for MRSA for every pimple or pustule or red scratch. If we overuse our remaining effective antibiotics, we'll only end up with a population of Staph aureus that is resistant to those, too.

    3) Don't freak out if you or your child develops a skin infection. Most staph infections are easily treatable. Even most MRSA infections are easily treatable.

    4) When you read the newspaper, always remember that they lean to the dramatic in all things. It makes for more entertaining reading.

    posted by Sydney on 11/03/2007 07:14:00 PM 2 comments


    great article

    By Anonymous Anonymous, at 5:20 AM  

    Was there this much news coverage 40 years ago about "PRSA"? Of course not. There is much more competition now among news organizations to put out the biggest eye-catching story. They don't realize how much hysteria they generate, or perhaps they do. The most disappointing aspect of this to me have been the TV news docs who have only perpetuated the entire overreaction.

    By Anonymous Anonymous, at 8:45 PM  

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