It’s been around for a very long time, but the germ with a ridiculously long name, methicillin-resistant Staphylococcus aureus, or MRSA, is finally getting the attention it deserves. We’ve known about the threat of antibiotic resistant “superbugs” at least since 1994 when Laurie Garrett’s book, “The Coming Plague: Newly Emerging Diseases in a World Out of Balance” drew raves. It was compared to Rachel Carson’s “Silent Spring,” which was generally credited with eliminating the use of the pesticide DDT and sparking the environmental movement in the early ’70s.
Still, it would be decades before doctors stopped prescribing antibiotics for viral infections such as flu and ear infections in children. And antibiotics routinely were used in commercially raised poultry and beef cattle, not to cure disease, but to increase weight gain. Combined with inappropriate use of antibiotics and careless disposal of unused medications, resistant strains developed.
Garrett’s effort won awards but didn’t attract that much notice outside medical and scientific circles. But even I knew then that the bug you picked up in a hospital was more likely to kill you than whatever you had gone there for in the first place.
Now a study of hospitals in the Chicago area has led Illinois to become the first state to order pre-admission testing of all high-risk patients and isolation of those found to carry the resistant staph germ. Pennsylvania and New Jersey passed similar measures this year.
Doctors, however, have not welcomed the new rule. Testing and isolation would be too costly, they said, preferring to focus on more diligent hand washing by hospital staff. Simple and cheap, but virtually impossible to enforce.
Doctors and nurses can spread the germs from staph-infected patients to others simply by not washing their hands carefully enough. And medical devices used in procedures can spread contamination among patients on dialysis and those recovering from surgery.
Government reports estimate MRSA infects more than 90,000 Americans each year and kills nearly 19,000. The U.S. Centers for Disease Control and Prevention reports 1.7 million patients develop various infections while hospitalized and almost 100,000 of them die. MRSA is believed to account for only10 percent or so. While the CDC considers MRSA testing as an option in combating infections, it also encourages other methods such as more judicious use of antibiotics, hand washing and use of gloves, gowns and masks.
The Journal of the American Medical Association published a chart that breaks down the cause of drug-resistant staph infections based on data from July 2004 to Dec. 2005 showing 26.6 percent as hospital onset; 58.4 percent as post-health care within one year; only 13.7 percent were non-health care related and 1.3 percent were of unknown origin.
Meanwhile, some hospitals and pharmacies are making a concerted effort to educate the public about safe disposal of medications. They have an unusual ally in this effort, the U.S. Fish and Wildlife Service. It seems unused drugs flushed into the waste stream are adversely affecting the fauna. Hormones in waterways are producing transgender fish. Male smallmouth bass have begun developing immature egg cells; other species show decreased testosterone production and altered head morphology downstream from a cattle feedlot.
Contaminants found in creeks and streams include everything from hormones, Warfarin and over the counter medications to, that’s right, antibiotics. Whether it’s plain old penicillin or Keflex, when flushed, they release large amounts of the compound at one time into the sewer system and that increases the emergence of antibiotic resistant bacteria. The report didn’t say whether drugs flushed after traveling through the human digestive system remain potent enough to cause fish deformities.
The APhA and Fish and Wildlife have issued new guidelines, among them: Do not flush unused medications. The Food and Drug Administration disagrees, at least for drugs that may be abused. (Oxycontin comes to mind.) We are now told to crush solid medications or dissolve them in water (also liquid compounds) and mix with kitty litter, coffee grounds or sawdust (anything that absorbs well and smells yucky enough to deter pets and children), then place in sealed plastic bags before tossing in trash. Remove and destroy all identifying personal information from bottles. Check local regulations for collection sites or hazardous waste facilities, or ask your pharmacist. Many will take back outdated or unused medications for safe disposal.
Do it for the fish, for the kids and pets. And for birds that flock around landfills. And, of course, for Grandma, who could wind up in hospital someday, at the mercy of superbugs.