Victim of MRSA and poor treatment.

NYU
By Dr. Marc Siegel
October 31, 2007

RX FOR THE 'SUPERBUG'

THE much-publicized Oct. 14 death of 12-year-old Omar
Rivera from a festering leg wound has led to too much focus on the so-called
superbug and not enough on the delay of diagnosis and the poor medical
treatment he received. Zooming in on this poor Brooklyn boy distorts the
true overall public-health picture.
The "superbug" is nothing new. The Centers for Disease Control this month
published a report documenting 94,000 cases of serious Methicillin-resistant
Staphylococcus aureus (MRSA) infection, with 19,000 deaths in 2005, but this
bacteria has been common in hospitals for decades.

In fact, the vast majority of these infections (85 percent) occur in
hospitals. The most threatened are patients who are already sick or whose
immune systems are compromised from other diseases. Yet across the city,
people are paying more attention to their bumps and boils than ever before.

The CDC is concerned that the strains circulating in the wider world may be
more virulent and cause more skin infections - but further studies must be
done to check out that fear.

Most important is the fact that almost all MRSA cases are treatable,
especially when recognized early. I've successfully identified and treated
many staph infections that turned out to be MRSA, and so have countless
other physicians.

Worry about the superbug is far more virulent than the bacteria. A neighbor
buttonholed me the other day asking for reassurance that the superbug
wouldn't get her - but then was afraid to shake my hand because she knew I
worked in a hospital, where the "superbug" is supposedly rampant.

Fear of the superbug is testament to the media's ability to spin a story
until the public feels as if a biblical-type scourge is rifling through
every community. But community-wide hunts for the superbug and mass cleaning
programs are enormous overreactions.

Driven by the extensive reporting, people are over-personalizing the risk.
But fear-driven responses are never the best way to eradicate disease. The
more worried and obsessed with a potential threat a person becomes, the less
likely he or she is to respond effectively.

One of my patients this week was told - wrongly - by his opthamologist that
an infection around his eye could be MRSA. He was so worried he couldn't
stop rubbing it, and spreading it on his hands wherever he went. It turned
out all he had was an allergy to antibiotic eye drops - which the eye doctor
unnecessarily prescribed, because he too was consumed by the hype.

What is the best way to approach a bug du jour like MRSA?

First, we must see the so-called "superbug" for the hospital-colonizing
bacteria it mainly is, and support all constructive programs to improve
infectious-disease precautions at hospitals: Important measures include more
hand-washing, greater care for keeping equipment sterile, cleaner rooms and
beds.

Second, we must dispel the false notion that MRSA, which is still relatively
rare outside the hospital, is somehow new and mysterious.

Third, we must support the production of newer antibiotics. Drug companies
make little profit on these drugs and are too quickly lambasted in the media
for unexpected side effects. Public attacks and knee-jerk lawsuits are a
disincentive for research and development of new drugs.

Finally, we in the medical world need to be more judicious in our use of
antibiotics, so that fewer bacteria develop resistance and proliferate in
the first place.

Bacteria that mutate and become resistant to the antibiotics they are
exposed to are the ones most likely to survive. Doctors and patients should
consider this Darwinian principle each time a worried patient with a viral
respiratory infection or an angry boil asks for an antibiotic prescription -
that is, asks us to treat his or her fear, rather than the disease.

A bacteria like MRSA can be better contained by learning to keep its health
risks in perspective rather than by reacting emotionally.

Dr. Marc K. Siegel is an associate professor of medicine at the NYU School
of Medicine and author of "False Alarm: The Truth About the Epidemic of
Fear."