Heeding the MRSA warning

A confluence of events recently propelled the subject of drug resistance into the mainstream. Public health experts maintain that it should have been there all along.

The events are worthy of note for various reasons.

For starters, last month the Journal of the American Medical Association published a Centers for Disease Control and Prevention report estimating the incidence of invasive methicillin-resistant Staphylococcus aureus in the United States. The study was important because it represented the first such effort to quantify the burden of this infection, both hospital-acquired and community-acquired, on a national basis.

At just about the same time, news reports around the country were detailing outbreaks of MRSA on the local level. Some cases involved the deaths of young people infected with this illness. In others, school systems where students were found to have MRSA closed their doors for deep cleaning.

Many parents weren't aware of MRSA, and what they heard shocked and scared them. In the wake of these disturbing anecdotal reports, they took their children to doctors for skin cultures and for answers.

Meanwhile, the impact of the data further raised awareness, both among health professionals and in the mainstream. And for good reason. Based on 8,987 observed cases of MRSA and 1,598 in-hospital deaths among patients with MRSA, the CDC researchers estimated that 94,360 invasive MRSA infections occurred in the United States in 2005. In 18,650 of these cases, the infections were associated with death. An editorial appearing in the same issue of JAMA noted that if these projections proved accurate, the associated death tally would exceed the total number of U.S. deaths attributable to HIV/AIDS in that year.

For some people, especially those in the general population, this conclusion was a startling one. But many public health officials saw the early warning signs years ago. The emergence of MRSA -- both hospital-associated and community-associated -- is, they say, a result of the inappropriate use of antibiotics. Many maintain that the emergence of superbugs will continue -- it's the price paid for these past behaviors. They also say the messages now should serve as a wake-up call for both physicians and patients.

This public health imperative -- the problem of antibiotic resistance -- has long been a matter of concern to the American Medical Association. The organization supports efforts to educate health professionals and patients about the appropriate use of antibiotics, whether through organized medicine or the World Health Organization, at the hospital or office level, or in medical schools. The AMA also strongly urges physicians to talk to their patients about the problem at hand and the importance of complying with the prescribed regimen.

The tangible data provided by the CDC researchers highlight specific areas in which these themes should spur action now. For instance, the CDC data indicate that the majority of MRSA cases are associated with health care exposure. This finding is an important reminder for physicians and other health professionals. Because MRSA is spread through person-to-person contact, observance of infection-control practices and, of course, good hand hygiene can make a difference.

But the CDC researchers also offer chilling evidence that MRSA is no longer relegated to the hospital or health care setting. Clear strains have been established in the community, and community-acquired MRSA is a reality. Epidemiology shows that to date, most of these MRSA cases are noninvasive, rather than invasive. But the threat still must be taken seriously.

With that in mind, the AMA works to raise physician awareness of CA-MRSA and the most effective methods of treating it and controlling its spread. In September, for instance, the AMA collaborated with the CDC and the Infectious Diseases Society of America to produce a pocket guide to help facilitate outpatient management of skin and soft tissue infections in this new era of community-associated MRSA. More information about the guide is available online (link).

MRSA recently grabbed the headlines. But the lessons of public health make it clear that, because of selective pressure, superbugs will continue to emerge. The fact that MRSA is now in the spotlight offers physicians teachable moments to discuss with patients the appropriate use of antibiotics. It also offers doctors a reminder of the easy steps that they can take every day that can make inroads against the problem.