MRSA: Closing Schools Just Window Dressing

The key to infectious disease control is striking an appropriate balance between overreaction and underreaction; not quarantining people unjustifiably and not exposing people to risk. This balance can sometimes be hard to find given the penchant of infectious disease to foment panic. However, sometimes it is easy to spot overreaction.

The community college in my hometown is one such example. 

Based on a single case of methicillin resistant Staphylococcus aureus (MRSA) infection the community college shuttered its doors. What strikes me as odd is the presumption that closing the school will have any substantial impact on MRSA at the school. While good sanitation and cleaning is important (and I don't know the particulars of this situation), it will not eliminate the risk of MRSA. The general population harbors MRSA are on the bodies at a rate of around 1% -- that means that the college with an enrollment of over 3800 students has at least 38 students who are chronically colonized with MRSA. Similar rates apply to the faculty and staff. The rate in healthcare workers is, by contrast, about 5% and those with chronic illnesses may have higher rates. Infection occurs primarily through skin-to-skin contact. This single case emerged amongst a larger group of MRSA colonized individuals and not from a school facility or structure.

MRSA is nothing new and no cause for panic. In most people it may cause a minor skin infection or boil (the "spider bite" for which there is no spider). Many people have minor MRSA skin infections that go unnoticed or undiagnosed and resolve on their own. Of course, MRSA can cause more serious infections such as pneumonia, bloodstream infections, infections of heart valves, or infections of bones/joints in certain contexts. 

By scrubbing down the school, a false sense of security will be instilled in the campus community and when the probable next case is announced a new round of panic and demands for more action will arise because the facts about MRSA's presence in the community (it can even be harbored by pets) were not part of the earlier discussion. 

While this may seem like an easy and straight-forward action and a "show of force" amidst the demands to do something, the negative repercussions of non-evidence based actions such as this will likely abound. This action will not substantially protect against or change the risk of infection as it is the campus community itself that harbors the microbe.


Bald's Eye, MRSA, and the Scientific Method

Like any good infectious disease physician I am always excited with the prospect of a novel treatment for a nasty infection such as MRSA. Usually these new therapeutics come in the form of traditional antibiotics such as tedizolid, ortivancin, or dalbavancin. 

However, the latest MRSA treatment to capture the headline is called Bald's Eye, a medieval remedy for eye infections. This concoction consists of a combination of garlic, onion, cow's bile, and wine. In a remarkable study of its efficacy using an MRSA skin infection mouse model, the potion proved efficacy.

The lesson to be drawn from this success is not that every ancient remedy should be dusted off but that when exploring novel therapeutics, the scientific method must be followed. Just looking at the ingredients, one can see the biological plausibility of an anti-infective property (as bile is known to be anti-bacterial). A similar story of adhering to the scientific method can be seen in the determination that the ancient Chinese herbal remedy artemisinin had anti-malarial effects. 

It is only by adhering to the scientific method, which is really the art of logic applied to scientific problem-solving, that arbitrary notions are dismissed and efforts focused on the truly possible. 

MRSA Probably Attends Every Super Bowl

As everyone was watching the Super Bowl today, I thought it appropriate to review an infection that is common in those who play football: MRSA skin and soft tissue infections.

One of the most famous associations of this organism with a football team was with the 2003 St. Louis Rams. In that incident, MRSA skin infections occurred in 9% of the Rams with--ominously--42% of players and  staff colonized in their nasal passages. 

More recent studies, have confirmed similarly high prevalence of infection with MRSA in high school football players as well.

Skin abrasions (i.e. turf burn) are thought to predispose to infections while the close contact amongst players coupled with suboptimal hygiene predisposes to colonization.

MRSA--another reason to prefer skateboarding (my favorite sport).