Superbug, The Fatal Menace of MRSA, by Mary McKenna. Free Press, N.Y. N.Y. 271 pp., 2010
Review by Wm Olkowski, PhD
What’s MRSA and Why is it Important?
Methicillin Resistant Staphylococcus aureus (MRSA) is a strain of the common bacteria we all carry on our skin and mucus membranes like those in the nose. Normally this commensal causes no problem but sometimes an infection develops that becomes very serious, cannot be treated with the commonly used antibiotics (AB’s) and can cause a horrible death.
AB resistance occurs when an infection is challenged repeatedly with an antibiotic. The AB kills off the susceptible bacteria leaving the resistant. A mutation is believed to be involved in developing resistance. As a result the species changes to one that cannot be killed by that AB. It is said to be resistant. There is now so much resistance to ABs a tragedy looms. And that’s the theme for this book.
The first big AB was penicillin. The AB methicillin was the next choice when people got resistant to penicillin. It’s a related substance hence the similarity in spelling, but very different in structure from penicillin and that was why it worked for so long. Penicillin was a wonder drug as it worked on a whole range of bacteria and saved millions of lives. Its very success caused its downfall, as the more it was used the faster resistance developed. And it was overused, for example, people were given this and other ABs when viruses were the cause and ABs don’t kill viruses.
Methicillin (first used in 1960) worked for a while. Then SA got resistant to it and these strains could not be controlled and an epidemic would ensue. Hospital stays got more complicated, longer and some people would die of what first would appear to be minor infections. Some of these deaths were horrible pus filled infections dissolving skin, muscles and bones.
As more doctors were unable to treat MRSA infections successfully the seriousness of this situation began to be appreciated. McKenna was a reporter who investigated a hospital epidemic of MRSA and then worked with the Kaiser Family Foundation making observations in ERs as part of a media fellowship program. In every city she found MRSA everywhere she looked. The range of infections ran from minor skin infections to gaping pus filled wounds in bones and muscles, and pneumonias that would kill. She started a blog, called “Superbug” for reporting on such cases and developing epidemics. This book documents her discoveries and is instructive in many ways.
It’s not just a Hospital Infection
At first MRSA was considered only a hospital acquired infection, but later different strains were found not associated with hospitals. In the early stages infections were noted in nurseries in hospitals, as new mothers would return after a few weeks with their infected babies, many of which died horrible deaths. Thus was born MRSA hospital infection epidemics. Even today MRSA is believed by many to be only a hospital infection.
Although MRSA strains from the community are very different from the hospital strains, the source of these community strains is unknown. They may be hospital strains that have established somewhere in the community and then mutated to appear different to the immune system and that is a big threat as MRSA, with its large arsenal of toxins is a terrible way of death.
One of the most important lessons from this phenomenon is the need and importance of detection and hand washing. Note that there is still no national surveillance system for reporting MRSA cases. The Dutch and other European health systems had such a system in place decades ago and have not experienced the same sort of epidemics we in the US have. The Dutch also cultured every hospital patient to detect MRSA strains upon entry to the hospital. In cases where no obvious infection was present but the organism was detected each patient was treated to remove such “colonized patients”. When every patient in the hospital is decolonized there is no epidemic.
Consequently each hospital afflicted with MRSA cases in our country had to go at detection and control with their own personnel and labs, a rather poor response to the suffering inflicted by this tragedy. One wonders why people persist in insisting on keeping health care in an industry whose goal is profit. Stupidities abound when ignorance masquerades as ideology. Do you notice that those who insist on how bad government is segregate out the military, the largest and most error prone part of government from their view of our political systems defects?
McKenna examines programs run by hospitals to detect and treat patients and their ability to contain these local epidemics. In one case she describes how a hospital put a nurse with sufficient authority to monitor compliance for hand washing by physicians and staff. The nurse documented that in too many cases compliance was less than 50%. Repeatedly the nurse found physicians going from patient to patient without washing their hands.
When compliance rose to 97% or more the epidemic was stopped and no further cases were noted. Fortunately a simple nose swab and culture detects these strains. But this costs a hospital not the insurance industry. Such fragmentation is unbelievable, especially when one knows it’s such a terrible process of treatment and when it fails a horrible death. So wash hands and make sure your doctor washes his/her hands before he touches you.
Next is a most amazing story of a cure. Decades ago I read a great book called “Man Adapting” by the famous microbiologist Rene Dubois. He proposed adding benign strains of SA to newborn babies so these inoculations would adapt and prevent infections by more damaging strains. At that time such a suggestion was an advanced idea. Now comes an example of just how such a procedure could work.
One of the hospitals tracking the source of the infective strain of MRSA traced it to a nursery where no baby had been found to be infected by a deadly MRSA strain then rampant in the hospital. Then after swabbing all the hundreds of staff one nurse in the nursery was found with a benign strain, labeled as 502a. Two investigators working to find useful treatments tried an experiment on a small family who had repeated MRSA infections and a few years of misery of unsuccessful but intermittent repeated infections. Apparently their MRSA strain would hide and then reinfect. So the two investigators set up an AB course to knock back the infection, treating with an AB mix for 12 days. After that they inoculated the family with 502a and the colonization was successful, as no reinfections occurred. But this experiment was never repeated as the two investigators separated and joined other institutions.
This story affirms an approach which Dubois suggested decades ago, but has never been adequately followed up.
So beware of hospital infections. Before admission look into their infection control systems and check on compliance for hand washing. It would help if hospitals were required to publish their infection rates and compliance with sanitation practices, but that seems just too much for a system running on profit.
Wishing MRSA on those who oppose a public healthcare system or even a public option would provide some incentive, albeit too late for prevention. But the decision makers in our congress don’t have to worry as they have a publically supported health care system which they denied the rest of us, even as an option.
“When will we ever learn?”