April 09, 2005
Drug Resistant Staph Spreading Into General Population

Staphylococcus aureus or staph is a bacteria that occasionally causes deadly infections. Methicillin-Resistant Staphylococcus Aureus or MRSA is a strain (or probably a group of strains) of staph that are resistant to many antibiotics. For a long time MRSA and other resistant strains were rarely found outside of hospital settings. Now a new article published by CDC researchers in the New England Journal of Medicine reports that drug resistant staph is increasingly being found in people who have no obvious connection to hospitals or other risk factors.

Overall, they found 17 percent of drug-resistant staph infections were caught in the community and did not have any apparent links to health-care settings.

"Close to one-fifth of what used to be a hospital-specific problem is now a community problem. And that's a large number," said the CDC's Dr. Scott K. Fridkin. "We didn't think it would be anywhere near that high when we started the study."

The drug resistant strains have become more robust.

The CDC researchers checked up to two years of lab reports for drug-resistant staph. More than 80 percent of the 12,553 cases were excluded because the patients had been hospitalized, had a history of surgery or dialysis or had another risk factor.

About 17 percent overall, or 2,107 cases, were determined to be community-acquired staph. The rate was 20 percent in Atlanta, 12 percent in Minnesota and 8 percent in Baltimore.

"When they got out in the community, it was felt these strains weren't strong enough to make it on their own. That no longer appears to be the case," said Dr. Henry F. Chambers of the University of California at San Francisco, who wrote an accompanying editorial.

Those cases are from a small number of cities for 2001 and 2002. The national figure is much higher. MRSA causes 130,000 people to be hospitalized per year.

Previously, MRSA was seen only in the hospital in patients with underlying diseases or compromised immune systems. Now the organism appears to be common among people everywhere, including those in communal settings such as the military, prisons, daycare facilities, and on athletic teams. The CDC estimates that roughly 130,000 people are hospitalized with MRSA each year.

This state of affairs is the result of decades of overuse of antibiotics. Natural selection has produced mutations to allow bacteria to resist many different antibiotics. Bacterial infections are starting to get scary again. Worse yet, the MRSA strains of staph could be stopped with Vancomycin. But Vancomycin resistant staph (VRSA) is believed to be spreading rapidly.

For years, the best treatment for MRSA was the powerful antibiotic vancomycin. But even this weapon has failed against new strains of staph that have emerged. Some infectious-disease experts predict that by 2010, 40% of staph infections will be vancomycin-resistant. And for the moment, there are few alternatives. Cubist Pharmaceuticals Inc. (CBST ) in Lexington, Mass., won approval in September for a new type of antibiotic, Cubicin, that works as well as vancomycin against staph. But experts figure it’s only a matter of time before the bug learns to evade Cubicin, too.

Worse yet, previously the "flesh eating" (really flesh killing) disease necrotizing fasciitis was caused mainly by strep. But now staph is developing the ability to spread rapidly in skin even as it develops the ability to resist a larger set of antibiotics.

In a separate article in the journal, researchers reported that they had linked drug-resistant staph infections to a rare, often-deadly disease known as necrotizing fasciitis, or more commonly, "flesh eating" syndrome.

"Necrotizing fasciitis is a terrible disease, but before now, Staph aureus was never the cause," said Dr. Robert Daum, a pediatrics professor at the University of Chicago and one of the first physicians to notice wider circulation of drug-resistant staph.

Surgeons cut large chunks of skin off of people suffering from drug-resistant necrotizing fasciitis. Even amputations of extremities are necessary in some cases. Sometimes the people survive badly scarred. Other times they die anyway.

In the United States tens of thousands of people die per year from infections that they picked up while hospitalized.

For example, with a hospital infection rate of 5%, of which 10% are bloodstream infections, and an attributable mortality rate of 15%, 26,250 deaths can be directly linked to nosocomial bloodstream infections. However, if a 20% attributable mortality rate is assumed, the number of deaths is from 17,500 (with a 2.5% nosocomial infection rate) to 70,000 (with a 10% total nosocomial infection rate).

Drug-resistant bacteria might be killing more people per year than are killed by car accidents. If that is not the case now it might be the case 5 years from now - barring either big advances in techniques to avoid infection or the development of better antibiotics to use on infected patients.

Meanwhile the US Food and Drug Administration (FDA) is using trailing edge benchmarks to test the efficacy of new antibiotics.

Another obstacle to drug development is the increased regulatory requirements for antibiotics. In the early 1990s, the FDA introduced guidelines that resulted in new and costly demands for the development of antibiotics.7 In an era when hospital- and community-acquired infections are increasingly drug resistant, the efficacy of new drugs are benchmarked against susceptible strains, such as methicillin-susceptible Staphylococcus aureus.

An FDA advisory board has stated that novel antibacterial agents, to be considered for approval, should demonstrate frank superiority to existing antibiotics.6 However, innovative products that fight drug-resistant strains are unlikely to be better than existing drugs that can effectively treat susceptible strains. New antimicrobials would be more likely to make it to market if the FDA introduced new references, such as drug-resistant strains of bacteria, and used new pathogenic targets to evaluate efficacy, such as the inhibition of toxins or prevention of biofilms.

Why should the FDA measure efficacy of new antibiotics against strains that are not antibiotic-resistant? Isn't the biggest need for new antibiotic drugs due to the development of resistant strains of bacteria?

Also, why should the FDA require that new antibiotics be better than existing antibiotics? What is wrong with allowing new competitors that are no better than existing choices? Keep in mind that some people are allergic to or otherwise react adversely to multiple antibiotics. They need more choices.

Think help is on the way in the form of new antibiotics? Don't count on it. Many drug companies have decreased or ended their efforts to develop new antibiotics.

Part of our problem is due to the overuse of antibiotics for humans and also in agriculture. Antibiotics derived from natural sources such as the penicillin family found in a mold have been used so much that resistant strains are now quite common. It is harder to develop an antibiotic totally from scratch. But another obstacle is the FDA. This problem is unlikely to be fixed until the yearly body counts from bacterial infections in the United States get much larger. The public fears dangerous drugs and generally wants more regulation, not less.

By contrast, Tyler Cowen points to a recent post by Bryan Caplan (and these four guys I'm mentioning are all economists) who reports on work by Dan Klein and Alex Tabarrok on how economists see the FDA.

What happens, however, if we listen to economists who specialize in the FDA, rather than random economists at the AEA? Klein reports that opposition becomes very one-sided indeed:

Alexander Tabarrok and I review much of the literature in our website “Is the FDA Safe and Effective?” (FDAReview.org). We include a compendium of 22 quotations by economists calling for significant liberalization of FDA control, and we explain that we have been unable to find quotations favorable to current levels of control by economists who work on the FDA. I believe economics reaches a clear conclusion in favor of significant liberalization of FDA control of pharmaceuticals. Thus, given the range of response options provided by the question, the first two options [strongly support/mildly support] are simply wrongheaded.

Bottom line: The public thinks the FDA is great. Regular economists think it's pretty good. And economists who specialize in the FDA think it's pretty bad. I think I see a familiar pattern.

To address the problem of drug resistant antibiotics We need:

  • a better regulatory environment to allow more antibiotics to make it to market.
  • more basic research on bacteria.
  • less use of antibiotics in cases where only viruses are involved.
  • better practices in hospitals to reduce the spread of pathogens to patients.

Stay well rested, well nourished, healthy, and away from hospitals. Wash your hands and body after exposure to others - especially after contact sports. Also, don't go visiting someone in the hospital if you have even so much as a cold.

Share |      Randall Parker, 2005 April 09 12:52 AM  Dangers Natural Bio


Comments
Invisible Scientist said at April 9, 2005 12:02 PM:

Maybe Howard Hughes was right: only the paranoid will survive.

Robert Silvetz said at April 9, 2005 5:23 PM:

Not to put to fine a point on it, but this blame-the-antibiotic-overuse theory is not really accurate. Wish I knew where it originated.

ANY use of antibiotics, let alone overuse, would eventually result in the rise of a resistant strain.

This is because germs-at-the-margin of exposure WILL always exist even under the best of circumstances, and thus darwinian evolution takes it from there.

Having said that, some stupid things do take place (antibiotics +cattle, overprescription), but how much speed-of-mutation towards resistance has been added is really an unanswered question.

It's easier to see if one thinks in terms of [years]*[patients]*[exposures]/[20 min/germ generation]. This is a mighty big number that suggests there was and always will be plenty of time for a bacteria to acquire resistance.

simon said at April 9, 2005 5:26 PM:

Randall,

Interesting post ... I like your concluding thoughts on the issue. Rising Staph resistance is a major issue that is lost in the busy rush of life.

What is particularly interesting about your blog is that it suggests both the promise and challenges that confronts humanity in making scientific progress. It would be interesting to index all these posts by technical field, problem domain, opportunity or challenge, etc. and look at policy implications in total. I am guessing that it will be a fruitful exercise and suggest both the magnitude of the challenge facing humanity as well as a potential agenda.

It is interesting how often you and your readers sight institutional and political dimensions associated with technical problems. Is the US becoming less open to innovation and science (scientific reasoning)? My reading suggests that it is. While scoical forces must be heard, it is unfortunate that technical solutions are dwarfed by political forces.

simon said at April 9, 2005 5:30 PM:

Robert, using your formula and logic one can easily see why over use of antibiotics accelerates the problem significantly. Patients increases exponentially, thus accelerating the problem.

Randall Parker said at April 9, 2005 5:47 PM:

Robert Silvetz,

I've read articles in the past which claimed a substantial (double digit percentage) portion of prescriptions for antibiotics are entirely unnecessary and are the result of the desire of doctors to placate patients who expect to get a useful treatment when they visit a doctor. Do you really think this is not the case?

I just did a quick Google search and found a JAMA research report on the problem.

Most sore throats are due to viral upper respiratory tract infections. Group A {beta}-hemolytic streptococci (GABHS), the only common cause of sore throat warranting antibiotics, is cultured in 5% to 17% of adults with sore throat. The frequency of antibiotic use for pharyngitis has greatly exceeded the prevalence of GABHS, but less is known about specific classes of antibiotics used. Only penicillin and erythromycin are recommended as first-line antibiotics against GABHS.

...


Results There were an estimated 6.7 million annual visits in the United States by adults with sore throat between 1989 and 1999. Antibiotics were used in 73% (95% confidence interval [CI], 70%-76%) of visits. Patients treated with antibiotics were given nonrecommended antibiotics in 68% (95% CI, 64%-72%) of visits. From 1989 to 1999, there was a significant decrease in use of penicillin and erythromycin and an increase in use of nonrecommended antibiotics, especially extended-spectrum macrolides and extended-spectrum fluoroquinolones (P

Well, why use antibiotics three quarters of the time when bacteria cause sore throats 20% or less of the time? Sounds like antibiotics are being overused for sore throats by a factor of at least 3 and perhaps even 4 or 5.

Do you really want to keep contesting this point? I could do more Googling and find yet more evidence for the widespread overuse of antibiotics in medical practice.

Oh, and yes, the use of antibiotics in animal feed is a massive breeding program for antibiotic resistance. The practice really ought to be outlawed. Or the agricultural industry ought to be required to develop their own unique classes of antibiotics.

Randall Parker said at April 9, 2005 6:08 PM:

simon,

Thanks. You say:

What is particularly interesting about your blog is that it suggests both the promise and challenges that confronts humanity in making scientific progress.

This is a very conscious effort on my part. Too many people who write on science and technology are either uncritical boosters or strongly opposed radical advances and new uses of technology.

So, for example, you get one group of people who profess to be entirely unworried about the possiblity that humans will abuse genetic engineering technologies to produce progeny that are harmful to the rest of us. On the other hand you can find prominent people (e.g. Leon Kass) who entirely oppose germ line genetic engineering. I always say that in new technologies that there are very dangers and yet also many ways to potentially to improve the human condition. I would like more people to approach new tech with that sort of attitude.

The problem is that some opponents of technology are motivated by spiritual reasons rather than rational analyses of evidence. Either they take a Pagan view and worship nature as God and oppose the products of human minds as inherently unnatural and hence ungodly or they worship a God (or Gods) directly and think we are attempting to usurp some role that ought to be God's monopoly.

On the other hand there are also utopians who think that if we just advance far enough in technology and unleash the market we will automatically find ourselves better off. They are projecting from past trends where technology has generally, on average and in spite of wars, lifted up humanity. But lots of trends in history have held for many centuries until, for various reasons, the trends suddenly halted. I do not think complacency is justified. I especially do not think it is justified because our power is going to be come so great that our mistakes can take place on a scale orders of magnitude greater than anything the human race could have done unwisely in the past.

Your point "that technical solutions are dwarfed by political forces" supports my view that progress is not inevitable. I do not buy the myth of the wise electorate or of wise leaders. Both representative democracies and more authoritarian systems can made massive mistakes. Voters are most often not either fair or conscientious. Leaders are quite often unwise.

Robert Silvetz said at April 9, 2005 6:19 PM:

Hi Randall,

You crushed me on points I had granted you full confidence on. (See last two paragraphs previous post).

My point wasn't about overprescription or its use in cattle. The point is that someone, somewhen screamed that the sky was falling due to abuse of antibiotics -- and I hold that the abuse may not have accelerated the timeframe significantly. ANY use of antibiotics will lead to resistant bacteria. In the absence of any empirically available controls, given the number of exposures, it's not clear to me that this state of affairs would not have been reached in almost identical timeframes even IF we had all behaved well with antibiotics. E.g. the abuse may be essentially noncontributory.

If one plays with cellular automata, with very high replication rates, varied massive dieoff between generations, and random point mutation, you end up with similar timecourses regardless of simulation parameters. (My misspent youth!) At the time I was shocked to see less than 10% time difference before stable automata populations arose. Admittedly jumping between fields, if those results were to hold, the time difference in real life for the rising of MRSA or VRSA would have been a mere 5 years.....

SpakKadi said at April 9, 2005 9:16 PM:

I have often been frustated by the tendency of doctors to prescribe medications of any kind, but particularly antibiotics, without knowing the true underlying cause of symptoms. Most doctors I have encountered don't even bother testing to see if a sinus infection is truly bacterial in nature, though UTIs, strep throat, and other infections whose symptoms can also be symptoms for more serious problems are usually tested - but antibiotics are given before results are found. For me, this is a problem because I am allergic to several antibiotics and the weaker ones I am capable of taking seem to have lost effectiveness. Of course, I have heard that the doctors who are more careful about prescribing antibiotics get patients who absolutely insist on getting antibiotics, even when the doctor tells them it will do no good in their case. Perhaps if there were as many commercials warning the general public that antibiotics don't work on viruses as there are for antidepressants, allergy medications, and ED products, this would be less of a problem.

Randall, I am curious if you have found any studies regarding the overuse of antibiotics in childhood and weaker immune systems or other health problems later in life. I know studies have suggested that having an overly sterile living environment can result in weaker immune systems later in life, but I don't know of any regarding the use of antibiotics in particular.

simon said at April 10, 2005 7:28 AM:

Robert, the models on Infectous Diseases that I have come across as an undergraduate working in a medical lab suggested that partial treatment, sanitation quality and overuse pushed the models over the top. That is, strain resistant bacteria did not aggressively spread through the general population - they died out (very low frequency). These models where calibrated against populations across the US, Europe and Latin American. It is interesting to note that strain resistance was correlated to region. Latin America had the highest level of identified strain resistant bacteria. They also have the highest level of partial treatment, antibiotic overuse and sanitation problems.

Rsilvetz said at April 10, 2005 8:33 AM:

Ola,

Thanks for the info on regional spreads. Take those with a grain of salt too. BU Med had a similar model and I incurred the wrath of many when I pointed out that it completely missed the impending spread of tuberculosis meningitis in immunosuppressed children.

One other core element to consider is that if one looks just across time, even allowing for the advent of antibiotics, that infectious disease has been declining overall since the start of the Industrial Revolution. This is probably simply related to less human communal contact and the sanitation improvements. Which makes one wonder if the arrival of children in preschool daycare is not a big step backwards from the infectious disease perspective -- propagating things like MRSA.

It would be interesting to know how those models would behave if stratified by economic conditions.

Randall Parker said at April 10, 2005 10:07 AM:

simon, Robert,

This discussion reminds me of a recent report on how the incidence of multi-drug resistant tuberculosis can be reduced. (same article here)

Supported by HHMI, the U.S. National Institutes of Health, and the Wellcome Trust, the study used modern molecular epidemiologic approaches, in addition to screenings, clinical assessment of people reporting symptoms, supervised treatment, and follow-up, to explore a global health problem.

At the outset, 22 percent of previously untreated patients with pulmonary TB were carrying drug-resistant strains, and 6.7 percent had multiple-drug resistance. By the study's final year, only 7.8 percent of new TB patients carried drug-resistant strains, and there were no cases of multiple-drug resistant TB.

The researchers report their findings in the April 2, 2005 issue of the British medical journal The Lancet. A commentary by Marcos Espinal, executive secretary of the World Health Organization's Stop TB Partnership, appears in the same issue.

People with TB must take four standard drugs daily for six months. They may begin to feel better after a month, which tends to lead them to skip doses, but if they stop taking the drugs for any reason, the drugs may become ineffective and multi-drug resistant TB may result. Multi-drug resistance refers to resistance to two of the most powerful anti-TB drugs, rifampicin and isoniazid. Overcoming this drug resistance is a major goal of public health programs fighting TB.

When García García's study began in 1995, regional health officials in Mexico had begun to upgrade their TB treatment program to a World Health Organization model called directly observed therapy (DOTS). The five-pronged strategy of DOTS includes political commitment to the eradication of TB, case detection by sputum microscopy, supervised administration of drugs for at least the first two months of treatment, an uninterrupted supply of all essential drugs, and a rigorous assessment of treatment and outcomes.

The results of the Mexican study “strongly suggest that DOTS reduces transmission of resistant strains by curing cases of TB that otherwise could become multi-drug resistant if they are not properly treated,” said Marcos Espinal, executive secretary of the Stop TB Partnership at the World Health Organization. “This study shows that DOTS is needed to control multi-drug resistance. Without DOTS, measures directed to multi-drug-resistant TB will not work.”

Would more highly supervised antibiotic drug use reduce the incidence of multi-drug resistance? Well, it certainly would for TB.

Bob Badour said at April 10, 2005 8:39 PM:

Robert,

In how many of your cellular automata simulations did you apply massive die-off to only a tiny localized part of the simulation?

When making wine, one often uses a champagne yeast because it outcompetes most other bacteria. By adding it early and in sizable quantities, the bloom of champagne yeast prevents any other organism from getting a foothold and spoiling the wine.

It would seem to me that competition with neighbours probably helps to keep the resistant strain from blooming and spreading. By knocking out those neighbours needlessly, overuse will accelerate the spread very rapidly.

I can picture a massive field of automata where in one generation the entire field is wiped out except for a small number of resistant automata. I can likewise picture the same massive field where the knockout area is the size of a dime or even a handful of dime-sized areas. It would seem that, after the knockout in the first situation, the resistant automata have unlimited horizons and ample resources. The second situation would offer the resistant automata much less opportunity to spread or even to thrive.

I agree that resistant strains are inevitable. I suspect proper procedures can gain a lot more than a 10% increase in the time it takes a resistant strain to become a problem or to make an antibiotic ineffective. However, proper procedures are impossible without supervision because even if we eliminated overprescription we would still face a population who stop taking the pills as soon as they start feeling better.

Dave Schuler said at April 11, 2005 9:38 AM:

One thing that's typically left out of this discussion is that if by “we” we mean the citizens of the United States there's very little we can do about this. Antibiotics are available over the counter in much of Asia i.e. they are totally unregulated. Those countries are just a plane ticket away. No level of regulation here will correct this problem.

Rsilvetz said at April 11, 2005 1:44 PM:

Sorry, didn't mean to be missing in action here.

In the automata experiments, we were unbeknownst to us, playing with rogue genetic algorithms, so we had culling functions, fitness functions, mutation functions, that determined destruction of an automata or its continued survival. We were not smart enough, to just blitz a piece of the field, we basically nuked the grid which left survivors, survivors grew - rinse, wash, repeat x 1,000,000 generations and sure enough, the original culling functions eventually lost their impact. Across these simulations, it was suprising to see that stable populations were reached in about the same order of time, regardless of culling function [antibiotic].

I'm glad to see a clear counterexample with the TB and hopefully the timeconstant of disease here isn't screwing with us. I was thinking mostly of regular bacteria and not the fungal/mycobacterium angle.

One thing also to factor in, is that antibiotics penetrate different tissues at different concentrations than the ideal. Thus when the wrong antibiotic is prescribed, sublethal concentrations will certainly induce resistance. In addition, it's not so much that they nuke the bug, but that they buy time for the immune system to eradicate the disease. Which raises the really hairy question: If a body eradicates a bug -- it means the resistant bug was passed on BEFORE eradication. So is the real solution transitory quarantine and an Andromeda-strain style disinfection of patients that manage to land in a hospital?

Randall Parker said at April 11, 2005 1:54 PM:

Robert,

Your point about a bug being passed on before it is totally killed off in one patient is an interesting one. Hadn't occurred to me. But it makes sense. The least resistant bacteria will probably die first. The more resistant (but not totally resistant) bacteria will last longer and will be more likely to be transmitted.

It is worth noting in that context that what is important about my post is that the bacteria are showing up outside of hospitals whereas before this did not happen. Well, if these bacteria were getting either totally wiped out or their carriers in hospitals were being effectively isolated then the bacteria couldn't spread from hospitals in the first place. This argues for more effective quarantining in hospitals even more than it argues for reduction in unnecessary antibiotic use.

Of course these drug resistant bacteria could have independently evolved outside of hospitals as well. But they were found in hospitals first.

I wonder if greater automation of patient care in hospitals would reduce the risk of pathogen spread. Reduce reasons for people to touch things and the result should be fewer routes for spread of pathogens.

Ken said at April 11, 2005 3:00 PM:

Greater automation of patient care would reduce all sorts of risks. If human judgement is needed, then you have to have a human doing it, but for anything that doesn't require such judgement, putting a human in the loop just increases the opportunity to screw something up.

For instance, a bottle of antibiotics given to a patient is asking for trouble. A patch applied once that delivers the entire course, much like the one that delivers a month's worth (?) of birth control or nicotene, would be much better.

One way or another, though, we'll have to maintain our lead in the arms race, whether it's by advanced genetic engineering or a stream of new drugs. Returning to the days when most children didn't grow up and cuts, scrapes, and ear infections were serious mortal threats doesn't appeal to me in the slightest, and it's worth taking quite a bit of risk to avoid that.

Anciano said at April 14, 2005 5:03 PM:

Get real guys. There are two big factors which accelerate the rate of antibiotic resistance- resistant strains are at a disadvantage unless the drug is commonly encountered.
1. Think of the sentry matrix: soldier on watch after dark, calls out “who’s there?”- unless the answer is rapid and precise, the soldier shoots.
2. Think of the pediatrician matrix: Mother A calls at night “little Susie is sick, feverish and pulling at her ear. This is the way that it always is when she has an ear infection”. What are the chances that Doctor will say “I must see the child and look for evidence of bacterial infection”- less than 1 in 10- it makes the Mom angry, the doc has to go to the hospital or the home to see the child, and there is a significant chance (any honest doc will tell you) that the doc finds no evidence of bacterial infection and following on her logic says “no biotic”. Now Mom has paid at least a copay, often full freight, her child is crying and upset, and she has no biotic which she knows that she "must get". The JAMA and similar journals won’t touch this issue. Commercial medicine is the problem- it doesn’t happen that way in the English NHS.
3. Think of how much influence big agribusiness has in Washington. What are the chances that Congress would outlaw feeding antibiotics to livestock? It makes the cows heavier. One in 10 is way too high.
4. “The market” doesn’t care about antibiotic resistance. The market cares about short term revenue. That’s what drives stock prices and stock prices keep CEOs on the job.

I’m an old timer who has practiced medicine in UK and US. American doctors use far too many drugs per patient; I’m not talking only about biotics. So why didn’t I stay in England? Couldn’t because I was and am a US citizen.

Ebony said at May 8, 2005 10:34 AM:

After visiting my doctor about 15 times in the last year I finally now know what is going on with me. It is alarming that I have never been in jail, part of a sports team or lived in a dorm and I am facing this. The general public needs to be made aware of this. I live in Baltimore MD and I guess my results were part of the study. This information is great, but if the general public has not clue of what they are looking for how would they get treatment. We must do better with the education process.

Elsie said at May 12, 2005 6:31 PM:

My mother recovered from a multi resistant staph infection four years ago. This week she went into the hospital only to find her roommate had MRSA in her blood. Is there a way to check the incidence of MRSA in a local hospital BEFORE going there?

bobby key said at January 8, 2006 6:04 PM:

Can staph infection interfere with concieving child?

dody said at February 5, 2006 7:13 AM:

Thanks for the info on regional spreads , but i ask one question please answer

how can avoid mrsa by specific method ?

please answer me

because this my search in master

thanks

Heidi Little said at February 15, 2006 9:18 AM:

Does anyone know if not having a spleen makes you more susceptible to MRSA? If so, is there any written proof of this?

sk Jarvis said at November 16, 2007 11:31 AM:

My ex-husband has a bad case of mrsa. He is scheduled to have a leg removed in January. He going to be coming to Thanksgiving with about 8 guests. What should I do to protect myself and my guests from any contamination? Thank you.

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