Experts Weigh In On Continued Rise Of MRSA

By Brian McCurdy, Associate Editor

   Methicillin resistant Staph aureus (MRSA) infections are on the rise around the world as infections pass between hospitals and the community. The infections are not only associated with morbidity and mortality but also pose a high financial cost to patients and the healthcare profession, according to experts. What is causing the rise in antibiotic resistance and what steps should DPMs take to prevent and combat infection?    The incidence of MRSA infection has increased 40 percent in five years and one-third of pneumonia among patients on ventilators is caused by MRSA, noted Richard Wunderink, MD, during a recent conference call on the subject. He notes the infection is common in hospitals as it can be spread between patients on the hands of caregivers. Dr. Wunderink says it can also be carried over into the community, partially due to the increasing treatment of outpatients.     “As the frequency in the hospitals increase, the spillover into the community becomes much more common,” says Dr. Wunderink, who practices pulmonology and critical care medicine at Northwestern Memorial Hospital in Chicago.    There are many costs resulting from antibiotic resistance since patients with resistance have longer hospital stays, according to Michael Niederman, MD, Chairman of the Department of Medicine at Winthrop University Hospital in Mineola, N.Y. He says MRSA also leads to higher costs for patients because hospital staff tends not to see infected patients as often as others. Dr. Niederman notes the efficacy of some drugs such as vancomycin and linezolid.    One recent study presented at the annual meeting of the Infectious Diseases Society of America (IDSA) found that linezolid had a higher cure rate and was more cost-effective than vancomycin in treating MRSA. According to the study of over 700 patients who were admitted to the hospital for proven or suspected MRSA, the average total cost for patients treated with linezolid was $4,187 whereas the average cost for patients treated with vancomycin was $5,058.    Dr. Niederman acknowledges some new drugs are in development but says their effectiveness remains to be seen.     “The patients we treat today are sicker than ever before. Antibiotic resistance is going to be here for a long time to come,” says Dr. Niederman.

Is The Main Cause Overuse Of Antibiotics?

   Warren Joseph, DPM, says part of the reason for the increased MRSA prevalence is the “incredible overuse” of antibiotics both inside and outside of hospitals. Many patients who present to doctors with minor ailments will receive prescriptions for antibiotics, and many of these are broad-spectrum drugs that may potentiate the development of resistant gram-positive organisms, according to Dr. Joseph, a Fellow of the Infectious Diseases Society of America. He adds that some patients also hang on to leftover antibiotics and take them when they think the drugs will help. Dr. Joseph points out that other patients may stop taking antibiotics too soon after viral symptoms decrease.    Patients also receive unnecessary antibiotics in hospitals, notes Dr. Joseph. He adds that lapses in infection control procedures, procedures sometimes as basic as doctors washing their hands in between patients, can contribute to the increased incidence of infection as well. However, Dr. Joseph points out that most strains of MRSA found in hospitals were actually community-acquired strains as opposed to nosocomial strains.    David G. Armstrong, DPM, MSc, PhD, concurs that inappropriate use of antibiotics among humans contributes to the increase in MRSA infections but also links the phenomenon to the natural evolution of microbes and a “dramatic increase” in utilizing antibiotics as promoters of growth in the livestock industry.

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