MRSA Is Ongoing Health Threat But Nothing New or Uncommon

December 27, 2007
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Registered nurse Cathy Ostrowski and infectious disease specialist Dr. David Dobbie, both of Spectrum Health, shake their heads whenever they hear about a school going into super-cleaning mode after a student comes down with methicillin-resistant staph aureus, or MRSA.

“We know those germs are going to come back” as soon as students return, Ostrowski said.  Not that MRSA isn’t a threat, she said, but staph aureus is a common virus carried by many people who don’t get infected with it. Whether an individual gets sick from it is more related to the condition of his or her own health, she said.

“We all come in contact with those types of organisms all the time, at the grocery store, at hotels, wherever we go. We come in contact with things that don't make us sick because  we're healthy humans, our immune systems are working appropriately. When they’re not working appropriately and you run into things … you can get sick.”

Long associated with pneumonia or surgical site infections in health care settings, since the 1990s MRSA in recent years has jumped into the general population, earning the moniker  “community-based” MRSA. It generally manifests as boils or skin infections.

“A significant percentage of the general population carries staph aureus. We've always had that,” said Dobbie, medical director for infection control at Spectrum Health.

Dr. David Baumgartner, also an infectious disease specialist and vice president of medical affairs at Saint Mary’s Health Care, recalled that MRSA was uncommon in Grand Rapids when he was a medical student in the 1970s and 1980s.

“I was sent to Detroit and actually there was quite a bit of MRSA in Detroit in the early 1980s,” he said. “By the time I came back to Grand Rapids in the mid-80s, it was quite prevalent in the hospitals in West Michigan, but not to the degree that it was seen in Detroit.

“Fast forward into the 1990s, and MRSA was seen in the community in Southeast Michigan, but not prevalent much here. For the last seven or eight years, MRSA has been pretty prevalent in the community in West Michigan.”

Dobbie said it’s the “R” in MRSA that makes smart people respect an organism as tiny as this virus: Resistant. Over the decades, the virus has mutated in response to drug treatment, first penicillin, and now certain antibiotics. Community-acquired MRSA actually has a different genetic makeup than the health care-acquired virus, he added.

Spectrum Health has purchased laboratory equipment that can quickly test as many as six samples from nasal swabs at one time for MRSA. Spectrum Health has been using it for five months, and Metro Health is considering the purchase.

“Right now, we screen people at high risk for resistance, then isolate them,” said Dr. Steven Triesenberg, medical director of the infection control department at Metro Health. “Across the country, there is some call to screen everybody.

“It is our biggest issue that we face,” Triesenberg added.

At Saint Mary’s, patients suspected of having MRSA infection are isolated and tested, using “a low threshold for screening,” said Dr. Naemeka Egwuatu, infection control officer. He said the hospital is not currently considering the rapid-result testing. “It occurs so much in the community,” he said. “It’s everywhere, but right now, we don’t think we need to screen routinely.”

Ostrowski said Spectrum is in the process of validation tests, running the lab work with total joint replacement patients of two surgeons. Testing pediatric heart surgery patients would be next on the list, she said. At high risk to be MRSA carriers are people who live in long-term care facilities, who are patients in the intensive care unit, or who have surgery that involves an implantable device.   HQX

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