Kjell Benson, MD, Washakie Medical Center, Worland Wyo.

The national news has been full of reports of bacteria that are resistant to antibiotics.  You may have been hearing stories around the country about MRSA, or Methicillin resistant staphylococcus aureus.  And you may be wondering what all this means for you and for the community.  I would like to address those concerns today and lay out the plans that Washakie Medical Center has made to combat the problem.

Question: What role does bacteria play in our health?

Answer: Bacteria are a constant presence around us, and in our environment.  For the most part they are normal and healthy.  Staph is a common bacterium, one that lives all around us all the time in the natural environment.  At any one time, 50 percent of people have staph on their skin.  Without bacteria, our gut would not digest food properly, without good bacteria on our skin we would be more likely to have infections.  Sometimes a certain bacterium invades an area of the body where it should not, such as the lung, and creates an infection.  When this happens it is often helpful to take an antibiotic to control the infection.

Question: How does someone develop bacteria that is resistant to antibiotics?

Answer: Sometimes bacteria develop resistance to particular antibiotics.  Any particular dose of antibiotics kills the majority of the bacteria in the body, but not all of them.  When a few bacteria survive they are more likely to have mutated and developed a gene that helps then survive the antibiotic.  Sometimes these genes make an enzyme to disable an antibiotic molecule; sometimes they make a pump that removes the antibiotic from inside the bacteria.  The more we use antibiotics, the more likely we are to harbor resistant ones.  In fact, people who have taken an antibiotic anytime in the last 12 months are 2.5 times more likely to be colonized with MRSA than those who have not. 

Penicillin was first antibiotic developed in the 1940s and due to overuse many bacteria quickly developed resistance.  Variations on the penicillin drug were created in order to make it more powerful and fight the resistance.  There are now four generations of penicillin drugs, however bacterial resistance has developed along with the drugs.  When we say “MRSA”, we mean a bacterium that has developed resistance to the fourth generation of penicillin, the last best penicillin we have.  We still have a few drugs that will kill MRSA, but they are more expensive, more toxic to the person and often can only by given through our veins, not by mouth.  The more we have to use these drugs, the more likely we will end up infected with bacteria that is completely resistant, that cannot be fought with any known medication.

Question: How can we avoid developing or spreading MRSA?

Answer: The most important action is limiting antibiotic use only to conditions where it is truly necessary.  Colds, upper respiratory infections and bronchitis do not respond to antibiotics.  When taken for these conditions, antibiotics only promote resistance and MRSA.  Be sure to question your doctor about whether antibiotics are required when he or she prescribes them for you, and do not ask for antibiotics when they are not indicated. 

The other important action in fighting MRSA is preventing its spread.  Staph and MRSA can colonize, or live, in the back of the nose without causing disease or any symptoms.  In other words, you can harbor MRSA and not even know it.  MRSA can then be spread to other sites on your or someone else’s body and cause a serious infection.  The first step is knowledge and Washakie Medical Center has decided to screen all patients with a nasal swab to check for MRSA when they are admitted.  This will enable us to track where people are getting infected, institute contact precautions to avoid spreading it to other patients, and have more appropriate antibiotic selections when drugs are needed. 

MRSA can also spread in the community setting, outside of the hospital.  You may have heard of some schools or athletic teams that have had outbreaks.  First it is important to remember that staph itself is a common bacterium and we will never eliminate it from the environment.  Infections with staph do occasionally crop up, for example on wrestlers skin with impetigo.  When the staph bacteria involved are resistant to antibiotics, impetigo can become MRSA impetigo.  It will be more difficult to treat, but is not fundamentally any more dangerous than regular impetigo.  Standard precautions should be taken so that students and athletes do not spread skin infections to each other, including hand washing and not sharing towels, soaps or toiletries.  Hysteria and panic should be avoided; MRSA is just another combatant in the age old struggle between humans and bacteria.

Question: What are hospitals doing to stop the spread of MRSA?

Answer: If you are a patient, you will have your nose swabbed on admission.  If the nasal swab is positive for MRSA you will be placed in Contact Precautions to avoid transmission to other patients.  If you are visiting, you will be asked to wear gloves and instructed on good hand-washing techniques or use of Alcohol Antiseptic Gel.  Sometimes you may wear a gown or even a mask if instructed by the nursing staff.  If an important outbreak occurs, public health authorities will inform us if there are any additional precautions that need to be taken. 

In the meantime, wash your hands frequently, cough into your sleeve, avoid touching your mouth or face with your hands and you will likely avoid MRSA as well as other infectious diseases this winter such as influenza, colds and bronchitis.