CorrectCare

LA Confidential: County Jail Solves MRSA Mystery

Itsy Bitsy Spider? These bugs are far smaller, yet they can wreak havoc

Spider bites can be annoying, even harmful, but the microscopic bacteria known as Staphylococcus aureus can be far more virulent. With up to 30% of the population colonized in the nose at any given time, staph is one of the most common causes of minor skin infections, says the Centers for Disease Control and Prevention. However, under the right conditions, staph infections can be very serious. When those bacteria are resistant to mainstream antibiotics such as methicillin, and when they infiltrate a high-risk setting such as a large urban jail, infections can spread like wildfire.

Bacterial resistance to antibiotics has been with us a long time. For methicillin, resistance was observed in the very year it was introduced, 1961. Several factors contribute to resistance. Of particular relevance to a correctional setting are crowded living conditions, which foster person-to-person transmission. Another major factor is inappropriate and increasing use of antimicrobials in general, with studies suggesting that up to 50% of antibiotic use is inappropriate. In the outpatient setting, physicians too often acquiesce to patients’ demands for meds, even when their illnesses are viral. Among inpatients, misuse often relates to empirical treatment in surgical cases.

Staph bacteria are generally spread by direct or indirect physical contact with the skin of an infected person or with objects that have become contaminated with the bacteria.

For a fact sheet on Staph aureus and MRSA, visit the CDC at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html.

— About the author:  John H. Clark, MD, CCHP-A, is chief medical officer for the County of Los Angeles Sheriff’s Department. This article is based on his presentation at the Clinical Updates in Correctional Health Care conference in Anaheim, CA, in April. Clark wishes to thank two colleagues whose efforts were invaluable in identifying this outbreak: Martha Tadesse, public health nurse in the communicable disease unit of the Medical Services Bureau, and Elizabeth Bancroft, MD, epidemiologist for the Los Angeles County Department of Health Services.

[This article first appeared in the Summer 2003 issue of CorrectCare.]