nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Wednesday, October 17, 2007

RESISTANT STAPH SPREADING! YIKES!

Note: If you don’t want to get this medical stuff, a quick reply won’t hurt my feelings (got your flu shot yet?).

Before we “scare ourselves to death” (as John Stossel says), it’s worth noting that this infectious agent, and its resistance, was a problem back when I was in medical school. We thought doom was just around the corner THEN, because methicillin was the toughest bug-fighter we had. To say that we now have data on how often MRSA infection occurs does not necessarily mean that it’s growing rapidly in incidence…it could also mean that we just did not have data, until now, that it’s always been with us to this extent (the “one data point” problem). We also have multiple generations of new drugs since I was in school: they have their day, and then fade, as resistance develops.

Note, it is primarily a problem in “healthcare settings”: I’ve always told people that hospitals are where the sick people are, and…so are their germs. Unless you want to sterilize hospitals with poison gas continuously, this will always be the case. Every hospital and clinic gets “inoculated” with new pathogens every day.

Sixteen thousand deaths is a lot, but needs to be put in context. In a bad year for influenza, we see up to 100,000 deaths. Cancer is down, heart disease is down—so, what’s going to take their place? MRSA is spread by contact, so watching students holding a vigil outside the school, holding hands (Lydia noticed this on TV), makes me wonder if the organizers brought along enough hand sanitizer for the participants.

I don’t disagree that this data should be a “call to action”. But, put it on the list with the other million things we should act on…and make your choice. Sanitation and infection control can be improved in some hospitals, but the only other choice we’ve had for the last five decades is to try to stay ahead of resistance by producing new agents. With the expense of developing new drugs skyrocketing ($1-2B), and the time it takes for approval growing (10-15 years), we may lose the race at some point: this is a Government Regulation problem, and I doubt more regulation will solve it.

Need a scapegoat? (it’s the American Way): All the people that went to the doctor insisting on a penicillin shot for a cold/sorethroat/flu forty years ago, and the doctors that gave in, and administered it (some of the most pissed off patients I’ve ever treated were the ones I told didn’t need an antibiotic). There is less of this today, but the damage is done, and we do need antibiotics.

Heavy pressure on a bacterial population leads to mutation…basic biology.

Drug-resistant staph infections may be spreading, study indicates. The CBS Evening News (10/16, lead story, 3:20, Couric) reported, "We're beginning tonight with a threat to our health that doctors say could be at least as deadly as AIDS: A staph infection resistant to antibiotics." NBC Nightly News (10/16, lead story, 2:20, Williams) added, "Tonight, a teenager in Virginia is dead. His family says [that it is] the result of a staph infection that resists antibiotics." Currently, "21 schools are closed because of it, and across this country,...awareness of this danger is now on the rise because it can be a scary, indiscriminate and silent killer, and it's often discovered when it's too late." The New York Times (10/17, A14, Sack) notes, "Nearly 19,000 people died in the United States in 2005 after being infected with virulent drug-resistant bacteria that have spread rampantly through hospitals and nursing homes," according to a study published in today's issue of the Journal of the American Medical Association. The study was performed by CDC researchers, and is "the most thorough study of methicillin-resistant Staphylococcus aureus' (MRSA) prevalence ever conducted." The CDC estimates that "MRSA, which was first isolated in the United States in 1968, causes 10 percent to 20 percent of all infections acquired in healthcare settings." The bacterium is "[r]esistant to a number of front-line antibiotics," and "can cause infections of surgical sites, the urinary tract, the bloodstream, and lungs." Because the infection is treated by delivering other drugs intravenously, health officials are concerned "that overuse will breed further resistance."

D

JAMES J DOUGHERTY, Brig Gen, USAF (Ret)

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