By Maryn McKenna
The Virginian-Pilot
Last month, public health researchers reported that six Canadians — one in Ontario, five in Saskatchewan — were infected with methicillin-resistant Staphylococcus aureus, or MRSA, drug-resistant staph.
That may not sound unusual, but there was something odd about their illnesses: They were caused by a strain that during the past few years has spread through livestock and farm workers in Europe and North America. But the Canadians made sick by the bacterium had no contact with animals or farming .
Last week, epidemiologists at Johns Hopkins Hospital revealed that 61 percent of the children in their pediatric intensive-care unit — kids enduring advanced cancers, organ transplants and tricky infusions of stem cells — were carrying MRSA, but not the usual hospital strains. Instead, the kids had a strain that predominates outside health care and is more transmissible, more virulent and harder to detect than the hospital variety.
Reports like these are warning bells, and there have been many of them ringing, mostly unheard, for a decade now. Collectively they signal that drug-resistant staph has changed in startling and threatening ways, and that our control efforts have not kept up.
Most people think of MRSA as a health care infection, and it is: It is a risk for patients who are elderly or immune-compromised, for those who are taking many antibiotics or are pierced by lines and catheters that breach the immune protection of their skin.
But MRSA is not just an irritant, and it is far from occasional. It is a consistent global epidemic, stretching over more than 50 years. And though it began in hospitals, it has now moved into the everyday world, where it has found a niche in industrial-scale farming, in the close quarters of gyms and prisons and in professional and school sports. It is an everyday complaint in emergency rooms nationwide, and it is the spark for infections that can destroy a child’s lungs before an ambulance can get to his door.
Its comprehensive assault has gone largely unnoticed, because some of MRSA’s victims are patients in nursing homes, some are kids seen in pediatric offices, and some are pets or livestock animals that are cared for by veterinarians .
If you follow the breadcrumbs of MRSA’s emergence through the many silos of medicine, here is what you find: almost 19,000 deaths a year in the United States from the bacterium’s most invasive forms. Almost 370,000 hospitalizations. At least 7 million visits, probably more, to doctors’ offices and emergency rooms. And a bill for additional health care spending that is in the billions, with estimates as high as $8 billion in a year.
MRSA managed its advance in part because we were not paying attention, and in part because a bacterium that produces a new generation every 20 minutes will always outpace pharmaceutical companies that take a decade, on average, to bring a new drug to market.
But it also escaped our control because we created the conditions that allowed it to. Patients expect prescriptions when they’re ill, and doctors have been too quick to prescribe antibiotics even when they might not be necessary.
More than anything, the crisis was bred of our craving for cheap protein, which led to industrial-scale farms that consume 70 percent of the antibiotics used in the U.S. each year. We failed to realize in time that antibiotic-resistant bacteria would leave those farms not only in the animals that received the drugs, but in their manure, in groundwater and in dust on the wind.
In hospitals now, infectious disease physicians talk somberly about a return to the era before antibiotics, to the possibility that there will be infections for which there are no longer any drugs that work.
We can walk MRSA back from this crisis if we take actions that other countries have implemented. We can call on health care to exert more leadership in combating infections in hospitals. We can tell primary care, and veterinary care, to use antibiotics more conservatively. Most of all, we can begin paying attention to antibiotic resistance, before it advances to a point at which no control strategies will succeed.
Maryn McKenna is a Minneapolis journalist and the author of “Superbug: The Fatal Menace of MRSA.” This column appeared earlier in the Los Angeles Times.
Copyright 2010 Landmark Communications, Inc.
All Rights Reserved