[Noah930]

Not too long ago, during my residency, it was not entirely common to have an MRSA patient. Not rare. But certainly the percentage of patients who came down with it as an infection were in the 10% range. A couple years ago, during my fellowship in Boston, I'd have to say that over 80% of patients that came in with abscesses of the hand (which I got called to take care of) had MRSA. Usually, these were drug addict types (or fight bite types). Not boy scouts, by any stretch of the imagination. But it does show the huge swing in antibiotic resistance in just a few years.

There's no conspiracy theory. There's no "medicine's dirty little secret." It's a bacterium. It's fairly prevalent. With time, antibiotic use, easy communicability between people (health care providers, patients, their families, etc), Staph aureus has become increasingly resistant to the common antibiotics we use against it. For healthy people, it's still not an issue, as your immune system will keep it at bay. But for those who become infected by it (i.e. by a cut, burn, or other portal of entry) it has become increasingly difficult to treat. The mainstay of treatment is now Vancomycin. It realistically only comes as an IV form (as the oral pill has very poor absorption, so it's useless except for treating very specific colonic infections like C. diff). That's a problem both of cost (as people either have to be hospitalized or get special home nursing arrangements) and logistics. There are a couple other drugs that seem to treat MRSA, at least on culture sensitivities that come back from the micro lab. Bactrim and Rifampin come to mind. But Bactrim, well, sucks against MRSA in the real world, despite what the micro lab says. And I've never seen anyone try to treat MRSA with Rifampin. Don't know why. I've never asked the ID guys why we don't try it.

The problem is that there are times when even Vanco is not effective against MRSA. Then, our last resort drug is something called Linezolid (or Zyvox). That comes as both pill and IV solution. But it's expensive, and (at least for my former patient population which comprised significantly of inner city not-so-employed or -sober people) sometimes very difficult to obtain. Well, the hospital would suck it up and pay for the IV stuff. But at some point, you have to release a patient, and there would be few funds available to pay for their oral Linezolid.

Massachusetts General Hospital had a couple reports of Linezolid-resistant bugs. That was from a few years ago, so it may be even worse, now.