SGH’s Director of Infection Control shares about the importance of simple hygiene habits to combat the deadly MRSA superbug.

He woke up coughing, feeling weak and with body ache. Just the flu, he thought. Less than 24 hours later, he was dead. An autopsy found that the man had died from pneumonia caused by the superbug MRSA. This happened in the US a few years ago, and although it is an extreme example of what might happen to patients with an MRSA infection, the case underscores the aggressive nature of MRSA, or Methicillin-resistant Staphylococcus aureus bacteria.

First identified in the 1980s, the MRSA bug has since made its presence felt around the globe. Once associated with an infection that people pick up in hospitals, MRSA has now spread to the community, meaning it can infect anyone, anywhere. Not everyone gets sick when infected with MRSA, but it can cause serious complications in people with a weak immune system.

A study of patients at Singapore General Hospital (SGH) and National University Hospital (NUH) who became infected with MRSA bacteria found that “they were 10.2 times more likely than uninfected patients to die during their stay in hospital”, said Dr Ling Moi Lin​, Director, Infection Control, Singapore General Hospital (SGH), a ​member of the SingHealth​ group. The study, done between late 2007 and early 2008, also found that MRSA-infected patients stayed 4.6 times longer in hospital and faced four times higher hospital-related costs, she added. More of these patients faced ​complications, requiring readmission to hospital within six months after discharge, leading to higher costs for outpatient and hospital treatment.

How can good hygiene play a part in preventing the spread of the MRSA superbug?

Although the study focused on hospital patients – a group of people who are likely to have low immunity and so are more likely to get MRSA than people elsewhere – the findings heighten the importance of good hygiene for everyone. “Practising good hygiene is one way to break the transmission of MRSA bacteria,”said Dr Ling.

MRSA is known as a superbug because of its ability to resist most antibiotics. Although antibiotics might work in overcoming MRSA infection, anyone infected with the bug will largely have to count on his own immune system to get better. It is not surprising that for older people with a weaker constitution, an MRSA infection can be fatal. MRSA can infect people in different ways. The most common is via a skin infection that may look like a pimple or a boil. Occasionally, it can spread to other organs in the body and become life-threatening.

A new antibiotic that is able to fight MRSA and other types of superbugs is unlikely to be available for many years to come. While that is worrying, the good news is that good hygiene practices can reduce the spread of the bacteria significantly, said Dr Ling.

A programme that actively screens high-risk patients for MRSA and promotes the use of alcohol hand rubs and cleanliness on the wards has led to “a drop over the years in the number of hospital patients infected with MRSA,” said Dr Ling. “The infection rate is now about 0.3 per 1,000 patient days, but we are aiming for zero,” she added. MRSA is spread through contact – shaking hands or touching something that an MRSA-infected person has touched. “These MRSA carriers shed bacteria in places where they have been,” said Dr Ling. While it is more likely for someone to get infected with MRSA in hospital, it is not true that anyone who is warded will get the bug, she said. It is still possible to pick up MRSA in the community.

Running out of time

Drugs to fight the new breed of superbugs aren’t being developed fast enough to keep up with the rapid pace at which the killers are evolving, said Dr Ling. “A new bug can come anytime. There is a possibility a superbug is being created right now. We just don’t know when it will show itself. We just have to be prepared for it.”

That means stopping the superbug – when it appears – from spreading and turning into an epidemic. And the only way to do that is to stop its transmission through the community. The growth of the superbug stems in part from the widespread and often indiscriminate prescribing of antibiotics. Many people don’t complete the course of antibiotics because their symptoms disappear. But by not completing the course as prescribed, only some bugs get knocked off,” said Dr Ling. “Those which survive become resistant. Over the years, resistant strains develop and spread. This scenario sets up the evolution of the superbug.”

Scientists continually undertake research to develop new drugs to keep up with the growth of such new strains of bacteria, but it takes years for a new drug to be available for use. “It takes creativity, knowledge and at least 10 years to create a new antibiotic. But by the time it comes out, it may already be ineffective in fighting certain types of bacteria. We’re running out of time and ideas,”Dr Ling said.

Ref: U11