The New Health Dialogue

We’ve written before about the threat hospital-acquired infections such as MRSA pose to patients, and the burden they add to our health care system. Maryn McKenna's new book, SUPERBUG: The Fatal Menace of MRSA, examines where the deadly infection came from, what it is and where it’s going. Unless we take action now, McKenna explains in her highly-readable book, the future looks pretty grim.  (McKenna has guest blogged for us, and we link to her blog when we need some Super-expertise about Superbugs.)

Methicillin-resistant Staphylococcus aureus is a particularly nasty strain of staph, a fairly common bacteria. Staph can cause all kinds of infections, from the serious (like pneumonia or sepsis) to the more benign (like pimples or boils). Staph infections can typically be treated with a round of antibiotics. MRSA is different. The deadly bug is part of -- quite literally -- a new breed of bacterium that resists almost all antibiotics. MRSA got its name from methicillin because it happens to be a pretty powerful and broad reaching antibiotic. Just not powerful enough.

MRSA is typically thought of as a hospital problem, as most strains come from and linger in hospitals and other health care settings. But McKenna’s book delves into the new threat of MRSA strains arising in communities. Approximately four million Americans are colonized by MRSA, meaning that they’re carrying the bug around but aren’t sick. Community-acquired MRSA is driving up health care costs (by billions) and claiming the lives and livelihoods of more and more patients. MRSA kills 19,000 and hospitalizes 500,000 Americans every year. In her book, McKenna skillfully balances the MRSA science and the human tragedy. (The descriptions of MRSA’s effects on the body -- rotting away bones, liquefying lung tissue and eroding skin -- are not for the faint of heart.)

MRSA has health care professionals locked in a spiral of escalation. Every time we make a stronger antibiotic, and MRSA eventually outsmarts it. The new drug wipes out most of the MRSA bugs -- except for the few that are tough enough to survive. Then those hardy bugs reproduce, creating a new breed of bug that is resistant to our new, stronger antibiotic. And then the process starts all over again. It is not a new problem, although we were slow to wake up to it. As McKenna notes, Sir Alexander Fleming warned of the potential dangers of widespread antibiotic use and misuse as far back as 1945, when he accepted his Nobel Prize for the discovery of penicillin. By the 1950s, new strains of staph that were resistant to standard doses of penicillin -- or any doses of penicillin -- were breaking out in hospitals across the world.

How can we fight MRSA? Detection and hygiene are key components. McKenna describes many examples of individuals unexpectedly contracting MRSA and she also pays close attention to outbreaks in three settings: athletics, prisons, and livestock agriculture. MRSA infections have run rampant in teams of high school, college, and pro athletes, where teammates spend large amounts of time together in enclosed spaces like gyms and locker rooms. Public health and disease control experts successfully fought back and eliminated MRSA in many of these environments by putting athletes through a disciplined regime of showers, antibacterial soap, and preemptive screening, along with disinfecting and cleansing the locker rooms and shared spaces. Crowded prisons have also been a MRSA breeding ground, and these infections can grow very serious before inmates access timely care.

Yet detection and hygiene aren’t always enough. MRSA has emerged in the food supply, and McKenna calls for far more care with the use and distribution of antibiotics in the livestock industry. She writes about a strain of MRSA that showed the ability to jump from animals (in this case, pigs) to humans. In the U.S. livestock industry, pre-dosing animals with antibiotics and packing them in tightly is a common practice. That may keep prices low, but it provides an ideal breeding ground for antibiotic-resistant organisms.

Health reform will provide incentives for all hospitals to fight infections by making data on health care associated infections like MRSA publicly available. Reform will also reduce Medicare and eliminate Medicaid reimbursement for HAIs.

What’s next? Dr. Robert Daum, chief of pediatric infectious diseases at the University of Chicago Medical Center, told McKenna that the next logical step -- and maybe the best chance we have at finally gaining ground in the MRSA vs. antibiotics battle -- may be to make a vaccine. That has its own challenges.

All told, the book is a great read. McKenna's exploration of MRSA is interesting and accessible, and honestly, a little scary. We use the word "unsustainable" around here a lot to describe the health care status quo without reform. "Unsustainable" is also a great word to describe our response to MRSA to date. The MRSA epidemic is worsening and requires decisive action. Now if you'll excuse us, we think there's a bottle of hand sanitizer around here somewhere...