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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, February 02, 2007
    MRSA in Los Angeles

    Meant to blog on this a while ago, but I didn't get around to it till now. It's important enough that I decided to dredge up and edit this three-month-old post. MRSA has broken out among the homeless population in Los Angeles in a very big way. (Warning: there are some pretty gross pictures in this article, but it's an excellent read.)

    MRSA stands for Methicillin-Resistant Staphylococcus Aureus. It's a scary bug that used to be seen only in hospitals and nursing homes, but made its escape to the community at large a couple of years ago. S. Aureus is the bacteria that causes most boils and many skin infections; the rule is, if you see pus, it's probably staph. All staph is aggressive, MRSA especially so. In addition, and unfortunately, its DNA is prone to mutate; this means it's managed to develop resistance to nearly every antibiotic we've thrown at it. Back in the 1940's when penicillin was first available, one of the reasons it saved so many lives is that staph had no resistance to it. That lasted about five minutes. As new antibiotics were developed and we became more familiar with the bacterium's resistance mechanisms, many new drugs were developed specifically to attack this problem. For years methicillin was our go-to drug to treat staph. When it became resistant to methicillin, we knew we were in big trouble. Hence the label MRSA.

    The only drugs we currently have to treat MRSA are vancomycin, which must be given intravenously, and two oral drugs. One is an old reliable: the trimethoprim-sulfa combination. One is new (and hideously expensive): linezolid. By hideously expensive, I mean the average wholesale cost is $83 per pill. But if someone is allergic to sulfa or it doesn't work against the MRSA, that is our best option.

    MRSA is a scourge in the HIV-positive population, who seem to be particularly prone to suffer from it. I've seen it in patients with no medical problems as well; last year I admitted a healthy guy with a severe MRSA cellulitis in his hand. He got it lifting weights at the gym. (Most gyms seem to be contaminated with it these days.) The entire Skid Row area seems to be infested with it, and as detailed in the article I linked above it has attacked paramedics, firemen, police officers and shelter workers as well as the homeless.

    I hope the Department of Health gets on this. MRSA has demonstrated its talent for disseminating itself. If it got out of the hospitals, there's no way it will be contained in Skid Row. I'd consider this as dangerous a threat to the public as tuberculosis.




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