Rivera Family Sues After NYC MRSA Death, Why Superbugs Will Take Over

Nobody will argue that the death of 12 year old Omar Rivera was not a tragedy, but why does his name need to be dishonored by suing the hospital and NYC Health and Hospital Corp?  This is not a one-sided argument, however.  This is the type of high-profile case that vilifies everyone, from the parents, to the hospital that treated the child, to the media, to our entire healthcare and judicial systems.  Firstly, this case is already causing a panic in the population because of how it has been handled by the media. This MRSA, or methicillin-resistant Staph Aureus, was first isolated in 1953 and has been a constant battle in hospitals, showing up in the sickest, most stressed and immunocompromised patients.  Along with VRE (vancomycin-resistant enterococcus), healthcare workers have constantly put themselves at risk to treat these “superbugs” that are nothing more than the natural response of bacteria to our use (and often overuse) of antibiotics.  All organisms have the ability to adapt to environmental pressures, and since the advent of antibiotics, humanity has pressured bacteria to evolve in order to survive our chemical assault.  The unfortunate part is, that through irresponsible use of antibiotics, we have hastened this evolution and continue to encourage microbial resistance.  As an ER doctor, since moving from Massachusetts to California just 4 years ago, we have gone from treating skin infections, known as “cellulitis”, usually caused by Staph and/or Strep bacteria (which live on all of our skin and you can’t get rid of, no matter how much antibacterial soap you use), with penicillin or a 1st generation cephalosporin like cephalexin (Keflex), to using entirely different classes or multiple antibiotics due to resistance.  Currently in California, greater than 50% of skin infections are due to MRSA, which is now classified as “community acquired”, since we no longer see it exclusively in very ill or immunocompromised patients.  Because this is such a new phenomenon, I still see primary care doctors and others placing patients on the “old” antibiotics for these newer “superbugs”. It sounds like young Mr. Rivera was placed on amoxicillin for his cellulitis, which just a few years ago, would have been fine.  This issue is so new, however, that studies are just coming out that document these new changes in resistance patterns and the proper antibiotic treatment is still under development.

So what can we do? We as citizens need to question any and all antibiotic use.  Stop demanding antibiotics from your doctors.  Stop using antimicrobial soaps and sanitizers (see this previous rant)- we evolved to live commensualistically with bacteria on our skin, you cannot and should not sterilize yourself.  In today’s high-volume, low-reimbursement healthcare system, it is easier for a doctor to prescribe antibiotics for a viral cold than to explain to a demanding, rude, uninformed patient, that antibiotics are only for bacterial infections like pneumonia, cellulitis, and urinary tract infections and do not treat viruses.  People expect a “magic bullet”, that by going to the doctor there will be come miracle cure for every ailment and sniffle.  Unfortunately this is not the case, but these expectations, along with the corporatization of healthcare, demanding “customer satisfaction” over good medical practice, is indirectly leading to the type of irresponsible antibiotic use that is causing these “superbugs” in the first place.  We as physicians need to take the time to discuss the proper use of antibiotics with our patients and give them only what they need, not what they think they need.

I could continue to rant about how our current legal system and our “sue-happy” nation is one of the major factors contributing to the impending downfall of our healthcare system, and how the Rivera family is disgracing the memory of their child by trying to leverage $25 million dollars from their son’s death, but I will leave it at this:  Everything we do has an impact, from every bit of fuel we burn contributing to global warming, to each mass produced bit of clothing we buy contributing to the oppression of those workers and dispersing toxins into the environment, to every dose of antibiotic we take contributing to antimicrobial resistance.  Most of our problems on a macroscopic scale are being caused by our individual actions on a microscopic scale.  If we each educate ourselves and begin making the right decisions, we will see a slowing of these phenomena, which represent nothing more than the equal and opposite reaction of our personal and collective actions.