"Superbug" — what you need to know about MRSA

By Carol M. Ostrom
Seattle Times health reporter

The head of the federal Centers for Disease Control and Prevention calls MRSA the "cockroach of bacteria." It's omnipresent, tough and adaptable.

This fall, methicillin-resistant Staphylococcus aureus suddenly went from a festering public-health issue to the top of the national news on word that it's worse than previously thought.

Many people — and many media outlets — started seeing it as a much bigger menace than a simple roach.

It became "the superbug," and the tales of its incredible power have featured people fighting for their lives after getting what they thought was a simple little "spider bite."

But what is MRSA, anyway? How afraid should you really be?

Last month, a report in the Journal of the American Medical Association estimated that in 2005, some 94,000 people were infected by the most serious form of MRSA infections, and one in five died.

Since then, public-health officials have been singing out of both sides of their mouths.

On one hand, they want to reassure people: Like many germs, MRSA is common. Many of us carry it around on our skin and in our noses, and it lives on surfaces from athletic gear to fabric. Outside the hospital, it's not hard to avoid, but if you get it, you'll likely just get a treatable skin infection.

On the other hand, the public-health gurus want to sound an alarm. They warn that MRSA is a symptom of a larger danger: the great number of germs worldwide becoming increasingly resistant to antibiotics.

"The prospect that effective antibiotics may not be available to treat seriously ill patients in the near future is real," says Dr. Jeff Duchin, communicable-diseases chief for Public Health — Seattle & King County.

So what do you really need to know and do?

Q: What is MRSA?

A: Germs, also known as bacteria, have been around forever. Staphylococcus aureus, also called "staph," was first identified in 1880 by a Scottish surgeon poking around in pus oozing from hospital patients. After antibiotics were discovered in 1928, staph was largely beaten back. But S. aureus evolved to survive the oldest type of antibiotics, called the penicillin-methicillin class. Methicillin-resistant Staphylococcus aureus (MRSA) was first identified in 1968.

Q: Why is it such a big deal all of a sudden?

A: Actually, the problem isn't new. Although most people don't get serious infections, staph has always been a "bad bug," says Duchin.

MRSA is even badder. Researchers are discovering that MRSA is surprisingly widespread and becoming tougher. It's a classic lesson in Darwinian evolution: As the weaker germs are killed by antibiotics, the strongest, most resistant ones survive and multiply, particularly when antibiotics are used improperly.

In 2000, a new strain of MRSA "took off like wildfire," according to Dr. Yuan-Po Tu, a MRSA tracker at the Everett Clinic. Before, most MRSA infections were caused by a strain mostly contracted in hospitals. This new, "community acquired" strain can be even more virulent, potentially causing severe illnesses even in healthy people.

Q: What does MRSA do?

A: Most of the time, community-acquired MRSA (sometimes shortened to CA-MRSA) causes skin and soft-tissue infections that can be treated with other readily available antibiotics. But if not properly treated, the bug can work its way into the body and is tough to get out.

The vast majority of serious, "invasive" MRSA infections and deaths occur in hospitalized patients who are suffering from other serious diseases, have lowered immunity or have recently undergone surgery.

Q: How is it spread?

A: MRSA likes to travel. Not by air, but by hand, towel, clothes, bedding and gym equipment.

Unlike the flu virus, MRSA isn't caught by breathing it in — there has to be actual skin-to-germ contact. The CDC says high-risk groups include children, athletes, military recruits, prisoners and other population groups who live in crowded or impoverished living conditions.

Q: So MRSA is inevitable?

A: No, because there are easy ways of avoiding it. Alcohol-based hand cleaner works. So does good, old-fashioned hand-washing.

And so does a bit of courage.

According to Duchin, not all health-care providers are religious about washing their hands according to guidelines. In the hospital, that means before and after seeing you. So you need to ask them: "Did you wash your hands?"

Don't be afraid of insulting them. "There are only two acceptable answers: 'Thank you for reminding me,' and 'I just did it, but thank you for asking,' " says Marcia Patrick, infection-control director for MultiCare Health System in King and Pierce counties.

Q: What else can I do?

A: Besides frequent hand-cleaning, the best defenses are avoiding skin-to-skin contact with other people's skin infections and learning how to care for wounds, Duchin says. And get a flu shot, he says, because MRSA-caused pneumonia can follow the flu.

The CDC also recommends:

• Showering immediately after exercise.

• Avoiding sharing items such as towels and razors.

• Using a barrier such as a towel or clothing between your skin and shared exercise equipment.

• Ensuring that surfaces are cleaned regularly at the public places you often go.

Any surfaces known to be contaminated by any type of staph, including MRSA, should be disinfected, but generally "extraordinary disinfection measures" or closures of schools or workplaces aren't necessary, Duchin says.

Q: Should I worry about cuts and scrapes?

A: Not any more than you already should: Keep them clean and covered. Watch for what Duchin calls the cardinal signs of infection: redness, warmth, swelling and pain, or a fever. If you have a bump or boil, surrounded by a lot of redness, don't assume it's a "spider bite." It probably isn't. Think MRSA, and make sure your doctor does, too.

Q: What about my kids?

A: "All kids are getting scratches and scrapes all the time, and the vast majority aren't getting infected" when kept clean and covered, Duchin says. "The world is full of bugs; that's why we have immune systems and vaccines."

But consider asking your day-care center, school or gym to install alcohol-gel dispensers and posters on what they are for, suggests medical writer Naida Grunden, who has written about a Pennsylvania hospital's successful efforts to reduce MRSA.

Q: If I'm going into the hospital, should I get a MRSA test?

A: There are different views on whether this simple test — a nose swab, basically — is worthwhile. Grunden says yes. "Could save your life," she says. But neither Duchin nor the CDC recommends that step because the germs are so common and it's not clear why some people get sick and others don't.

Q: OK, I'm careful. Can I quit worrying?

A: "It's important to understand the real threat posed by antibiotic-resistant bacteria, but it's not necessary to panic," says Duchin.

Even so, don't be lulled into a false sense of security, he warns, or MRSA and other germs could soon outstrip our ability to kill them.

MRSA in the NEWS

Estimates based on a US-wide extrapolation of data collected from a number of hospital sites and recently published by the Center of Disease Control (CDC) in JAMA (Klevens, R.M., et al., Invasive Methicillin Resistant Staphylococcus aureus Infections in the United States. JAMA, 2007. 298(15): p. 1763-1771) put the number of annual MRSA associated fatalities at more than 18,000. This makes MRSA infections a burden comparable to the one caused by AIDS.

The involvement of the CDC gave the report a semi-official character and massive media attention in the US. The increased public concern bears the danger of scientifically unfounded hyperactivity and even panic reactions. Besides the widely publicized school closures there have been reports of discrimination against suspected MRSA patients by employers, co-workers, and even family members.

Outside the US and the UK the issue is less prominent. However, media prominence does not correlate with the severity of the problem. In a report by the DGKH (German society for hospital hygiene) “Krank im Krankenhaus” PDF published in cooperation with Alliance Health Insurance, the number of MRSA associated fatalities was estimated at up to 50'000 (in a sample population of about 450 million).

This corresponds to a significantly higher prevalence compared to the 18'000 for the US (a population of about 300 million). Although the report was mentioned in a number of news articles there was no obvious effect on public opinion or politics.

However, there is reason to believe that the serious concerns surrounding MRSA will eventually be contained. There are number of promising treatments on the way. More importantly since MRSA is a problem of hygiene rather than therapy on a larger scale, hospitals are rapidly changing their practices. Much has been learned and continues to be learned form virtually MRSA free zones such as the Netherlands. In addition low-cost, reliable, and efficient methods for mass screening such as BCM® MRSA ELF® are made available.

One should not forget that the human costs resulting from other hygiene related microbial pandemics are much greater. One example is Shigella spp. which according to WHO estimates kills 1.6 million people every year. As in the case of MRSA such tragedy could be almost entirely prevented if proper practice and low-cost robust methods of screening were implemented.