Because this week is really hectic, I just want to follow up on this post I wrote about MRSA.
One of the hidden stories in the rise in the frequency of antibiotic resistant bacterial strains is that this has also been accompanied by an absolute increase in the number of infections. In other words, it's not the case that you used to have 90 sensitive infections and 10 resistant infections per year in your hospital, and now, you have 50 sensitive and 50 resistant infections (which would be bad enough). Instead, you have the same 90 sensitive infections and 90 resistant infections (for a frequency of 50% resistance). That's an 80% increase in infections (180 versus 100). This is a bad thing.
Essentially, rising resistance rates in a given hospital mean that infection control has gone to shit--which given the 33% infection over a three year period in the hospital-acquired MRSA infection rate is a pretty accurate statement.
A second point is that in this article that I pulled the figure from for that post, the authors present the figure that MRSA mortality rates dropped nearly forty percent. This sounds like a good thing, especially in light of the massive increase in MRSA infections. But don't let the statistics fool you: because there are no demographic and health data attached to the cases, it's far more likely that MRSA is infecting patients that are far more likely to survive infection. As MRSA casts its net wider, it's infecting healthier patients. That's not a decrease in virulence, but, again, a breakdown of infection control.
By the way, regarding 'patient choice', without adjusting infection rates for the amount of surgical procedures, as well as the patient demographics, how would patients be able to choose the most 'disease free' facility? Also, there is this depressing reality: someone has to end up in the crappy hospital. We shouldn't have free-market rationing of infection control.
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Thank you for raining on everyone's parade. The mainstream media usually want to scare the public as much as possible, so when they try putting a spin of goodness on some news about resistant strains, it never made any sense to me.
I had never suspected that healthier people were getting infections, which would of course reduce the mortality.
Now I wonder if the media softpedaling is driven by fear that resistance, and its transmission to other species, is clear evidence of evolution.
Evolution operates on all possible scales of time and scale, so maybe they worry that this business is just the camel's nose in the tent.
The very first sentence of my doctoral thesis, which focused on the mechanistic enzymology of a protein that confer resistance to aminoglycoside antibiotics, is
"...a hospital is no place for a sick person to be."
- Lowell Levin, Professor of Public Health, Yale.
I wrote my thesis in 1986. Sad to say that the issues of antbiotic resistance, including infection control, have changed so little, or if anything, have worsened.