DR. HOOK- MRSA update: Everybody's vulnerable-- wash your hands!

The Grapes of Wrath is one of my favorite books of all time. Unbelievably, as slow a reader as I was, I finished the book in three days during my summer vacation after eighth grade. (In Ohio, our school system required that we read only The National Enquirer and Garfield, so my mother made me read books that her friends' kids had to read in the NYC school system.) 

I still vividly remember feeling completely despondent after finishing Steinbeck's novel. (I don't think I've ever completely recovered, come to think of it.)

Aren't grapes supposed to be associated with happiness? Kings are fed grapes while being fanned by servants. Grapes make Napa Valley the capital of wine and sophistication. Grapes make jelly for peanut butter sandwiches. What's Eating Gilbert Grape introduced many of us to Leonardo DiCaprio. 

But staphylococcus, from the Greek staphyle, which means "bunch of grapes," can be more than just sour grapes.

Staphylococcus aureus, which I will call staph, is a common bacteria found on 25-30 percent of healthy Americans– on the skin or inside the nose. Because penicillin became ineffective to kill this pest, a "super penicillin" called methicillin was developed in 1959. However, by the early 1960s some forms of staph had become resistant to that as well–earning the name Methicillin-Resistant Staphylococcus Aureus, aka MRSA (pronounced Mer-Sa). So MRSA is a resistant type of bacteria that doesn't respond to some common antibiotics.

MRSA caused over 94,000 life-threatening infections and over 19,000 deaths in the US in 2005. And as you've surely heard by now, here in Virginia, on October 15, MRSA killed a 17-year-old high-school student in Bedford County. And thus the national attention for this nasty bug.

But MRSA is nothing new. I wrote an article about it in October 2005 because a nurse said visitors often complain about MRSA precautionary measures in the hospital. "Why do I have to put on this neon yellow gown before I enter this isolation room?" many ask when visiting sick patients. "Don't you at least have organic cotton?" 

Well, MRSA is transmitted from person to person by direct contact, or just by sharing personal things like linens, bathroom items, athletic equipment, and clothes. Ten to 30 percent of hospitalized patients will have a problem due to MRSA infection, such as wound infections, skin infections, bladder infections, and pneumonia. So put on the gown, clown!

There are two groups of MRSA depending on the genetics of the staph. Hospital-acquired (HA-MRSA) accounts for 85 percent of cases and community-acquired (CA-MRSA) for the other 15 percent. About 1-2 percent of Americans are colonized with MRSA. This means the MRSA is on the skin or in the nose, just hanging around but not causing any problems.

However, if the MRSA enters the body– say through a cut, a needle stick, or surgical procedure– then it can cause an infection. If the skin is infected, an abscess (aka boil) can develop which is a pocket of pus. (In the microscope, the staph looks like clusters of grapes– ergo the name.) If it enters the blood stream, it can infect numerous organs like the kidneys and heart. 

There are antibiotics to treat MRSA, but in general it's better to prevent the infection. Wash, wash, wash the hands or use an alcohol-based cleanser like Purell. If there is a skin trauma like an abrasion or cut, it should be cleaned regularly and tended to. If it's an abscess, a doctor should see if it needs to be drained. Also it's wise not to demand antibiotics for viral colds (a useless therapy) because taking antibiotics increases the risk of carrying MRSA. 

MRSA merci, I hope we can eradicate MRSA one day, but I don't think it's going to happen any time soon. MRSA is our medical Grapes of Wrath.

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.