by WatchfulEye » Mon 05 Nov 2007, 15:06:53
MRSA is endemic in most parts of the western world: USA, Europe, Australasia, etc.
In the UK, it's rampant in hospitals - but these days, it's increasingly common in the general population. It's estimated that as many as 40% of all hospital MRSA infections weren't actually hospital acquired, but were actually brought in when the patient attended, and only became apparent because of their weakened state.
The other problem is that MRSA is a big problem for GPs - it's very difficult to treat without injectable antibiotics, and this means that people with MRSA infections may need admission to hospital because community treatments may not be optimal.
One of the problems is that Staphylococcus aureus is a particularly nasty bug, but a prevalent one (everybody on earth carries it somewhere on their body), but more importantly seems to be able to evolve relatively rapidly to gain resistance to antibiotics. Back in the 1950s when penicillin was brand new, it had 100% effectiveness against S. aureus. However, just 10 years later, penicillin was worthless for S. aureus - virtually all S. aureus was resistant to penicillin, instead a variant of penicillin, methicillin, was required.
Methicillin and its derivatives, have been the mainstay of treatment for S. aureus for 40 years. But in the last 10-15 years, we've seen methicillin resistant S. aureus (MRSA) beginning to appear, even despite continually updated advise to physicians on antibiotic use.
The problem is that there are relatively few antibiotics that act on MRSA - and resistance to those is now starting to be seen. Nowhere near as common as MRSA, but a significant problem in specialist hospitals where patients have severely weakened immune systems (e.g. blood disorders units).
However, MRSA is not the only troublesome resistant infection. PRSP (penicillin resistant Streptococcus pneumoniae) is increasingly common in the US and in some European countries (not the UK). E.g. it is endemic in Spain - this is thought to be because the population have general access to antibiotics over the counter at pharmacies, and consequently antibiotic usage in the Spanish population is several times higher than, for example, the UK. It is occasionally seen in the UK, usually in returning travellers, and is a huge problem as PRSP pneumonia is an absolute bear to treat.
Clostridium difficile infection is another classically, hospital acquired infection, that is on the rise. C. diff is a highly contagious infection causing profuse diarrhoea. C. diff is a ubiquitous organism, but normally it is kept in check by the bodies 'friendly bacteria'. Kill the friendly bacteria with an excessive dose of a powerful antibiotic (like the ones needed for MRSA or PRSP) and suddenly, the body is a sitting duck for C. diff - because it is not at all responsive to antibiotics for the above organisms. As it's due to loss of friendly bacteria, it's the powerful 'best' antibiotics that really let it rip - the number one culprit behind C. diff is Cipro - When you absolutely, positively want to wipe out all your natural defences, accept no substitutes.
It spreads like wildfire in hospitals and care homes too. It's airborne as well as spread by direct contact - so if someone uses the toilet, microscopic droplets may be ejected during the flush. They land on the seat, dry, turn to dust and are then spread in the air. It's also impervious to alcohol, so scrupulous hygiene with hot soapy water, as well as strict isolation with negative pressure ventilation, and thorough disinfection of all surfaces with powerful disinfectants (not alcohol) is the only way to manage it in hospitals. Unfortunately, certainly in the UK, isolation rooms are few and far between, and many hospitals may not even have individual negative pressure ventilation systems for their isolation rooms.