There’s lots of recent hype about infections with MRSA (methicillin resistant staphylococcus aureus). The media uses that hype to sell ad space, but for the medical profession it’s old news. Here’s a reality check: Many of us are infected with MRSA already and don’t know it. Blame your friends, blame your family, but it ain’t always the doctor’s fault.
As a medical student many years ago, one of my tasks was doing cultures on my patients. Lots of germs would grow, some bad, some common and innocuous. Out of curiosity one morning at Harborview Hospital in Seattle, I decided to culture the floor of the nurses station. Picking an area near the baseboard where I thought germs would likely be lurking, I did a swab and submitted it to the microbiology lab. Expecting to find a veritable menagerie of single-celled killer bacteria, I was surprised a few days later to find that the only things growing were 3 colonies of common staph. Is the hospital really a bastion of infection? Or is the housekeeping staff that good?
In the hopes of reducing some of the hoopla regarding MRSA, here’s a bit of background. (References are available for each of the items in the list below list, but this is “common knowledge” among physicians:
• Methicillin is a drug that commonly treats germs such as staph.
• Staph is short for a group of germs called staphylococci. These are common germs that in certain situations can cause infection. Methicillin and its derivatives historically have cured such infections.
• Germs can develop resistance to antibiotics.
• Methicillin doesn’t kill MRSA. This germ is “resistant.”
• Resistance develops when germs are repeatedly exposed to antibiotics. Resistant germs are naturally selected and survive.
• Over prescribing antibiotics by physicians has been a major cause of drug resistance. Physician education in this area has been ongoing for decades.
• Over demanding antibiotics by patients, i.e., the expectation that every cold, flu, bronchitis, ear infection, sinusitis, etc., needs an antibiotic, is equally causative. Patient education in this area is relatively recent.
• Staph have been around for millennia, MRSA have been around for at least the past 20 years.
• MRSA became common about 10 years ago. The Puget Sound region was one of the first areas of the country to experience an upsurge.
• MRSA is now the most common cause of skin abscesses (boils) seen by physicians.
• There are at least 3 common antibiotics besides methicillin used to treat MRSA: sulfa (commonly trimethoprim/sulfamethoxazole, aka Bactrim or Septra), doxycycline (a long acting drug similar to tetracycline) and clindamycin (aka Cleocin, a drug in the “mycin” class like erythromycin.) All are effective. Sulfa is probably the most effective currently.
• The mainstay of treating skin infections of any cause, especially when they have developed into boils/abscesses, remains incision and drainage (I & D). Just “letting the pus out” cures most of them.
• Healthy people carry MRSA (and many other bad germs) around on their skin, hands and in their nostrils all the time.
• Germs can be passed on from a healthy person to another who then develops an infection.
• Some MRSA infections do progress to major infectious illness with resultant loss of life or limb. This is extremely uncommon in comparison to the prevalence of MRSA itself.
• MRSA is one cause of the problem often referred to as “flesh eating bacteria”. Regular staph germs and streptococci (germs similar to those that cause strep throat) are also causes.
• Hand washing by everyone is vitally important in preventing spread of not just MRSA but all potential infections. More germs are spread by hand contact than by coughing or sneezing.
• Checking for MRSA in patients and clinicians, especially in hospitals and specifically in pre-surgical patients, is not cost-effective. The same precautions to prevent hospital spread of infection or post-operative infection should be taken for all patients, as there are many germs besides MRSA that can wreak havoc, and a large percentage of healthy people carry MRSA in their body, especially their nose.
• Treating a healthy patient who is found to have MRSA will cause other germs to develop resistance to other antibiotics, thereby magnifying the problem of drug resistance.
Bottom Line: Each situation needs to be managed thoughtfully with good science. Lots of people are suing doctors because they got an infection, often in the hospital. Many infection suits are defensible. Doctors and hospitals often win, and rightly so.
About Chuck Pilcher
Chuck provides expert witness review and testimony in medical malpractice cases related to the fields of emergency medicine, urgent care, EMS and general inpatient and outpatient hospital practice.
He has 35 years or experience as an emergency physician, most of those years as Medical Director of a now 50,000 visit per year suburban Emergency Department. Board certified in both Emergency Medicine and Family Medicine, he has has helped both plaintiff and defense attorneys with malpractice litigation for over 25 years. He is proud that attorneys on both sides have found his assistance valuable, and is especially honored when he has been retained by opposing counsel in a subsequent case following a deposition or trial. His CV can be found here.