Taking up and defeating the 'superbug'

This editorial appeared in Monday's Los Angeles Times:

The staph superbug known as MRSA has been around a long time. But only a few months ago was it revealed that the antibiotic-resistant bacterium has spread beyond the occasional hospital and now kills more Americans than AIDS. Rather than fomenting panic, this knowledge should provoke us to take a long-overdue look at hospital procedures, pharmaceutical development and even farming methods.

The Centers for Disease Control and Prevention reported in October that methicillin-resistant Staphylococcus aureus seriously sickened more than 94,000 Americans in 2005 and almost 19,000 died, making it far more common and dangerous than previously believed. By comparison, 17,000 Americans died of AIDS-related causes that year. Though most infections still occur in hospitals, close to 15 percent are simply "out there," especially in locker rooms, gyms, prisons and tattoo parlors. In November, another study found that the number of hospitalizations from MRSA had more than doubled in six years.

We know a lot more about how to combat MRSA than we did about AIDS in the early years, and we have far more weapons at our disposal, some of them laughably simple and cheap. Like everyday soap. Certain powerful antibiotics can still kill an infection.

But, with a few exceptions, hospitals and public agencies have been slow to gear up against MRSA. More than 30 studies have shown, for example, that health-care workers wash their hands about half as often as they're supposed to, even though washing before and after seeing each patient would drastically cut down on infection rates. Hospital surfaces and equipment aren't cleaned as often as they should be, and careless habits - like touching potentially contaminated surfaces after hands have been washed but before touching the patient - contribute to the spread.

The first order of business should be to get a clear picture of MRSA. Where is it and how prevalent? An upcoming bill by California state Sen. Elaine Alquist, a Santa Clara Democrat, would make MRSA a reportable disease and require hospitals and nursing homes to report their infection rates. In Tennessee, which tracks MRSA, it quickly became the third most common reportable disease in the state, behind chlamydia and gonorrhea. A similar bill was vetoed in 2004 by California Gov. Arnold Schwarzenegger, but the recent news from the CDC should make him rethink his position, despite the almost certain opposition of hospitals.

Testing newly admitted patients also can cut down dramatically on infection rates. Loyola University Medical Center in Chicago began screening patients in its intensive care units in 2005. By isolating infected patients and taking other protective measures, ICU infection rates plummeted by more than half, and in November the hospital expanded its screening program to all new admissions. Alquist's bill would require screening of only the most vulnerable patients, but the results might entice more hospitals to extend testing. The potential benefit in both health and savings is enormous. After an initial investment of about $50,000, the rapid-turnaround screening tests cost $20 to $30 a patient. The cost of treating MRSA patients in California already tops $3 billion a year.

The proliferation of superbugs similar to MRSA is outpacing the development of new antibiotics, which are less profitable for pharmaceutical companies because they're used for a limited time. The federal government should help spur research in this area, perhaps by expanding the Orphan Drug Program, which gives companies financial incentives to develop drugs that have a limited market.

But bacteria will continue to outwit medicine, and more rapidly if we fail to curb the overuse of antibiotics. A few doctors have responded to the MRSA alarm by routinely giving patients with any infection one of the few drugs that still kills the superbug. Misuse of a last-line-of-defense antibiotic is almost guaranteed to render it ineffective.

This is more than a medical situation, though. Use of antibiotics is routine on animal farms; they're often mixed into feed to prevent diseases from sweeping through tightly packed quarters. A recent study of Canadian pig farms found that a quarter of the swine were infected with the human strain of MRSA. At minimum, the U.S. Food and Drug Administration should conduct a similar study.

The discovery of antibiotics transformed modern health care. Now the transformation has to revolve around keeping those amazing medicines effective.