MRSA was first identified in 1961, only two years after the 1959 development of the antibiotic methicillin. [1.] It was first noticed in hospitals where antibiotics were routinely over-utilized. In response, hospitals mandated "rigorous hygiene" through isolation precautions, frequent hand washing, and use of antibacterial sterilization procedures. These precautions had no noticeable effect except to increase the incidence of these infections. These rigorous control measures did nothing to contain MRSA, which spread from hospitals to other treatment facilities, including nursing homes and tertiary care facilities.
The CDC estimates that invasive disease due to MRSA has doubled since 2001 [2.] and in the ICU they have tripled. [3.] MRSA colonizes at least 1% of the global population and is increasing due to continued routine and indiscriminate antibiotic use. In 2004 two thirds of the isolates of S aureus from intensive care units were MRSA. [4.] In 2005 alone there were 368,600 U.S. hospital stays associated with MRSA [5.], 100,000 cases of invasive MRSA and 18,650 deaths due to MRSA. [6.]
Vancomycin, long considered the antibiotic of last resort in the treatment of MRSA is now becoming increasingly ineffective. There are now cases of Vancomycin resistant MRSA known as VRSA, hVISA, and VISA depending upon the degree of resistance. [7.] Reported rates of hVISA vary from 2% to 76%. [8.]
MRSA is just one example of the many species of bacteria that have adapted to and survived antibiotic use. MRSA has become resistant to every antibiotic ever developed to fight it. Other antibiotic resistant bacteria that have emerged include: multi-drug resistant tuberculosis, clostridium difficile, vancomycin-resistant enterococcus, and multi-drug resistant streptococcus pneumoniae. [9.] These organisms are the "tip of the iceberg" representing a few examples of the effects of increasing antibiotic use throughout the world. [10.] Bacteria have recently been isolated from the soil, which actually utilize antibiotics as food. [11.]
The Crisis
Resistance is a normal and predictable outcome from antibiotics usage. Its emergence is dependent upon the frequency and duration of antibiotic use. Continuous employment of antibiotics will result in even more resistance. Newer antibiotics temporarily forestall this process, but do not halt or reverse it.
Antibiotic resistant organisms, including MRSA, are widely dispersed around the globe. They exist in every niche, including institutional living environments, hospitals, homes, and schools throughout the world. This unfortunate reality is directly correlated with irresponsible and overuse use of antibiotics.
The more antibiotics are used to fight infections, including MRSA, the more aggressive this organism has become. The newest strains of community associated MRSA (or CA-MRSA) are even more destructive and invasive than the original hospital acquired mutations that were originally isolated. [12.]
The medical profession continues to deny that there is a problem. [13.] Medical authorities are unrelenting in their assertion that there is nothing wrong with the antibiotic-based system of medicine [14.], but choose to blame "a few antibiotic overusers" as the sole cause for the current crisis. More "prudent" use of antibiotics is the proposed solution.
This position is specious. The crisis of antibiotic-resistant bacteria plagues our entire world. It is the result, not of exceptional cases, but widespread reliance on antibiotics everywhere. The antibiotic approach to infectious disease, agriculture, and hygiene has proven to be a time bomb with serious repercussions in health and the environment. Overuse of antibiotics has accelerated this trend, but even "prudent" use of these agents would have the same result.
The use of antibiotics as a continuing strategy to fight the spread of MRSA or any other organism that is not immediately life threatening is not only ineffective, but it is fundamentally short-sighted and irresponsible.
Next week: Parts 7 and 8 of an eight-part series: Complimentary and Alternative Medicine and Conclusion
References:
[1.] Barber M, Methicillin-Resistant Staphylococci, Journal of Clinical Pathology 1, 1963:308-11.
[2.] Klevens RM, Morrison MA, Nadle J, et al; Active Bacterial Core surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA, 2007; 298:1763-1771.
[3.] Zoler ML, Resistant Infections Tripled in ICUs over Decade, Infectious Diseases, Internal Medicine News, 2004, Sept 15:51.
[4.] US Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System. Campaign to prevent antimicrobial resistance. www.cdc.gov/drugresistance/healthcare/ha/HASlideSet.ppt
[5.] Elixhauser A, Steiner C, Infections with Methicillin-Resistant Staphylococcus Aureus (MRSA) in U.S. Hospitals, 1993–2005, Statistical Brief #35, Healthcare Cost and Utilization Project, http://www.hcup-us.ahrq.gov/reports/statbriefs/sb35.jsp July 2007.
[6.] Klevens RM, Morrison MA, et al, Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA, 2007 Oct 17; 298(15): 1803-4.
[7.] Ochiai K, et al, Studies on Inheritance of Drug Resistance between Shigella Strains and Escherichia Coli Strains, Nihon Iji Shimpo, 1866, 1960:45-50.
[8.] Schwaber MJ, Wright SB, Carmeli Y, et al. Clinical implications of varying degrees of vancomycin susceptibility in methicillin-resistant Staphylococcus aureus bacteremia. Emerging Infectious Diseases, 2003; 9:657-664.
[9.] Pichichero ME, Casey JR, Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children. JAMA, Oct 17, 2007; 2981772-1778.
[10.] Tomaselli KP, New CDC report, recent events add to MRSA's infamy, American Medical News, November 12, 2007:33.
[11.] New York Times, Science Times, April 8, 2008.
[12.] Williams SC, Superbug: What makes one bacterium so deadly, Science News Online, Nov 17, 2007;Vol. 172,No. 20.
[13.] Dixon BK, Anti-MRSA Program Succeeds Across Institutions, Internal Medicine News, Dec 1, 2007:33.
[14.] Harrison CJ, In Fight Against MRSA, Panic is Unwarranted, Opinion, Internal Medicine News, Jan 1, 2008:9.
Ronald D. Whitmont, M.D., is a board-certified internist with a private practice of classical homeopathy in New York.
Dr. Whitmont's Web site
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