Mentioning MRSA to someone outside of the medical field often elicits a blank stare or a vague look of confusion and mistrust. In fact, going so far as to mention Methicillin Resistant Staphylococcus Aureus (MRSA) is usually enough to end a conversation completely. For the most part, the destructive, life-altering scope of MRSA isn’t known to the general public—nor is the risk of acquiring MRSA in the hospital. Knowing many patients and health care workers, I’ve seen prognoses that have varied from life-threatening and permanently disabling, to non-deadly, but career ending. This is the story of two acquaintances of mine: one who contracted MRSA in the community at large, and another who contracted MRSA while at the hospital.
Down on her luck, living in a small, government subsidized apartment, my first acquaintance was forced to share her space with several other near-homeless individuals. Crowded in a tiny room, many of her roommates were poorly fed and suffered from mental illness. As is the case in many situations of extreme poverty, drug abuse and poor hygiene were rampant—as were skin infections. Such close-knit quarters were a breeding ground for CA-MRSA, or Community Acquired MRSA. Community Acquired MRSA differs, in that it’s a) often more aggressive b) less resistant to antibiotics than its hospital counterpart.
After several weeks of living in such squalid conditions, my acquaintance began to develop a rapidly deteriorating pneumonia—presenting with a high fever and severe shortness of breath. After she collapsed on the floor, writhing for breath, her boyfriend of the time called an ambulance.
After coughing up blood, she was immediately transferred to the intensive care unit. The presiding doctors diagnosed her with ARDS—acute respiratory distress syndrome: an often deadly condition that requires a mechanical ventilator to assist breathing. A study from the University of Maryland estimates the mortality of ARDS to be anywhere from 36% to 52%. For the next two weeks, she struggled in and out of consciousness—suffering mild brain damage from the loss of oxygen. Although she beat the odds, in the end, she still has mild residual lung damage and memory loss. For several months after her ordeal, she was required to take a high dose antibiotic decontamination protocol, which was also toxic to several organs. After many months of struggle, her life is back on track and her health has improved greatly. Most importantly, she is now fully MRSA free.
My second acquaintance contracted MRSA while training to become a doctor. After having treated several patients infected with the disease, her nasal cavities became colonized. From there, the colonized MRSA spread to her left arm, where it formed a small, but continuously open, sore. As a potential source of infection to her patients, she was taken out of hospital and was unable to continue her studies. Among healthcare workers, MRSA nasal colonization is a constant problem. A French study from 2004 found that 9 percent of workers in clinical wards were colonized with MRSA. HA-MRSA or HospitalAcquired MRSA is usually a) less aggressive than its community counterpart b) more resistant to antibiotics
The sore on my acquaintance’s arm remained for more than a year, despite high dose antibiotics and a stringent decontamination protocol. By this time, she was so far behind in her studies she had to drop out of school. She now lives in constant fear that her infection may spread beyond her arm or even into her bloodstream. She tries her best not to think about worst case scenarios.
Despite having had profoundly different experiences and outcomes, both of my acquaintances share one thing in common: MRSA infection. If better decontamination protocols had been in place within hospitals, or better public health policies existed for the homeless and near-homeless, I have no doubt that my acquaintances would be much healthier and happy today. As hospitals begin to meet the MRSA challenge head on, new and innovative strategies that think outside of the box are required.
Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base
http://www.ncbi.nlm.nih.gov/pubmed/11056707
Carriage of methicillin-resistant Staphylococcus aureus among hospital employees: prevalence, duration, and transmission to households.
http://www.ncbi.nlm.nih.gov/pubmed/14994935
