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What can we learn from a television medical drama like Grey’s Anatomy?

Updated: Jun 1, 2023


Source: ABC website

“Infections are like sleeping monsters. You can't see them. You can't feel them, but you must do everything in your power to contain them. Because when the monsters wake up, they are out of control. All that time you spent convincing yourself the sleeping monster wasn't real, it was gathering strength. The infection was spreading. The monster's awake now and there's nothing you can do about it”
Dr. Miranda Bailey episode 21, season 9.

Besides being the longest-running American primetime television series, Grey’s Anatomy is still a high-rated medical drama series. Therefore, it is reasonable wondering whether the medical care and illness depicted in the show are so scientifically accurate that they might be exploited for educating a wide general public.


Let’s go to analyze the accuracy of episode 21 season 9 and the key take home messages that people might take away from watching it.


Briefly, CDC investigates the surgeon Bailey since three of her patients acquired a fatal bloodstream infection caused by MRSA USA600, a strain of Staphylococcus aureus that was really isolated from patients with invasive life-threatening infection at the beginning of 2000 in Detroit, and is currently recognized as a global public health concern. It turns out that Dr. Bailey carries MRSA USA600 asymptomatically and spreads it to her patients when she performs surgical incision of their skin because her gloves have microscopic tears [1].


Can the same microorganism be present asymptomatically on the skin of an individual and cause sepsis and death when transmitted to another subject?


First of all, let’s remember that skin is our primary defense barrier. Besides avoiding the entry of environmental threats in our body, skin host a community of living microorganisms called microbiota, which may include S. aureus, even MSRA strains. Overall, microbiota “peacefully” lives on our body surface, provided that the skin barrier is intact. In contrast, when skin barrier is breached by cuts, including surgical incision (Fig.1), or when invasive medical devices, such as endotracheal tubes, intravenous lines or urinary catheters are used, microorganism like S. aureus can enter, spread and established infections in multiple organs such as lungs, heart, bones and bloodstream [2, 3].



Fig.1 Illustrative image of a Surgery


The risk of developing life-threatening infections increases when people have a weakened immune system, such as hospitalized patients. Therefore, MRSA infections are a real worry in healthcare facilities, where workers have a key role in their prevention by following strict hand hygiene procedures, such as washing their hands with soap and water or using hand sanitizer before and after each clinical appointment.


Why have S. aureus strains acquired resistance to antibiotics?


Antibiotic resistance is a natural process (Fig.2) by which bacteria become resistant to a group of medicines, which were once able to defeat them. For example, MRSA, which have emerged fifty years ago, are strains of S. aureus that developed resistance to antibiotics like methicillin, amoxicillin, penicillin, oxacillin, and even more. Therefore, common bacteria causing skin infections that are usually resolved by antibiotic treatments, in case of MSRA strains can result in hard-to-treat infections. Despite being a natural process, the excessive and inappropriate use of antibiotics has dramatically accelerated the rise of antibiotic resistant strains. For example, patients frequently take antibiotics in the attempt to treat colds, flu, and other illnesses caused by viruses which are not sensitive to antibiotics. Given that antibiotic resistance is a growing global public health concern, it's important to educate people to use antibiotics only when it is necessary (i. e. for the treatment of bacterial infections), at the prescribed doses and for as long as necessary[5].



Fig.2 Ways by which bacteria can alter, block or expel antibiotics and acquire resistance.[3]


As a final comment, it’s noteworthy to say that Grey's Anatomy may have exaggerated the scale of the contagion, but the consequences of a surgical incision infection due to MSRA strains aren’t unrealistic. Since MRSA can typically be treated in the early stages, personally I think that this episode of the medical drama series aims to educate about these "sleeper monsters" and the importance of 1) being aware that even minor skin infections require a prompt diagnosis 2) responsible use of antibiotics are urgently needed to tackle the growing increase of resistance.


Bibliography


2.Clebak KT, M. M. (2018). Skin Infections. Prim Care. Primary Care. doi:10.1016/j.pop.2018.05.004 PMID: 30115333.

3. de Jong NWM, V. K. (2019). Immune Evasion by Staphylococcus Aureus. Microbiology Spectrum. doi:10.1128/microbiolspec.GPP3-0061-2019. PMID: 30927347

4. Johane M. Willey, K. M. (2020). Prescott's Microbiology (11 ed.). New York, United States: McGrawHill.

5. Moore CL, Osaki-Kiyan P, Perri M, Donabedian S, Haque NZ, Chen A, Zervos MJ. USA600 (ST45) methicillin-resistant Staphylococcus aureus bloodstream infections in urban Detroit. J Clin Microbiol. 2010 Jun;48(6):2307-10. doi: 10.1128/JCM.00409-10. Epub 2010 Mar 24. PMID: 20335422; PMCID: PMC2884493.

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