By Joe Darrah
I don’t play much tennis, but a few years ago I was diagnosed with tennis elbow, AKA bursitis, a condition in which the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone, becomes inflamed (ie, infected). Not thinking too much of my initial symptoms (swollen elbow with redness and limited mobility), I started to become more concerned when a colleague suspected Lyme disease due to the bull’s-eye type appearance that the irritation began to take as the redness expanded around my elbow and up my arm.
During a doctor’s appointment later that day, my worries hardly subsided upon the reaction of my primary physician, who was immediately concerned at the sight of it. While he quickly ruled out Lyme disease, he would not rule out a staph infection or cellulitis (both were later confirmed and I experienced a recurrence this summer). When he next picked up his office phone and dialed the closest hospital to alert staff that he was sending me over I began to think, “wait, does he think I might have MRSA?” A snap assumption to make, yes, but it seemed an appropriate connection based on his obvious concern and his actions. While in hindsight it was premature of me to ask him if I should call home on my way to the ED and have all towels in the house discarded (he unequivocally dismissed the idea), I think my intentions were (was “where”) in the right place based on information that I’ve read about MRSA in the national media. And this has led me to question whether or not overall media coverage of MRSA is balanced.
Media Treatment of MRSA
It’d be difficult to dispute that MRSA is currently a healthcare topic that gets a seemingly incalculable amount of coverage and has become a condition that many in the general public are familiar with. But is that recognition generated by media coverage, or is the media coverage indicative of what the general public demands? That’s similar to the chicken vs. the egg debate. Instead, I’m more curious and skeptical over whether or not we’re seeing improvements in reducing MRSA cases. A recent Google news search revealed numerous and varied results related to MRSA in both healthcare and community settings.
The latest “trending” articles mostly pertain to a study that’s revealed MRSA’s presence in wastewater treatment plants in the Mid-Atlantic and Midwest, something that should not be considered abnormal, according to Randy D. Wolcott, MD, CWS, TWC editorial board member. The wastewater report doesn’t touch on the “normalcy” of the findings, but does claim the study “is thought to be the first to investigate US wastewater as a potential [environmental] reservoir of MRSA in the US (www.medicalnewstoday.com/articles/252403.php)." So, how do we gauge how serious these findings are? To me, that’s difficult to ascertain. According to a major national study whose results were announced this summer (see a copy here:http://vitals.nbcnews.com/_news/2012/07/03/12549053-deadly-mrsa-infectio...), overall incidence of MRSA is decreasing in hospital and community settings overall. These results show hospital-onset infections dropped from 0.7 per 100,000 people to 0.4 per 100,000 people in the US between 2005 and 2010. During the same time, community-onset MRSA infections fell from 1.7 per 100,000, on average, to 1.2 per 100,000 people.
The findings are reportedly based on data collected by the US Department of Defense (DOD) on more than 9 million active and non-active military personnel (of which 82 percent were non-active and 52 percent were male). So, what’s more significant, these findings or the wastewater reports? And, what’s one to think regarding similar MRSA articles, say, those that that claim “living near livestock increases MRSA chances”? Is this overhyping obvious news or is it revealing facts that not enough of us know? The article found here (www.gadling.com/2012/11/07/mrsa-mrsa-me-how-to-avoid-a-community-acquire...) is unquestionably overdramatic in its attempt to educate readers (and is sure to make fans of Marvin Gaye shudder at its headline). But is this a productive approach to discuss MRSA or not? As a provider, do you think the fear tactic is warranted? Appropriate? Is it something you’re concerned about, or do you just accept the responsibility to educate as you see fit when you’re with your patients?
Are We Improving on MRSA Reduction?
The decreases noted in the DOD study mean MRSA infections “still represent a large burden of disease, but at least there are some encouraging results,” according to study author Clinton Murray, MD, chief of the infectious disease service at Brooke Army Medical Center in San Antonio. About 19,000 people die yearly from MRSA infections, according to the CDC, while about 1 in 5 of those who develop invasive MRSA infections die. The DOD research also shows the percentage of MRSA infections that developed outside of hospitals may have peaked in 2006 at 62 percent of infections before decreasing to 52 percent in 2010. David said that while these numbers are positive, rates of community-onset infections are still much higher than in previous decades.
“If a doctor left the States in 1999, and came back in 2010, [he or she] would be shocked,” David said. Additionally, community-onset MRSA went from “never causing infection to being the No. 1 cause,” he added. The DOD data used did not include people's risk factors for developing MRSA infections, an unfortunate attribute, according to David, because tracking such factors may have yielded clues as to which improvements in healthcare practices are having the biggest impact. Could it be that media coverage has become so frequent that “incomplete” studies are being conducted in attempts to prove MRSA is not so deadly? What does the presence of MRSA mean for an otherwise healthy adult in his mid-30s vs. an older patient living with diabetes and a chronic wound(s)?
At Southwest Regional Wound Care Center, Lubbock, TX, Wolcott et al have learned through a newly published study of their own that routine clinical cultures still frequently miss detecting staph in samples and that staph is broadly prevalent in chronic wounds but very often is only a minor component that does not even affect wound management. In fact, if MRSA is less than 1 percent of a wound sample, it’s not treated (but it is routinely monitored), Wolcott said.
“There is no question that the media coverage (of MRSA) is overdone,” he added. “When a headline reads ‘flesh-eating bacteria,’ my thought always is, ‘What other kind of bacteria are there?’ The types of chronic infections that kill people are ventilator acquired pneumonia, which kills 67,000 people per year; COPD kills 50,000 people per year; and wounds kill up to 50,000 people a year; and the list goes on until the total is well over 500,000 people per year who die from the direct downstream effects of their chronic infections. And yet, the media coverage is on MRSA.”
Still, Wolcott said there are benefits to the media focus, regardless of whether that focus is considered justified, in the awareness that it raises for a condition that obviously can’t be ignored, especially among wound care patients (and within that cohort those who live with diabetes).
“The biggest benefit we see is with patients with diabetic foot ulcers,” Wolcott said. “Patients are scared by MRSA, so they come in earlier, giving us a better chance to get them healed.”
I’d have to think many in the media would define this as justification for the approach to overall coverage. It’s certainly a healthy debate.