This detailed analysis ran alongside the Story of Bella that you will find elswhere on this site. It lends a great deal of credibility to the concerns we are raising. The illustration below was published with the Bella feature.
Feature By Carolyn Menteith
It is incredibe how quickly times change - and nowhere more so than in the medical world. In the past 100 years, diseases that were often kllers have been. brought under conol with the latest vaccinations and drugs. As such, the average life-expectancy has increased by almost 20 years. But there is a major downside to increased drug usage. No one can fail to have noticed the media concern for the new so-called superbug MRSA.
Methicillin- resistant Staphylococcus aureus is something of a mystery to most people. Everyone knows it causes major problems in hospitals, it is virtually impossible to kill, and it can Lead to death. What fewer people know is that roughly one in every three people (possibly more) in the UK are carriers of MRSA - and, in a healthy person, it is nothing to worry about.
Staphylococcus aureus bacteria are found on the skin and in the nose of these people (who are called S. aureus ‘carriers’). In healthy people who are carriers, S. aureus is harmless; however, these bacteria sometimes invade the skin to cause infection. This is more likely if you have a cut or graze that can allow bacteria to get under the surface of the skin. To put its seriousness into perspective, S. aureus is the cause of skin infections such as boils, pimples and teenage acne - not exactly life- threatening (no matter how much teenagers may think it is!).
However, in some people, S.aureus can get into the bloodstream and travel to internal parts of the body to cause more serious infections. For example, blood poisoning, Lung infection (pneumonia), bone infection, or heart vaLve infection (endocarditis). These serious infections are more Likely to occur in peopLe who are already unwell or debiLitated, or who have a poor immune system. In these people, the bacteria multiply, and the resultant infections need to be treated with antibiotics. There are various strains of S. aureus and some have become classed as MRSA.
MRSA strains are very similar to any other strain of S. aureus - some healthy people are carriers, and some people develop the types of infections described above. The difference is that most S. aureus infections can be treated with commonly used antibiotics. In recent years, however, some strains of S. aureus have become resistant to some antibiotics (hence the name: methicillin-resistant Staphylococcus aureus). MRSA strains are not only resistant to the antibiotic methicitlin, but also to many other types of antibiotics.
While they have got a very bad name, MRSA strains of bacteria are no more aggressive or infectious than other strains of S. aureus - however, the resultant infections are much more difficult to treat because many antibiotics don’t work. Therefore, infections tend to become more severe than they may otherwise have been if the cause of the infection is not diagnosed early, and the antibiotics that do not work are given in the first instance to no effect.
MRSA occurs most commonly in people who are already in hospital. People who are more prone to it are those who are very ill, debilitated, or have wounds or open sores. The wounds may become infected with MRSA, and the infection is then difficult to treat. Infections that start in the skin may spread to cause more serious infections. Also, catheters and tubes going into veins or parts of the body (‘drips’ etc) are sometimes contaminated by MRSA and can lead to urine or blood infection.
S. aureus bacteria (including MRSA strains) spread from person to person usually by direct skin-to-skin contact. Spread may also occur by touching sheets, towels, clothes, or dressings that have been used by someone who has MRSA, as it can live away from the body for quite some time. So while S. aureus (including MRSA strains) will not normally cause infection if you are well, the bacteria may get on to your skin where they will do no harm. So, for example, people who visit patients with MRSA, or doctors and nurses who treat them, are not likely to develop an MRSA infection themselves. However, without adequate hygiene precautions, they may pass it on to someone who is ill, or who has a wound, who then may develop infection.
Keep it clean
Basic hand-washing procedures do a lot to prevent the spread, but, to be effective, hands must be washed for more than 30 seconds. Time yourself next time you wash your hands, and I bet you don’t even come close! I also bet you don’t wash between your fingers, or if you do, I also bet that you turn the taps (the same ones you handled with your dirty hands) off with your now clean hands! I have seen it on the news, but it has never impacted on me in any way - until a few weeks ago.
Digby, my Polish Lowland Sheepdog, began to cultivate some interesting lumps. My long-suffering vet, Jeff Yellowtey, told me that the first three were really nothing to worry about. Then the fourth one appeared, which was quite different, and so Jeff decided they should go. Oigby was duty booked in for surgery, and I began all my usual panics about anaesthetic. Then a chance conversation made me worry about something aLtogether different and more scary - MRSA. My dog was going to be in the canine equivalent of a human hospital (a breeding ground for MRSA), and he was going to have invasive surgery (a potential flashpoint for MRSA infection).
There have been cases of MRSA in dogs and it has been suspected for a while that there are canine carriers in the same way as human carriers, so how worried should I be? Time to do some serious research and call in a lot of a lot of favours from friends. The first person I contacted was Chris Laurence, Veterinary Director at Dogs Trust. His reaction was not to worry too much and that the reason it is so prevalent in hospitals is because the infection load is too high with vulnerable patients - not the case in veterinary hospitals. He also stressed the need for strict hygiene to prevent the spread of any infections in any species. He went on to say," I think problems in veterinary practices will be far less because the work rate is less intense, with better isolation of patients. After all, very few stand by each other’s beds for a chat!”
How very true, and when you think about the number of people that patients come into contact with in hospitals, you can see how easy infection is, but I still wasn’t convinced there was no risk. This was especially true as, by now, I had discovered that MRSA is zoonotic - in other words, it can pass between animals and man. Research also shows that it is humanotic - meaning our pets are just as much at risk of catching MRSA from us as we are from them. Not only that, but fullblown MRSA infection had been discovered in dogs - this is no longer just a human superbug.
MRSA was first reported in animals three years ago when Canadian microbiologist Dr Donald Low discovered that an Irish thoroughbred horse had the bug. Since then, Dr Low has confirmed cases in cats, dogs, guinea pigs and horses in the United States and Canada.
Warning to all
‘This is a warning to Britain about MRSA,” said Dr Low of the Mount Sinai hospital in Toronto at that time. ‘I’ve looked at the case of a horse, a thoroughbred, which ended up infecting its owner.” The British Veterinary Association at the time urged pet owners not to start abandoning their pets. Spokesperson Dr Alistair Gibson from BSAVA (British Small Animal Veterinary Association), said at the time, ‘We don’t want to see a massive scare that will make people get rid of their pets. What we need is for research to be done into this. Meanwhile, owners should take a sensible approach, wash their hands regularly and not panic.”
Having read the further research that has been done since however, it would seem that animals have as much to fear from us as we have from them - possibly far more.In fact, in Ontario as far back as 2000 four MRSA infections were diagnosed in one vetinary diagnostic laboratory.
- Case 1 was a dog with a post-operative wound infection which was found to be identical to an MRSA identified a year earlier from her owner, who had been hospitalised for surgery.
- Case 2 involved a dog with a MRSA ear infection - the owners had frequent outpatient contact.
- Case 3 was a horse with a post-operative MRSA wound infection whose owner was colonised with an identical strain.
- Case 4 involved a dog requiring leg amputation following an MRSA wound infection at a fracture site. The owner of the dog had previously been hospitalised for cancer.
The conclusions were that, in all four cases, evidence suggested that the source of the MRSA was the owners or other human sources. In other words, S. aureus is no respecter of species boundaries, and we are all in this together!
I was starting to get worried. Not just for my dog, but about MRSA in general. The advantage of my job is that I can ask for a second opinion, and so I did - from everyone I thought could help. I started off with my regular port of call for all things veterinary - Trevor Turner, vet for Crufts and Disc over Dogs and an amazing fount of the most up-to-the-minute knowledge. He explained to me several things I didn’t understand, including how antibiotic-resistant infections had appeared in dogs in the first place.
When the new synthetic penicillins first appeared on the market, they were very expensive - around eight times the price of ordinary penicillin, which most strains of S. aureus had become resistant to. As such, vets used them because they were so effective, especially in the rapidly increasing skin conditions that were arising in dogs. However., worried that clients it would be put off by the price, they often prescibed them at half dosage. This gave the infections a chance to become resistant. Yes, they cured the skin condition, but it would come back a week later - and this time it had evolved to become resistant to the antibiotic. Now we had an antibiotic resistant infection that could jump species. (Also we had an almost epidemic of virtually incurable skin problems but that is another article!)
Trevor did tell me that MRSA is treatable. The problem is, the antibiotics that are strong enough to kill MRSA are so toxic in the doses that have to be used that there is a real danger to the patient - and in a debilitated patient, the drugs are as much of a risk as the MRSA. Many human MRSA patients actually die from the drugs they are given to fight the MRSA and not from the MRSA itself. Trevor’s final point was to stress most strongly the vital importance of hygiene and sterility within vet practices (and indeed hospitals, and for anyone who is around open wounds - human or dog). Worryingly, he admitted that he could see MRSA becoming a serious problem, as a large proportion of veterinary practices do not have, a high enough standard of asepsis (sterility) to be able to prevent a potentiaL MRSA outbreak.
Time to talk to the British Smalll Animal Veterinary Association to see if the profession as a whole was concerned. Spokesperson Dr Alistair Gibson certainly acknowledged it was a growing issue and that it has been discussed a lot over the last couple of years. As a result, he feels that vets are far more aware of the potential for MRSA, and, in most cases, are taking the necessary steps to prevent this.
The BSAVA is just about to publish guidelines on its website on how vets can prevent infection and how to deal with an outbreak. Alistair was quick to point out that we shouldn’t look on our pets as a source of infection - he reiterated that they are far more at risk from us, because far more humans are carriers! However, he did say that where either the owner or the animal was immune-suppressed, run down or debilitated, extra hygiene measures should certainly be taken to avoid it being passed from one to the other.
The BSAVA is pushing for the UK's research bodies to do more more investigations into canine carriers and to arm themselves with as much knowledge as possible. One of the researchers that the BSAVA has been working closely with is Dr Tim Nuttall from Liverpool Vet School. Tim doesn’t think we’ll see a superbug epidemic. While there are antibiotic-resistant strains of S. aureus in dogs, they are generally very treatable ones. Actual MRSA is very rare in dogs.
From all the research that has been done in the UK, it seems that it is passed to dogs from owners who have some access to hospitals - or else to dogs who have access themselves to hospitals. Once the family dog has it, he can then act as a carrier to pass it back to the family. So, in families where there is MRSA infection, the key to getting rid of it is to treat the dog (and cat) as a member of the family for treatment.
In the case of dogs visiting hospitals, the dogs should be treated, for MRSA purposes, in the same way as the rest of the staff. First cases Tim went on to tell me that the 20 or so cases of MRSA that he had heard of in UK vet hospitals were most likely either harbouring MRSA passed to them by their owners before admission, or perhaps had picked it up from a member of staff who was a carrier.
So what conclusions did I come to after all this? I don’t know - and I don’t seem to be the only one. No one really knows if this is a storm in a veterinary teacup - or a time-bomb waiting to explode. Certainly, antibiotic-resistant strains of Staphylococcus aureus are crossing the species boundary, and MRSA is a growing problem in UK hospitals. Unless there is a general recognition of this, and unless action is taken and standards of asepsis are raised (considerably, in some cases), veterinary hospitals will follow suit - and probably soon.
Satisfied that my own vet has high standards, Digby had his lumps removed with no problems - but I still worried every step of the way. Already the first dog has died here in the UK as a result of MRSA infection. I only hope that we can prevent the same headlines in the veterinary profession that are currently dogging the NHS.