ON MRSA & Prevention

The latest JAMA features a study reporting incidence of invasive methicillin-resistant staphyloccus aureus infections at a rate of 32 per 100,000.

As an accompanying editorial puts it, this is a truly "astounding" rate.  If accurate, the mortality rate, 6.3 per 100,000, means that 18,650 people died of invasive MRSA infections in 2005.  The editorial noted that this number exceeds the number of Americans who died of HIV/AIDS in 2005.

The authors note that "[t]he incidence of other important invasive pathogens in 2005, such as invasive infections with S pneumoniae or Haemophilus influenzae, ranged from 14.0 per 100 000 to less than 1 per 100 000, largely due to the availability and success of vaccination."

Unsurprisingly, the study also documented disparities among MRSA infections, with both African-American and elderly populations having significantly higher incidences of infections than whites in their respective communities.

MRSA, which was one almost exclusively a nosocomial infection present in acute care facilities, has begun to appear in health-care related community settings.  The authors warn, however, that

invasive MRSA disease is a major public health problem and is primarily related to health care but no longer confined to acute care.  Although in 2005 the majority of invasive disease was related to health care, this may change.

Although there are many fascinating and troubling implications of this study, what interests me most is the relationship between the study findings and the narrative I have been suggesting regarding the lack of resources and policy attention paid to public health and preventive medicine.  It seems difficult to contest the notion that it is both cheaper and more effective to prevent MRSA infections from occurring rather than treating subsequent infections.

Indeed, the majority of hospital-acquired infections could likely be prevented by better adherence with basic hygiene measures (see here [PDF]).  While the issue has gained exposure in the last 5 years, and this latest study will surely help, it is nevertheless the case that intensive and organized public health and prevention schemes have been sorely lacking (see prior link for more analysis).

This micro-level problem is simply, IMO, a symptom of the larger problematic public health policies in the U.S., which allocate almost nothing to public health and preventive medicine and instead direct approximately 95% of health care dollars to acute care and biomedical research on acute care interventions.  Indeed, the JAMA editorial notes that "traditionally [MRSA] has not been considered of major public health significance."

Needless to say, I think such allocation policy is deeply misguided.  This latest study at least indirectly supports my view.