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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

 

OMG! MRSA! '¦and antibiotics and pets

November 26, 2007 / (7) comments


M.ethicillin R.esistant S.taphylococcus A.ureus, AKA, MRSA. It’s all over the news and the news is not so good. Though this group of bacteria has been with us for decades, alarming the medical community with its recalcitrance in the face of our most useful antibiotics, its newsworthiness has suddenly soared. That’s partly because of its increasing incidence in the general population (94,000 people are infected annually in the US) and partly because so many of those infected actually die from it (about 19,000).

Last month, my son’s school experienced one of this country’s numerous, well-publicized MRSA outbreaks. Several staff members (though no students) were hospitalized. The TV newshounds set up shop across the street, tying up traffic and generally making a nuisance of themselves.

Parents could be seen screaming their indignation into microphones, “Why didn’t we hear about this before now? How could they allow our children to be exposed to such deadly bacteria without broadcasting its presence?”

Before the day was out, my son has been effectively branded with a large, green, Sharpie-marker circle around one red spot on his arm (likely sustained from our dog Vincent’s playful tusslings or some tree-climbing adventure). He was remanded to the pediatrician’s place ASAP and told to beware of pustular development at the site.

That’s a lot to handle when you’re a nine year-old. He came home scared and confused—not least because half the school’s parents had elected to pick up their children early. (I was working and couldn’t be bothered to freak out over a teeny red spot I’d already observed and discounted, having read about the school’s issue before most other parents). Nonetheless, he’d had to be driven to the doctor, only to be handed a note and told to reprimand the nurse for her breach of privacy over the circle thing. 

What a fuss over a red spot! Whose kid doesn’t have at least a few little cuts and scrapes at any given time?

In the school’s defense, MRSA definitely deserves some special attention. That’s because treatment almost invariably requires hospitalization and surgical debridement is often employed to limit its spread. No, it’s not a fun kind of bacterial infection to harbor—not that any ever are. In some cases, patients succumb to its effects, but that’s increasingly rare as long as the site is attended to early on.

Though human-to-human spread (especially in hospital and locker-room settings) is the mainstay of transmission, recent attention has been paid to animal hosts. That’s because the use of antibiotics in our food supply has become an issue for many Americans. And also because pets, too, can harbor MRSA bacteria on their skin just like humans. Their rates of infection with these potentially deadly bacteria are also on the rise. Consequently, that’s led to a great deal of finger-pointing in the pet-vet direction.

For my part, what stresses me most on the subject is not so much the individual pets affected—my cases have all recovered well with appropriate treatment (I’ve seen perhaps five in my career). Rather, I concern myself more with the possibility of animal to human transmission. It seems this is a real possibility, though contamination from pets is still theoretical and requires further study.

To that end, research is currently underway at the University of Missouri. Yet another study is being prepared in association with the American College of Veterinary Internal Medicine.

But the larger issue here is even more sinister than the possibility of infection from pets you share your bed with. It’s that our antibiotics, particularly those in the penicillin family, are increasingly useless against a rising tide of so-called “super-bugs” armed with wily genetic mutations geared to surviving our best drugs’ efforts.

Is it the cows, pigs, fish and fowl we overstuff with antibiotics? Is it the chronic antibiotic therapy for persistent skin infections in pets? Is it the round of antibiotics we foist on our flu-ridden children or put down our own gullets whenever a cold threatens? It’s probably all of the above—each situation influencing the evolution of these bacteria to varying degrees.

MRSA may be just the tip of the iceberg when it comes down to the nuts and bolts of antibiotic overuse. Will we have the technological and political wherewithal to stem the tide in time? Not for at least 19,000 of us every year—not unless we find better ways to deal with the problem than circling our children’s lesions with Sharpie markers and pointing fingers at pets.

PS: Thank you to the Veterinary News Network for providing valuable information, including statistics, for this post.

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COMMENTS (7)
1
by on 11/28/2007 03:32am

Oops--sorry about typos! Sometimes the fingers get ahead of the brain-wish I could go back and edit my errors.

2
by on 11/27/2007 10:01pm

taMRSA madness is rampant now, and the media has the general public in a frenzy. Yes, MRSA can be quite serious, along with its lesser-known cousin VRE (Vancomycin resistant enterococcus). Current human guidelines mandate culture and sensitivity; and first-line treatment for MRSA is usually a relatively inexpensive drug; trimethoprim-sulfamethoxazole (Bactrim, Septra, TMP-SMX). In most cases, simple good hygiene is the key to prevent spread--decontamination of soiled inanimate objects, proper covering of wounds, and scrupulous handwashing. Closing schools and canceling activities is overkill, and ridiculous. We all carry Staph. aureus on our skin as normal skin flora, so the potential is there for everyone to develop this superbug; particularly those who have received frequent and varied courses of antibiotics. (Remember this parents; next time you want your kid's pediatrician to give them an antibiotic for their sore throat--probably 90% are viral and won't respond to antibiotics, the only reason to treat with antibiotics is a positive Group-A Strep culture). I would assume the same guidelines should apply to our pets; culture & senstivity and cleanliness should be a given in suspected MRSA cases.

3
by on 11/27/2007 07:04pm

A study was recently published about a strain of MRSA in humans that was found to have originated on swine farms in the Netherlands:

http://www.cdc.gov/eid/content/13/12/pdfs/07-0384....

4
by on 11/27/2007 11:41am

To add on to what Xslf has said:

I don't know if I could recall the hundreds and thousands of times that a client in our hospitals has asked if it is ok to just "get the antibiotics" instead of coming in for an exam AND then the number of veterinarians who have given in and prescribed the antibiotics. It is really a sad situation. Rather than opt for a culture and sensitivity test to determine the species of bacteria and best course of action, so many would rather continually shell out $20-30 for antibiotics every 6-8 weeks and allow the pet to suffer as well as select for the "bad bugs". To be fair, I have also seen many veterinarians and veterinary staff avoid mentioning a culture and sensitivity screen because of a perception that the client can't pay. All in all,very sad!

The University of Missouri study should be very interesting. They are actually trying to divide the pet owners into 3 categories....those who work in the veterinary field with pets, those who work in human healthcare with pets, and finally, those who have pets but are not associated with the healthcare industries.

5
by on 11/26/2007 05:06pm

Janine: One of the websites I linked to in the post had a link to the Bella Foundation. Before this post I had no idea it existed. Thanks for the direct link.

6
by on 11/26/2007 02:16pm

Not sure if you've heard about it, but there is a group dedicated to helping educate pet owners and veterinarians about MRSA in pets. It's called the Bella Moss Foundation (named after the creator's dog, who died from a MRSA infection because no one diagnosed or treated it properly):

http://www.thebellamossfoundation.com/

7
by on 11/26/2007 02:01pm

a few random comments:
* One thing that drives me crazy on pet message boards are people who post messages like "I think my cat/dog has an ear/eye infection, and I have some antibiotics left. Can I put some on my pet? I don't want to go to a vet"
Or worse, those who recommend to other people to put antibiotic on any little cat scratch they happen to get.
Arrggh!
* As someone who is allergic to Penicillin (a few years back, a single dose of AMOXYCILLIN given to me for a tonsil infection sent me in an ambulance to the ER), I sure hope I won't catch one of those bugs.
* My mother has chronic bronchiectasis, and goes through alternating rounds of antibiotics to control the infection in her lungs. Our of us dread the day they will no longer have effect, and we are well aware that we are actually selecting for that day. Too bad the other option for is to stop breathing...
(when they stop working it will probably be time for her to go on the waiting list for a heart and lung transplant. Not a prospect we are looking forward to).

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About fully vetted

Patty Khuly, VMD, MBA

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Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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