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Friday, June 25, 1999 Published at 15:15 GMT 16:15 UK


Health

Stand by for superbug scares

Victorians knew how to fight superbugs, says Dr Colin Thomas

MRSA season is here again so stand by for sensationalism and inaccuracy.

The bug is a boon for sensationalist headline writers who come out with such classics as "Killer bug ate my hamster".

It is also regularly misclassified as a "Killer virus" when in actually it is a bacteria.

MRSA stands for methicillin-resistant Staphylococcus aureus. However, the title is slightly misleading.

The bug is indeed resistant to methicillin - in its day the domestos of antibiotics - but what makes it notable is that has also been successful in fighting off nearly every antibiotic known to man.

New antibiotics have been developed to combat MRSA, but how long can we keep ahead?

Patients most at risk

The S. aureus bug is not usually one that causes disease, and MRSA is no exception.

However, ill, fragile, and debilitated individuals - the kind of people you might find in hospital - are the most vulnerable to these so called opportunistic infections.

Once infected with MRSA it is virtually impossible to eliminate the infection.

Vancomycin is now the antibiotic used as a last resort, but recently a VISA or vancomycin intermediate-resistant strain of the bug was identified in a Scottish hospital.

If full resistance to antibiotics develops, then this is very worrying.

Not so much for opportunistic infections like MRSA, but the possibility that this type of total drug resistance might eventually spread to more virulent diseases like meningitis.

The reason bacteria develop antibiotic resistance is two-fold. First too many antibiotics are being used - the US Centers for Disease Control and Prevention estimates some 50 million unnecessary prescriptions are written for antibiotics each year.

Second, the chance spontaneous mutations that confer antibiotic resistance - evolution if you like - occur more quickly in bacteria. During a single human generation bacteria go through 100,000.

Hospital outbreak

I remember a few years ago when I was working in the NHS we had to deal with an outbreak of MRSA in our hospital.

Included in the control measures were checks on medical and nursing staff for carriage of the bug in the throat, on the skin, or up the nose.

Because medical staff - especially junior doctors - move from hospital to hospital quite frequently, a carrier in the profession can be very problematic.

We discovered MRSA in a junior doctor's nose - a course of topical antibiotic for surface infections of the nose would have sorted it out.

I set about contacting him, but discovered he was on holiday for two weeks in Devon.

We had no idea where he was, but as he wasn't working we left matters until he returned.

I repeated the test, but to my amazement the MRSA had vanished. the reason for this? He had been in the sea surfing, with probably gallons of seawater forced up his nose, and the fragile MRSA had literally been ousted.

Perhaps those Victorian bathers had it right all along.



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