The House Guest

"Bob"

“Bob”

In the 1991 comedy What About Bob? Bill Murray plays Bob Wiley, a psychiatric patient who not only befriends the family of his psychiatrist played by Ricard Dreyfus, Murray turns into that dreaded house guest who just won’t leave. To make matters worse, Murray ends up marrying into the family notwithstanding Dreyfus’s numerous efforts to get him out of there including “death therapy” – placing 20 pounds of explosives in Murray’s backpack on a hiking trip. I’m reminded of the film by research published this week that casts MRSA in the Bill Murray role.

Investigators visited the homes of 350 people in Chicago and Los Angeles who had come to the hospital with skin infections. At these home visits investigators looked at family members’ noses, throats and groins for MRSA colonization. Of the 812 household members studied they found that MRSA colonized one or more of the body sites in 50% (405) of the cases.

Using fancy genome sequencing techniques they also found that: (1) MRSA persisted within the households from 2.3 to 8.3 years before their samples were collected (2) MRSA is transmitted from person to person within households that contain an individual with a skin infection, and (3) MRSA can evolve so that it becomes genetically unique to that particular household. Similar research has found that these newer strains are more drug resistant and dangerous than earlier strains thus making the MRSA harder, or even impossible, to treat.

How MRSA got into those households in the first place was not part of the study. But we know from other research that, ironically, hospitals themselves are implicated. That’s because when hospitals discover a patient is colonized with MRSA they don’t treat it – they don’t “decolonize” that person. Instead, so long as the person isn’t infected (sick) they’ll send them home once their primary illness permits.

But given that MRSA colonization is the greatest risk factor for MRSA infection, and because the researchers involved in today’s study conclude: “Decolonization of household members may be a critical component of prevention programs to control MRSA spread in the United States,” it seems time to reconsider the wisdom of sending MRSA-colonized patients home untreated.

The good news is you don’t need 20 pounds of explosives to it. We have the technology.

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