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In SUPERBUG: The Fatal Menace of MRSA, author Maryn McKenna describes the chilling situation in which we find ourselves, confronting the epidemic of methicillin-resistant Staphylococcus aureus (MRSA). Also chilling is how we collectively reached this point and our options for the future.
As she indicates on her Web site, the author of this noticeably well-written book, Maryn McKenna, is an independent journalist examining domestic and global public health, medicine, and health policy. She is also the author of BEATING BACK THE DEVIL: On the Front Lines with the Disease Detectives of the Epidemic Intelligence Service (The Free Press/Simon & Schuster, September 2004).
McKenna was formerly a beat writer for the Atlanta Journal-Constitution and covered the United States Centers for Disease Control and Prevention (CDC) from 1995 to 2006. Her stint in this capacity earned her the moniker “scary disease girl” from coworkers. She first encountered MRSA while shadowing epidemiologists from the CDC in 2003, examining an outbreak in the Bay Area of California.
In the Author's Note section of the text, McKenna analogizes the ubiquitous outbreak of MRSA as a flood and suggests, “It is a crisis of many dimensions.” According to the author, the MRSA outbreak is comprised of 3 segments: in hospitals, in everyday life, and now, in animals.
Chapter 1 provides a case history of MRSA and subsequent effects in the Chicago area. Chapter 2 is a historical analysis of an outbreak of a Staphylococcus aureus series of infections in New York, Seattle, and elsewhere in the 1960s. Chapter 1 also presents a summary of Sir Alexander Fleming and the early halcyon days of the “discovery” of penicillin and its widespread use, initially as a component of mouthwashes, chewing gum, throat lozenges, and other commodities sold without a prescription in the early 1950s. The effectiveness of a derivative of penicillin, later named methicillin, an effective agent against resistant strains of Staphylococcus, is described. The quick adaptation of resistant strains of Staphylococcus to methicillin in 1961, which was brought to light in a letter to the British Medical Journal sent by British bacteriologist, Patricia Jevons, is described, and is the focus on the problematic methicillin-resistant Staphylococcus aureus (MRSA) dilemma. In Chapter 3, McKenna provides further case histories and chronicles the emergence of community-associated MRSA along with the flourishing of hospital-acquired MRSA. Chapter 4 presents the chronology of methicillin resistance, which first appeared in the United Kingdom in 1961 and in the United States in 1968, and McKenna suggests, by 2000, MRSA had become the most commonly identified antibiotic-resistant pathogen in the world. McKenna elucidates the resistance mechanism for MRSA with a thoroughly detailed scientific description. In Chapter 5, McKenna presents the scope of the MRSA epidemic and how it has confounded researchers. The analogous rise in cases of MRSA parallels that of the AIDS epidemic in the 1980s. The final sentence of Chapter 5 refers to the converging of hospital and community epidemics. One disturbing point brought up at various points in the text is that there is not a required reporting mechanism in place for MRSA cases throughout the United States.
In Chapter 6, the MRSA epidemic is once again compared to a rising flood. One disturbing realization that is taking hold is that MRSA could pass between human and animal hosts, which is a concern for veterinarians and physicians alike. Chapter 7 addresses MRSA as a cause of pneumonia, and MRSA's coupling with influenza as well. McKenna also provides the results of researchers analyzing the1918 influenza pandemic with currently available technology, obviously unavailable in the last century, which shows that a large proportion of the deaths of the 1918 pandemic “…were due to severe pneumonia caused by common bacteria including staph.” (p.101) Chapter 8 presents the effects of contact sports on MRSA infections in elementary-age participants through professional athletes. Chapter 9 addresses MRSA within prison populations.
Chapter 10 presents information on how MRSA has infiltrated the food chain globally, initially from porcine sources. Human-acquired strains of MRSA have been dubbed nontypeable (NT). Pointing to agricultural uses of antibiotics, McKenna recounts data pointing to the use of 29.5 million pounds of antibacterials in animals, of which only 2 million pounds are used to treat disease. The remaining 80% is used for nontherapeutic purposes, eg, growth promotion or disease prevention. The concern is that this nontherapeutic use is leading to further resistance. In Chapter 11, infection control policies and procedures from hospitals across the United States are described. Use of soap, protective clothing, and system controls are presented.
In Chapter 12, the sobering description of the end of the line of novel antibiotic options to treat MRSA is detailed in depth. The initial emergence in 1989 of vancomycin resistant enterococci (VRE) is described with the subsequent initial case of vancomycin resistant Staphylococcus aureus (VRSA), which presented in 2002 in a Michigan woman.
In Chapter 13, McKenna presents the story of the converging of the 3 MRSA epidemics, and describes calls for funding emanating from eclectic sources to develop a vaccine to potentially stem the consequences of MRSA. Finally, in the Epilogue, McKenna describes the outcomes of patients (if information was available) for whom cases studies were presented throughout the previous chapters in the book. The Appendix lists the various antibiotic treatments, and the classes of antibiotics to which they belong, used with MRSA. McKenna concludes with advice to patients and caregivers when presented prescriptions for treatment of MRSA to insist that physicians discuss the prescribed drug's name, what class it belongs to, and what the rationale is for the physician believing the drug will be effective.
I recommend this book for pharmacy faculty members and students. It is a terrific book to use as a reference for infectious disease background reading. Each chapter of the book contains case studies of patients affected by MRSA and provides patient histories along with the patient descriptors. The volume provides a complete background for consideration of MRSA and its reach. The success and failures of all of the antibiotics used to treat MRSA are described from both efficacy and length of therapy perspectives. The book would be useful for health policy considerations, and for understanding the global effects of unrestrained and inappropriate use of antibiotics in clinical and agricultural contexts. The complete referencing (which is a hallmark of this author's work), the contents of the material covered in the book, and the manner in which it is written and distilled provide a rich backdrop for stimulating discussion and intellectual interchange.