Mrsa

[legion]

I don't want to hijack the thread about Kevin's fight with MRSA.

Instead, I wanted to start a separate thread about the bacteria itself.

Specifically, has the over prescription of antibiotics led to the evolution of this drug-resistant bacteria?

[Noah930]

I think so. Overprescription has certainly hastened its spread. But people are people, and human contact has also made its spread evolve quicker.

[Nathans_Dad]

Look at it this way. We have been kicking the snot out of bacteria for over 60 years now. Bacteria are just like any other living thing, they will adapt to survive. Thus you have the emergence of drug-resistant bacteria like MRSA.

By the way, MRSA is getting a lot of press now but it has been a problem for at least the last 10 years or so.

It's an arms race with the bacteria, we have to develop new ways to kill them because they will adapt to make the old ones ineffective.

And to answer your question, yes, inappropriate antibiotic usage exposes the bacteria to the antibiotics more and thus allows them to gain more resistance unneccesarily. Both doctors and patients are to blame, think of how many times you might have gone to the doctor and wanted anti-biotics for a cold (which is viral and antibiotics have no effect on). If you haven't done it, I assure you lots of others have.

[legion]

Last time I was prescribed anti-biotics was 1993--when I was bit by a neighbor's dog. I still have scars...

[targa911S]

I think it's the health care industries dirty little secret. Although the death certificates don't say it, it killed both my elderly parents within 10 months of each other. I don't think they are telling us everything.

[peppy]

When my sons were in the ICN they had what the parents called the cootie room. I do not think they lost one child the whole time we were there.

[livi]

There is a very clear correlation between use of antibiotics and bacterial resistance toward it. It is a very nice, classic, example of Evolution in motion. Survival of the fittest. First, different types of bacteria have inherently different types of resistance. The sensitive types will die, leaving more life space to the resistant ones. Bacteria also have a phenomenal capacity for changing their protein synthesis, with random mutations producing even more resistant strains. Basically, the more antibiotics and particularly broad spectrum AB´s (kills several types of bacteria), the more the bacteria have to come up with ways to protect themselves. This is a fact for almost all kinds of bacteria, MRSA being just one, albeit numerous.

There is statistically a very close correlation between number of individuals treated with antibiotics and level of resistance.

In Sweden we are still lucky. We have had a very strict policy for decades, not to prescribe any AB´s if not really necessary. Hence we have still a very 'virgin' flora of bacteria. It is still often possible to treat outpatients with simple Penicillin for ear infections and pneumonia.

On the other hand, in many souther European countries, that has become almost impossible. They now need broad spectrum AB´s for most infections. This leading even more resistance, craving even broader antibiotics. It is a vicious circle.

[Tobra]

In a word, Yes.

For years, pedi docs(no offens meant Markus, sounds like you have a more rational approach in the land of the midnight sun) have written antibiotics when they knew the odds were 95% it was a viral problem and they would not help a bit.

Methicillin Resistant Staph Aureus is just that, resistant to methicillin(a hot rodded penicillin that is not used much any more) also resistant to a lot of other stuff. They are different ways bacteria defeat antibiotics, but if they are never exposed to an antibiotic, they are more likely to be sensitive to it. MRSA is mainly treated with Vancomycin, a drug only available intravenously, which is a lot more expensive than a pill.

In the recent past, Vancomycin(pretty cool name eh?), which is nasty stuff, was held in reserve and you had to satisfy certain requirements(MRSA or other rare infections that give the infectious disease specialists hard ons, a short list) before you could institute treatment with this drug and it was watched very closely.

Now, it is being used routinely as a prophylactic antibiotic prior to orthopedic surgery involving an implant. Starting to see more resistance. VRE(vanco resistant staph epidermidis, don't ask me why it is not VRSE) has been identified and I personally have been involved with a few cases. Seeing more VISA(S. Aureus with intermediate sensitivity to Vanco)

Here is something that will, or should, get your attention. A large percentage of people are colonized with MRSA in their nares(nostrils), not infected, but carrying it, a la Typhoid Mary. A bit more sunshine for your day; 10-15 years ago, the vast majority of MRSA cases were hospital aquired, it was unheard of for someone who was not a total train wreck hospital victim turned up with it, ie dialysis patient who used to be a heroin addict. Latest numbers I have seen(Sacramento area only), the majority of new MRSA infections are community aquired, which is a little terrifying to me, and I don't rattle easy.

[legion]

I think my dad picked up MRSA in his port before he died.

[masraum]

The crappy part is that for folks like me who haven't taken many antibiotics in our lives, we are probably still pretty susceptible to these new resistant strains. Hopefully, not having taken many, that means that we are better prepared to resist them possibly having a greater number or diversity of antibodies.

[pwd72s]

Way I see it, it's a mixed bag, reward/risk wise. Back in '85, I suffered a burst diverticuli. (Livi will probably agree here) According to the surgeon, I was lucky that some new broad spectrum antibiotics had just become available...otherwise I wouldn't be here to bug you guys in 2007...

Let me tell ya guys...there is nothing like living with a stoma for a few months to make you appreciate your A-hole. To this day, I try to avoid being far from a toilet...missing a chunk of big intestine will do that to a guy.

[livi]

I agree and I am happy you are still around to bug us newbies!

Every infection has a more or less correct treatment. In cases like yours no effort should be spared and the heaviest stuff used.

[Nathans_Dad]

Originally Posted by Tobra

VRE(vanco resistant staph epidermidis, don't ask me why it is not VRSE) ...

VRE stands for Vancomycin Resistant Enterococcus, there isn't a Vanc resistant staph epi as far as I know.

[Flatbutt1]

Originally Posted by masraum

The crappy part is that for folks like me who haven't taken many antibiotics in our lives, we are probably still pretty susceptible to these new resistant strains. Hopefully, not having taken many, that means that we are better prepared to resist them possibly having a greater number or diversity of antibodies.

I may not be reading your post correctly, but the resistance to ABs is not on your part but rather on the bugs'.

If the bug is resistant then it doesn't matter how often a patient has taken the drug. As I say, I may have mis-read your post.

[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.

[Noah930]

Originally Posted by Flatbutt1

I may not be reading your post correctly, but the resistance to ABs is not on your part but rather on the bugs'.

If the bug is resistant then it doesn't matter how often a patient has taken the drug. As I say, I may have mis-read your post.

But if antibiotics are given more frequently, then drug-resistance will evolve more quickly. By using antibiotics, we may be killing the susceptible bugs, but we're also naturally-selecting out the resistant ones. So, of the bacteria that are left behind (after we come swashbuckling through with antibiotics), a greater relative percentage of them are of the resistant type. If we're using antibiotics needlessly (i.e. to treat conditions that aren't caused by bacteria, or if the antibiotic selection doesn't match the bacterium strain responsible for whatever infection we're trying to treat), then we're offering no possible benefit to the patient, but only selecting out (and perpetuating) the resistant bugs already out there.

That's where physicians have a responsibility to the general population. Don't use antibiotics if there's not a proper indication for them. Because it can actually do harm to society, as an evolutionary whole. And as a patient, you've got to understand that if a doctor doesn't prescribe you an antibiotic (for a good reason), they may not be the useless clod you think they are.

[jyl]

So are there steps ordinary folk can do to reduce their risk of this MSRA?

[masraum]

Originally Posted by Flatbutt1

I may not be reading your post correctly, but the resistance to ABs is not on your part but rather on the bugs'.

If the bug is resistant then it doesn't matter how often a patient has taken the drug. As I say, I may have mis-read your post.

Right, that was my point. I haven't taken AB often, but that probably doesn't mean diddley if I get hit with something like MSRA because it's not me that it's resistant to it's the drugs. I do however suspect that because I haven't/don't take many AB or other drugs, that I may have a more diverse and strong set of antibodies than folks that take AB all the time, so I may actually be more resistant to some of these bugs. But that's just my uneducated supposition.

So basically, I haven't taken many AB and I'm still screwed.

[masraum]

Originally Posted by jyl

So are there steps ordinary folk can do to reduce their risk of this MSRA?

wash your hands

don't use needles that you find in alleys

don't have sex with women that you find in alleys

and live in a bubble.

[pwd72s]

Originally Posted by jyl

So are there steps ordinary folk can do to reduce their risk of this MSRA?

Yes! Conservatives are less susceptible than liberals...,