Mike the Mad Biologist

If you want the short version, Superbug: The Fatal Menace of MRSA is a must read. While I have a couple minor quibbles (more about those in a bit), they don’t detract from either the importance or the style of this book. While there has been a lot written about methicillin resistant Staphylococcus aureus (MRSA) that describes how awful these infections can be, unlike most authors, McKenna makes it clear that this epidemic arose and persists because of human error.

Rather than throwing our hands up and proclaiming doom and gloom–although there is a fair bit of that (and rightly so)–McKenna describes some of the successful efforts to control MRSA and describes why they haven’t been implemented in the U.S.

I could only find three areas of disagreement. First, the most dangerous commensal bacterium in the U.S. is not MRSA or S. aureus in general. It’s E. coli associated bacteremia, which, in the U.S., kills twice as many people annually as does MRSA. And unlike S. aureus, we are all colonized with it (not that exceeding HIV/AIDS deaths is nothing to shake a stick at). The only other problem is that the last word is given to vaccination, which, to date, hasn’t been successful. I would have ended with the successful MRSA control programs. Finally, while community-acquired MRSA is a problem, most of the deaths are still the ‘typical’ MRSA cases of healthcare-associated disease targeting immunocompromised patients; I think a little too much emphasis was placed on the community-acquired MRSA.

Nonetheless, even if you’re an expert on MRSA, you’ll learn something new. Superbug is a good read and worth the purchase.

Comments

  1. #1 Maryn
    May 4, 2010

    Mike – thanks so much for this piece! Huge appreciation that you broke out the time. I’ll look back on E.coli.

    About vaccination: I don’t actually think it’s the answer — so the last word was more meant to reflect that staph researchers do. Even if we were to achieve a staph vaccine (debatable), and to decide whom to give it to (tricky), we’d face the much larger issue of whether people would take it. We’re becoming a society that turns away from vaccination, sadly; new vaccines face a much steeper curve of acceptance than ever before.

  2. #2 JT Wenting
    June 8, 2010

    Stating bluntly that everyone is colonised with E.Coli in conjunction with superbugs is needless alarmism.
    There are a great many strains of E.Coli, most of which are perfectly harmless and even beneficial (in fact, without them our digestive tract would likely shut down).
    Those beneficial strains are those everyone has in their gut, not the malevolent variety.
    Those who for some reason loose those colonies are in deep trouble.

  3. #3 Michelle
    June 8, 2010

    JT–

    I’m only guessing here, but I think Mike raised the point that we’re all colonized with E. coli to point out the complexity of the problem when someone’s affected by a pathogenic strain. You can’t just go blasting away at every strain in the body as treatment, not without upsetting the *useful* colony. On the other hand, you can’t just do nothing, as pathogenic E. coli strains can be really, really dangerous.

    A recent PNAS paper on attempts to create an E. coli vaccine against certain pathogenic strains discusses some of these issues. You might find it interesting.

    Blog post on experimental vaccine

    Original PNAS paper

  4. #4 Mike the Mad Biologist
    June 8, 2010

    JT,

    The link refers to the observation that ~36,000 people die annually in the U.S. from E. coli-associated disease. That’s not alarmism, but data. If you skim through the blog at all, anyone will see that, of course, I don’t think all (or even most) E. coli are the problem.

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