Drug-Resistant Staph Infection (MRSA) Deaths Nationwide Now Exceed Those From AIDS; Prison Connection Ignored

by John R. Dannenberg

The Journal of the American Medical Association (JAMA) reported that nationwide, more deaths in the United States are now resulting from drug resistant invasive MRSA (methicillin resistant staphylococcus aureus) skin infections than from AIDS. Overall, an estimated 90,000 invasive MRSA infections occur annually nationally ? a rate of 32 per 100,000 people. The October 2007 JAMA report called this rate ?astounding.? While many staph cases are simply mild skin infections, the invasive ones studied here are life-threatening, entering the bloodstream or destroying flesh.

PLN has reported extensively on MRSA infections in prisons and jails (see: PLN, Aug. 2007, p.1). Indeed, the greatest liability (58.4%) turns out to be for patients in community care settings, a category that includes nursing homes and correctional settings. Infections acquired in a hospital, often incidental to elective surgeries, account for 26.6 %.
Another 13.7% arise in ?community-associated? functions (this category includes schools and sports teams), while the remaining 1.3% were unclassified. There was also a strong correlation with age (3 times more prevalent in those over 65) and race (2 times more prevalent in blacks), while gender was not a factor.

The JAMA study surveyed data from nine urban regions around the country, and analyzed 5,287 reported invasive cases. 90% were in the form of bloodstream infections, while the remaining 10% were flesh-eating disease. Among the 5,287 infections, there were 988 deaths. Thus, even with hospitalization and the latest antibiotics, one?s chances of dying from invasive MRSA approaches a staggering 20%.

As a result, hospitals have taken drastic preventive steps. Obvious was the need for yet improved hygiene procedures by hospital staff, including improved hand-washing. Many hospitals have also recognized that many patients serendipitously harbor the MRSA organisms already when they arrive, and to the extent possible, they isolate them until they are first screened of MRSA. It is also known that about 5% of all U.S. hospital and nursing home patients suffer from mild MRSA skin infections, which, if they were to invade an open wound or enter the body through invasive medical equipment (e.g., dialysis shunts, catheters, or intravenous tubing), could develop into systemic infections.

The JAMA report concluded that invasive MRSA infections disproportionately affect patients in health care settings, but are no longer confined to hospital intensive-care units. Since prisons and jails present many of the same cross-infection attributes of health care centers and nursing homes (e.g., common socialization areas, dining rooms, and air handling systems), they plainly remain major sources of potential outbreaks. Dr. Buddy Creech, a Vanderbilt University infectious disease specialist, called the spread of drug-resistant MRSA ?epidemic? and hopes the new JAMA report will spur development of a ?holy grail? MRSA vaccine.

Sadly, this report barely even mentions the MRSA epidemic sweeping prisons and jails around the country and the spread of the disease from these facilities into the community, as PLN has extensively reported in the past. Once again, the public health impact of mass imprisonment is largely ignored by the medical establishment.

Sources: Journal of the American Medical Association, vol. 298, Vol. 15, pp. 1763-1771 (October 2007).