Staph Infections And MRSA: Passive Attitude Of Physicians Is Causing Harm To Patients!

Staph And MRSA Infections Are Increasing! Why?

Staph infections and MRSA infections are on the rise. Every year, they become more and more common. These infections can be very serious, even causing death. A recent experience has led me to believe that the nonchalant attitude displayed by many physicians is contributing to the increase and spread of both infections. To help you understand this conclusion, explanations of the infections are necessary, but first let me tell you a little bit of the personal side.

My best friend is a mental health social worker in a Southern California county women's jail facility. She works with the sickest of the sick. It is not uncommon for her to encounter young women, so seriously disturbed, that they eat their own feces. In her position, she is often faced with hopeless situations, women who may never be helped. While speaking to her on the phone, she explained that her neck was killing her. I was aware that she had been feeling ill for several days, and then she told me she thought there was a bite or sting of some sort on the back of her neck. A member of her family had looked at it and told her that it appeared to be filled with pus. Because I have had repeated experience with staph and have had MRSA, I was immediately alarmed. I knew that it sounded like a staph infection, maybe even MRSA.

I know the facility my friend works in has a continuing problem with MRSA; a problem so pervasive that when she was hired, she was forced to sign a confidentiality statement promising to never disclose to media that the problem was severe or ongoing. There are signs throughout the facility warning of MRSA. In spite of the facility's awareness that MRSA is rampant, anti-bacterial gel has not been made readily available. Containers that are supposed to hold the gel are often empty for weeks, and employees are instructed to buy their own gel and wipes for use while at work.

I told her to google staph and look at some of the pictures and then to call her 24 hour insurance nurse advisor. The back of her neck looked just like the pictures and the nurse advisor told her to get to a hospital within the hour, which she did.

She was seen at Marina del Ray Hospital by the ER doc who was on call that night. He is certified in emergency medicine and has no malpractice cases pending. The hospital she went to has a decent reputation. The doctor incised the abscess and drained it. When my friend asked him to culture it, the doctor said there was no need; he knew that it was staph. He prescribed 2 antibiotics, and she was on her way. She was given no follow-up instructions, but was given 2 days off work. A review of the chart shows no mention of staph. Since that visit, she has had to see two additional doctors. The second physician took cultures, and even though he also believed the abscess was staph, told her to have someone in her family squeeze the abscess to get more liquid out of it. That's right! In the absence of a definitive diagnosis and the probability that the abscess was staph, expose members of the family! Great advice! The first culture has come back as staph and the MRSA results will be back by next week. She finished her course of antibiotics, with limited improvement. The third physician, a work comp doctor, has started her on a second, different course of antibiotics because the first course was ineffective. Not only was the first course ineffective, the original prescription only provided a 7 day dose, which according to the third physician, should have been prescribed as a 10 day regimen. Errors all around! I feel that this is just the beginning of what may be a long and difficult journey for my dear friend. Staph, once it has invaded, has a nasty habit of rarely leaving, only to return, time and time again. These infections can last for years.

The first physician, despite telling my friend that she had a staph infection, refused to take a culture, did not record that diagnosis in the medical record and prescribed incorrect antibiotics. The second doctor, knowing that it was staph, took a culture, but advised her to expose her family members to this highly contagious infection.

From MedicineNet.com, A Staph infection is: "Staphylococcus is a group of bacteria that can cause a number of diseases as a result of infection of various tissues of the body. Staphylococcus is more familiarly known as Staph (pronounced "staff"). Staph-related illness can range from mild and requiring no treatment to severe and potentially fatal." Most of these infections are caused by an organism called staph aureus. These infections are contagious and usually manifest themselves through abscesses, boils or furuncles. Pus is usually present. When staph enters the blood stream, it can cause sepsis and organ failure, which can be fatal. Almost all literature concerning staph infections recommends that physicians take a culture and determine the nature of the infection. Treatment for staph is most generally an antibiotic ointment applied topically and a broad-spectrum oral antibiotic. Culture of the site is part of the accepted standard of care.

MRSA, or antibiotic resistant staph aureus, can be difficult to treat and is highly contagious. From MedicineNet.com: "MRSA infections are usually mild superficial infections of the skin that can be treated successfully with proper skin care and antibiotics. MRSA, however, can be difficult to treat and can progress to life-threatening blood or bone infections because there are fewer effective antibiotics available for treatment." Culture of the site is part of the accepted standard of care.

Staph and MRSA are infections that can be caught by anyone. MRSA, up until recently, was rarely found outside of hospitals, prisons, or where large populations were held in crowded, sometimes unsanitary conditions. Now, however, they have become more community-based infections and MRSA is found almost everywhere, including schools, gyms and locker rooms, even grocery stores. Left untreated, or improperly treated, MRSA mortality rates can be very high. Pediatric cases of MRSA are on the rise, with toddlers and young children, and the bacteria is now invading their ears, noses and throats in record numbers.

The infections have become so prevalent that many states have found it necessary to include staph and MRSA as work-related illnesses. In those states, if you are a hospital, health care worker or prison employee, staph and MRSA are automatically presumed to be illnesses contracted in the workplace and you are compensated for your illness and entitled to medical care.




Why Is The Standard Of Care Being Ignored?

A diagnostic and treatment process that a physician should follow for a certain type of patient, illness, or clinical circumstance is called the standard of care. For each set of symptoms and conditions, there are procedures that prudent physicians should follow. So, in the case of suspected staph or MRSA, almost every piece of literature stresses the necessity of obtaining a culture. A culture is the only way to determine staph aureus or MRSA infection on the skin or in a lesion. In the absence of a culture or blood work, there can be no definitive diagnosis, and therefore, it is possible to treat the patient with an ineffective medication. If the medication is ineffective, the patient's condition can become worse, and in the worst of cases, the patient can die.

I would not want to be the patient of a doctor who, when presented with an infection that he believes may be staph, refuses to take a culture. I would not recommend that physician to a friend or family member, and I would refuse to pay a bill from a doctor who fails to provide me with an official diagnosis because he does not comply with the accepted standard of care.

Why would a physician refuse to culture a lesion that he encounters? Why would a physician skip running a simple test? Laziness? Incompetence? Rushed?

The Possible Consequences Of Sloppy Medical Care!

Everyone knows what can happen if the medical care you are provided turns out to be sloppy. The resulting damage can be life-lasting or even life-ending. With the ever increasing incidence of staph and MRSA in this country, there is no excuse for ignorance or laziness on the part of the medical community. Ignorance or negligence is inexcusable in relation to these two diseases. There is too much information readily available regarding the treatment of staph and MRSA. The diseases are no longer rare and every physician should be responsible enough to educate themselves. Doctors do make mistakes, but the pattern of treatment experienced by my friend was not a mistake. The pattern of treatment she has received may fall short of malpractice, but it is far from what would demonstrate best practice. Finally, the pattern of care received does nothing to convince me that the medical community is taking this illness seriously.

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Comments 21 comments

cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

standard of care for treating a skin abcess is incision and drainage with follow-up for removal of packing in a couple of days. at the two-day follow-up, the infection is usually seen to be cleared. antibiotics and culture are considered unnecessary. your friend got more than the standard of care, perhaps because of her workplace's reputation for MRSA, if she gave her doc the full history.


cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

standard of care for a skin abcess is incision and drainage (no antibiotics, no culture). this approach has been recently validated in a study published in a reputable journal. almost invariably, at follow-up in a couple of days for packing removal, cure is noted.

your friend received more than the standard of care, perhaps because she shared her history of exposure at work.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Hi,Doc!

Always glad to hear from you! Any info you give is valued! I know that American Family Practice has published a new study on the standard of care for skin abscesses. Think they published on 4/15, but I do not have paid access to the publication. I would love to see it if you have a link that I could use, or even a link to the journal that you reference.

From almost all of the literature that I have read, a culture should be done, especially if staph or MRSA is suspected. This was a large abscess, with the affected surrounding tissue >5 cm. She gave the doctor the full history and info on her risk of exposure, and also requested the culture in case work comp was to be filed. The abscess was drained and no packing was used. I was surprised, because of the size of the abscess. Also given no follow-up instructions. By her visit to her doctor, the wound had closed from the outside, the abscess had filled again and the second doctor suggested that a family member should "squeeze it".

As I was writing this, I hoped that you would read it and comment. My friend has had a rough two weeks, and is still sick.

When I had staph, the infection lasted for well over a year. I was visiting the surgeon almost every other day. The MRSA was two years ago, and that was equally unpleasant.

I am unconvinced that the ER doctor, or her own doctor, acted within the standard of care, and if they did, feel that the standard should be re-examined. The prevalence of staph and MRSA in the community alone should call for a concerted effort to lessen the occurrence of the infection. How? I don't know. But this is a serious and growing public health issue.

Thanks, Doc!


cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

annals of emergency medicine, sept., 2010. the study included those with MRSA. cure rates were about the same with or without antibiotics and side effects were much higher in the antibiotic group. there was a secondary outcome of recurrent infection within 30 days that may have been improved with antibiotics - more study is needed.

unnecessary antibiotic use promotes resistance to even more antibiotics.

i, however, like you, am amazed that nothing was done to keep the abscess open and pus from recollecting. after the packing is removed, warm water soaks for 20 min 4X per day is usually prescribed.

if a patient asked me for a culture to document a worker's comp claim, i would have certainly agreed to this harmless intervention.

your friend probably does have MRSA, given the size of the abscess and the surrounding redness.

was she given bactrim (trimethoprim-sulfa)?


chefsref profile image

chefsref 5 years ago from Citra Florida

Hey Jillian

WOW, Excellent and scary. And still leaders, be they in medicine, industry or government are slow to respond to circumstances

Up and useful

Lee


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Hi, Doc!

Thank you for the info. Will be doing some reading tonight. How boring, right? The first physician gave her a 7 day dose of Bactrim and a 7 day dose of Keflex. Because the abscess and surrounding tissue were still hot, red and inflamed, and of course, full of pus, the third doctor put her on a second course of Bactrim, but for 10 days, and doxycyline. She was concerned about the antibiotics, too, and they have made her sick. You know what they do... When the first doctor did not use packing, I guess that is what really got to me. Had my staph infection after a C-section. Came home with it. And the doctors kept stressing that the packing had to be there, so that it would heal from the inside out, like you said, with no recollecting of the pus. My doctors gave me the exact instructions that you gave regarding the packing and warm water soaks. Hopefully, my friend will be better soon. This has really hit her hard. Thank you!

Dear Lee,

It is scary, especially after you have had it. They say that the best prevention is antiseptic gel, but even with that there is controversy.

You, as a chef, might be interested in this article about staph food poisoning. http://www.webmd.com/food-recipes/food-poisoning/t... . Pretty interesting! Thanks, Lee!


cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

one hospital significantly lowered their rates of MRSA infections by doing nasal cultures of all admissions, isolating the MRSA positive patients, making staff wear gloves and gowns to tend to the positive patients, and rigorous hand-washing requirements.


cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

some MRSA is resistant to Bactrim, too. docs should have an idea what MRSA in your area is likely to repond to. there's vancomycin, and some new drug (after my time) that starts with a "Z".


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

I had heard about a few facilities lowering their rates through pre-screening and then concentrating on keeping the infections contained by paying strict attention to hand-washing and isolation protocols. The articles I read stated that the hospitals involved started that because so many insurance policies (beginning with Medicare and now commercial insurance companies)are denying payment for any services that they believe are due to 'hospital acquired' illnesses or complications.

I have heard that there are several new drugs on the horizon for both staph and MRSA, but that so far, evidence doesn't show any of them to be the "golden bullet", as one study coordinator says. The problem seems to be that overuse of the effective antibiotics has caused the strains to change and then the drugs become ineffective. Even vancomycin and linezolid, which is relatively new, are losing some of their effectiveness because of overuse in certain areas. Haven't heard of the one that begins with a 'Z'.

Just let me tell you, Doc, if you were still practicing, I would be your patient, although with all of my issues, you might not want me. When I met the doctor I have had for the last 5 or 6 years, she told me that I was going to ruin her averages because my blood work was so bad.

Pretty funny, right? I love her, and now my blood work helps her averages! She is probably the best doctor I have ever had! Don't know how she does it!

It is tough, really tough to fight this infection effectively, but R&D is being conducted all over the world, so hopefully...


cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

well, it doesn't start with "Z". you got it. linezolid.

glad you have a good doc. the best thing about my doc is that she listens to my suggestions. she's also compassionate and cautious. she had me go through some unnecessary tests (US and MRI)last year due to not understanding perimenopause (i didn't completely either, we're both internists, so i didn't argue 'til late in the game. when i finally got to the ob-gyn, the tests were already done. i think there may be a hub in there. thanks for inspiring the idea, jillian), but she is a keeper.


PETER LUMETTA profile image

PETER LUMETTA 5 years ago from KENAI, ALAKSA

What a facinating article but a sad one also. I hope you and your friend weather your storms well. I can identify with your fears since I am diabetic and not getting the treatment I need. Health problems are very distressinga and scary. It really helps to have folks like Cathylynn and you Jillian to help us understand what we need to do. Peter


CreatePerfection profile image

CreatePerfection 5 years ago from Beautiful Colorado

Dear Jillian, I am concerned for those who must rely on conventional medicine for treatment. I do not want to stereotype the whole industry, but my personal experiences have been tainted by substandard care. In 1999, I fell backward from a boat, in drydock, to concrete below, giving me a hematoma on the right back of my head and breaking 4 ribs in my back. I was in the hospital for 5 days without being bathed once, or even having my hair combed. The staff told my husband upon my being admitted that there was nothing wrong with me. On the 5th day of my stay, a Physical Therapist dropped by and I asked him what I had to do to be released, but I told him I wanted an xray of my back before I left. He sent me for xray immediately, where it was discovered I had 4 broken ribs in my back. He said, "What has your treatment been like?" I told him I had not been bathed even once or had my hair combed and that in addition to other negligence, the doctor had not been by to see me and the nurses seemed annoyed by my asking for a bed pan, and were adamant that I should just get up and go to the bathroom, myself. I could go on, but you get the gist.

I will do everything in my power to avoid any type of conventional medical treatment.

Thank you for this very insightful article.

Up/Awesome

Blessings...

Lela


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Doc,

Your brain works like mine-thought you might be referring to linezolid; I think of it as the one beginning with the 'z', also. My doctor is also an internist; they are the best, in my opinion. Glad that you have a doctor you communicate with. I love my doctor, too! She is just about the smartest person that I have ever met, and at the same time, easy to talk to and she has that unique ability to make her patients feel comfortable and safe.

Dear Peter,

Thank you, but you must be careful to get the meds you need and take care of yourself. Those damn ATM machines don't help, right? A diabetic with a staph infection is not a good thing! Think I will edit the article to include precautions. Thank you, and take care!

Dear Lela,

The experience you had was so horrible! No excuses for that! It took me many years to find the doctor I have now and I have worked for more than I care to remember. They are just people, none perfect (except for mine)and the M.D. behind the name does not change the basic personality. Don't give up on conventional medical treatment.

There are some really fine doctors out there! I have also known many of them. The 'art' of medicine is just that. Knowledge changes medicine everyday. Here is something I have found useful. When I needed an Obstetrician, I called the hospital OB unit and asked the nurses who the best OB-Gyn was. They directed me to the right one. When I needed a new internist, I asked nurses. They led me to the doctor that I have now. The nurses know who is the best and they also know who is the worst.

Thanks, Lela. Wish you lived close. I would introduce you to my doctor.


cathylynn99 profile image

cathylynn99 5 years ago from northeastern US

new blood test approved by FDA for MRSA sepsis - only takes 24 hrs.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Hi, Doc! Told you we think alike! Put a link to the article about the new test about an hour ago. I was really happy to read about it! So important! I hope that it cuts down on the overuse of antibiotics and at the same time saves many lives! I think I will give it its own capsule, so it is more noticeable! Thank you!


aristip 5 years ago

thanks for post


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

You are welcome! Aristip


Sembj profile image

Sembj 5 years ago

Bravo for bringing our attention to a topic that doesn't receive nearly enough attention. It is alarming how fast the threat has grown quite unnecessarily, in my view, if proper steps and procedures had been undertaken earlier a lot of harm and heartache could have been averted or even if introduced at this late date some of the devastating consequences could be dodged.

My understanding is that a lack of proper cleanliness and hygiene in the hospitals was where a lot of the problems started and practices there are still far from perfect.

Useful and important information - thanks.


Jillian Barclay profile image

Jillian Barclay 5 years ago from California, USA Author

Semj,

You are right! It is believed that most staph and MRSA was originally found in hospitals and spread that way. Now, it is everywhere: schools, gyms, jails, even the workplace. It is a scary infection!

Thank you for commenting!


katesisco 4 years ago

Actually the above reason is why doctors are not wanting to see this epidemic of staph. Not only is it hard to cure, it goes away and comes back repeatedly, as you said. I expect another way staph got out in the community was on clothing. A kindness gone wrong; clothing donated by deceased family may carry staph.


Jillian Barclay profile image

Jillian Barclay 4 years ago from California, USA Author

My best friend works in a county jail as a psychiatric social worker. I agree that it can be found on clothing. My friend washes her clothes in CLOROX 2 every day when she comes home. Even wearing gloves has not helped. The deputies are convinced that staph and MRSA are in the air and coming through the ventilation system. She has now had staph twice and is still being treated. Once you get it, it seems to never go away. There are signs all over the jail that warn of ongoing MRSA and staph---soon, we will be seeing those warning signs hanging in schools and locker rooms, too, I fear!

The doctors say that community acquired staph is very common---the problem is that no one seems to be aggressive in trying to eliminate it.

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