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Can't blame MRSA on illegal immigrants

That's not a rumor you want to start, but I heard Laura Ingraham mention it right after talking about the TB guy who's made a number of flights legally from Mexico into the U.S. A whole alphabet soup of government agencies have dropped the ball on this one, and it's not an illegal immigrant issue.

Neither is MRSA (what I heard: as an aside she asked where these germs were coming from right after talking about the TB infected Mexican . . . like we can't grow our own!). It's a problem which started in the 1970s with hospitals overusing antibiotics, patients having shorter stays, and the staph bug moving on out to the community. In 1998, the CDC reported on the problem with nosocomial infections (infections that originally preyed on the weakest and sickest in hospitals)

By the late 1980s and early 1990s, several different classes of antimicrobial drugs effective against gram-negative bacilli provided a brief respite. During this time, methicillin-resistant S. aureus (MRSA) and vancomycin-resistant enterococci (VRE) emerged, signaling the return of the "blue bugs." In 1990 to 1996, the three most common gram-positive pathogens—S. aureus, coagulase-negative staphylococci, and enterococci—accounted for 34% of nosocomial infections, and the four most common gram-negative pathogens—Escherichia coli, P. aeruginosa, Enterobacter spp., and Klebsiella pneumoniae—accounted for 32%

The most recently updated MRSA page at CDC was done this week--the earlier one was from 2005, but the recent concern apparently caused them to revise it.

Methicillin-resistant Staphylococcus Aureus (MRSA) is a type of staph that is resistant to certain antibiotics. These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin and amoxicillin. Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities (such as nursing homes and dialysis centers) who have weakened immune systems (see healthcare-associated MRSA).

MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.

The most recent guidelines run to 219 pages, but to sum it up, WASH YOUR HANDS, PEOPLE, and don't let a medical staff person touch you until they do. "Improved hand hygiene practices have been associated with a sustained decrease in the incidence of MRSA and VRE infections primarily in the ICU (p. 49)"

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I shouldn't be surprised, but I was

Medical staff need special training to learn to use alcohol hand disinfectants properly. Who knew?

There was an alarming story in the WSJ this morning about antibiotic resistant super bugs (Henry Masur, President of Infectious Diseases Society of America). He said that annually nearly 2 million U.S. patients acquire infections in the hospital and nearly 1 in 10 die, and more than 70% of those infections are resistant to at least one of the drugs used to treat them. We have so over regulated big pharm and the market is so limited, that research on new antibiotics is stalled. In the past 15 years FDA has approved approximately the same number of new antiviral medications that target HIV as it has antibiotics to treat all bacterial infections combined. Yet, thousands and thousands die of resistant strains of bacteria. It's market forces and length of time to get approved. Many, many people with HIV, but limited number in the groups affected by all the different bacteria. Also, there is no political lobby or Hollywood movie stars putting on benefits for the rest of us who develop a raging infection in the hospital.

We're losing more people to this than to HIV. What good will it do the gay guy if you save him from his past only to have him die of a bug that's resistant to antibiotics?

Anyway, back to the hand rubs. I searched Medline for "antibiotics AND resistance" and got something like 35,000 hits, so I reentered the search adding hospitals, and eventually I found this little gem: "Introducing alcohol-based hand rub for hand hygiene: the critical need for training." Infect Control Hosp Epidemiol. 2007; 28(1):50-4.

RESULTS: At baseline, only 31% of Health Care Workers (HCW) used proper technique, yielding a low reducation factor (RF) of 1.4 log(10) colony-forming units (cfu) bacterial count. Training improved HCW compliance to 74% and increased the RF to 2.2 log(10) cfu bacterial count, an increase of almost 50% (P<.001). Several factors, such as applying the proper amount of hand rub, were significantly associated with the increased RF. CONCLUSION: These results demonstrate that education on the proper technique for using hand rub, as outlined in European Norm 1500 (EN 1500), can significantly increase the degree of bacterial killing.

Well, what do you know! Makes me think of kindergarten when we were taught how to wash our hands. Is that still taught in public schools?

Bad bugs need drugs campaign