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Scary News

by Rob on October 19, 2007 · Comments

in American Medicine

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Everyone has heard about the teen who died of MRSA infection in Virginia.  This has been a big news item and merits a huge amount of concern.  When I was training, the biggest concern about MRSA was in hospitalized patients, and it was not an invasive infection.

What we are seeing is the direct effect of antibiotic resistance on the innocent bystander.  I suspect this is the first of many such reports, unfortunately, and would strongly suggest policy makers to adopt an aggressive approach to solving this problem.

The public response has been quite impressive.  I did a Google search for this post and came across an amazing number of headlines, including:

  • Mum catches MRSA from her baby
  • Dog catches infection from syringe
  • 5-Year-Old Hospitalized For Drug-Resistant Infection
  • Abington student diagnosed with impetigo
  • You Can Protect Yourself & Your Family From MRSA
  • Forget global warming, stop MRSA terrorism and get rich
  • One Case of MRSA Staph Is Confirmed in Wetzel
  • Counties find MRSA costs are plaguing prisons

The bottom line?  The fear factor has hit about resistant bacteria.  Even cases of impetigo are making the newspaper (albeit from MRSA).  The disease is real and the concern is getting higher.

We diagnose MRSA regularly in our office now, with entire families being infected with skin abscesses caused by the bacteria.  Thankfully, they have all responded to drainage and use of an old antibiotic (TMP/SMZ) to treat.

The newest news is even scarier to me:

ROCHESTER, N.Y., Oct. 16 — A strain of pneumococcus resistant to all of the antibiotics approved for use in children has emerged in the wake of the widespread use of the heptavalent pneumococcal vaccine, researchers here said.

The pathogen — serotype 19A of Streptococcus pneumoniae — was isolated from nine children in a single pediatric practice here over a three-year period, according to Michael Pichichero, M.D., and Janet Casey, M.D., of the University of Rochester.

The 19A serotype is not included in the current pneumococcal vaccine, and has previously been reported to have caused disease among Native Alaskan children, they noted in the Oct. 17 issue of the Journal of the American Medical Association.

But the pathogens seen in Alaska were not multi-drug resistant, Drs. Pichichero and Casey said. (See: Pneumococcal Disease Rebounding in Alaskan Native Children)

In the nine cases they found — two in the respiratory season from September 2003 through June 2004, two in 2004-2005 season, and five in 2005-2006 season — the first four required a tympanostomy tube insertion after a series of unsuccessful antibiotic therapies, including high-dose amoxicillin (Amoxil), amoxicillin-clavulanate (Augmentin), and ceftriaxone (Rocephin).

from Medpage

Here are my thoughts on this whole situation:

  • I think the public’s getting scared may help doctors to get scared.  This panic may not be completely justified (reporting every case of MRSA in the newspaper), but overall the problem with resistant bacteria is scary.
  • People want to place this at the feet of the doctors over-using antibiotics.  While this certainly may have sped up this development, it would have taken perfect compliance by every doctor everywhere to avoid this.  It is simply in the nature of organisms to adapt to their environment.  This is just expected.
  • The development of the "blockbuster drug" mentality by Pharma has basically dried up the antibiotic pipeline (so I am told).  We have no children’s antibiotics marketed to us by drug companies.  It is far more profitable to have a lipid or diabetes drug that will be used perpetually for years than it is a medication to use for, at most, 2 weeks.  How does that need to be addressed?  I am not sure.  Either the idea of blockbuster drugs needs to be lost, or there needs to be more profit in antibiotics.  
  • The government needs to get scared.  More people are dying from MRSA than HIV.  It is a serious problem.  It could happen to anybody.
  • Immunizations will help a lot.  The development of HIB and Pneumococcal vaccines have greatly reduced the burden of childhood infectious disease.  
  • In the future, we will have "home autoclaves."

Okay, that last one may not come true (with the possible exception of Michael Jackson), but the reality is that we may be entering a "post-antibiotic age."  New medications may be developed, but we will once again have to fight this foe on a different level.  Who knows, this may be the next pandemic.

Scary stuff.

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  • I think that good old basic hygiene will do the most good. Washing our hands, our bodies, our gym clothing (and not a week later), our sheets (weekly), etc. Thanks for putting this out there.
  • It remains to be seen how this can be effectively dealt with.
    We send so many people home colonized for bad organisms, and not only is there no way to make sure people don't spread it to others in the family, I don't think we really know how to disinfect a person and their home. The cleaning of these schools in Virginia was a nice PR thing, but probably will have little effect -- we blame the environment when it's the people that are the problem.

    We know that once someone is colonized they stay that way for a long time. It would be nice to have some way of negating this, like colonizing them with competing "good" bacteria, but this isn't feasible as far as we know.

    All we're left with is the idea of universal universal precautions.
  • Sarah
    A question for you: in a wilderness EMT course, I learned that the best thing to do for an infected cut/scrape/boil (in the wilderness) was to put a hot wet compress on it (like hot-tub hot, not skin-burning hot) repeatedly. The rationale was that the sustained heat would kill the bacteria without killing the surrounding flesh. My partner and I have done this many times with success. Is MRSA such a tough little bacteria that this doesn't work? I can't understand the proliferation of superficial skin infections. And is MRSA not only super-resistant to antibiotics, but also super-resistant to our immune systems?
  • We here at Autoclaves-R-Us have been working closely with celebrity spokesperson, Michael Jackson on the launch of our new home sterilization unit to coincide with his soon to be released single "Heat It."
  • The danger vis a vis Michael is that he might climb into the autoclave instead of his oxygen tent...


    As to MRSA and pneumococcus: it is indeed scary, and one would assume will only get worse. I'd think that even in that perfect world of perfect physician compliance, it would still have happened, if later.
  • Dan
    I have to disagree with you. Abusing and flooding the market with the latest antibiotics is the problem here. Not too mention, that any new drug that hits the market must make money right away. Therefore, we can't reserve some of the wide-spectrum drugs for serious bacterial infections and use our vintage drugs for acute infections.

    Doctor's are lazy! My wife today presented with the possibility of strep throat. The doctor didn't even run any tests and just placed here on the newest (most expensive) wide spectrum antibiotic on the market. It is this type of irresponsibility that is creating such virulent strands.
  • Very good post. I've just sent you news from my locale.
  • Rob
    Dan: There are no latest broad-spectrum antibiotics being released. The last new antibiotic I had was Ketek, which was pulled off of the market about 2 years ago. I have been (as have a large portion of physicians) practicing in the antibiotic-resistant age, always starting with front-line antibiotics like Amoxil or Doxycycline.

    There is certainly a part physicians took in over-prescribing. There is also the part of the demanding patient asking for an antibiotic (see previous posts). But the bottom line is that antibiotic resistance is nothing new. It started happening right after they started giving the first antibiotic. Adaptation is a normal phenomenon that happens despite the best intentions of people.
  • A
    not all antibiotic-demanding patients are bad -- I'm more concerned with the patient (demanding or just prescribed by MD) who doesn't finish the course of antibiotics.

    take, for instance, a male relative of mine. played football and other sports since he was 10, and never had a problem (could have to do with his mom's affinity for bleach and other cleansers). now at a military academy, has had recurring cases of cellulitis and was most recently diagnosed with MRSA. Interestingly, the academy does their laundry -- but because of cost concerns, they don't use detergent. they just throw everyone's clothes in the same loads. And they are wondering why the infection is spreading like wildfire there??
  • GingerB
    The government is too busy with the possibility of a pandemic flu!

    I work at a Federal site and have been bombarded with at least six different messages this fall -urging me to have a flu plan, urging me to cough into my sleeve instead of my hand, urging me to get a flu shot..... The halls are also full of this poster with this dumb looking chicken inside a red NOT sign.

    And I listen! My plan is not to get it or to work at home if I do. I got a flu shot and bothered my husband and children to get theirs, and have been washing my hands more. I guess they think the shot will keep regular flu cases from being confused with avian flu?

    I imagine in a few months I'll be bombarded with messages reminding me that antibiotics don't do anything for viral problems, and not to expect an antibiotic....

    Sometimes they're slow to get started but once they start preaching they don't give up.
  • Good post Rob! The whole thing is unnerving to say the least. I had no idea it was this rampant. Makes me afraid to have a procedure or surgery. Whitecoat rant has a post about the over use of antibiotics too, although he doesn't mention MRSA.

    Oh well...I guess all we can do is our best and then give the rest to God. I do mean take all the precautions, do the research and do everything we can to eradicate this or at least slow it down. The give it to God part was for me or anyone feeling fearful. Even though doing our best, sometimes things are out of our hands and we still have to do what we have to do and live life.
  • Rob
    I don't disagree with the paranoia. I actually think it is good for there to actually be a reaction. Let's hope the plan is laid to take this thing on. Ginger, while I don't think the flu paranoia is wrong, I do think that a potential crisis does get trumped by a real one. This problem will not get better, it will not get any better, just worse. That is a sure thing.
  • Hey there Dr. Rob,

    Really, more people dying of MRSA than HIV? That, if true, is amazing and scary.

    Yep, the "fear factor" headlines are surely there... how much is this really a problem we should be worrying about -- out in suburbia? I am not a medical professional -- is this the same as the "pneumonia vaccine" that I am assuming has granted me magical protection for a whole decade?
  • Good discussion on antibiotic abuse. Blame the demanding patient or the lazy doctor is the same thing; ignoring that they are both equally to blame.

    I never try to convince Jane Blame off the street not to take the antibiotic, it's clear she did not come for my opinion. She's dysfunctional to begin with. I'll take it as a confidence builder and work on her next time.

    But Joan Regular always listens and we can have a reasonable discussion of risks and probabilities.

    Maybe if patients made the effort to find a primary care physician they trusted, physicians could be a little firmer in their counsel?

    Maybe it's a multifactorial issue?
  • medrecgal
    Yikes!! I read that statistic on another medblog recently (about more people dying from MRSA than from HIV) and almost had a coronary, since that nasty critter got me 9 days in hospital, a trip to surgery, and a lengthy course of antibiotics last spring. No wonder my doctors freaked out a bit when they realized it was MRSA. But I was an informed patient who knew enough to take ALL of the antibiotics (at least a month's worth, actually, if I remember right) once I got out. I'm just glad I didn't realize how awful it could be (i.e., didn't know it could actually be lethal) when I was actually tangling with it. Guess the lesson in all of it was that you don't mess around with the likes of MRSA. Now if I could stop being so paranoid about washing everything...
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