I am going to go out on a limb here and write about a subject that I know next to nothing about. But that’s part of the problem…
Imagine the sensation it would cause in the news media: a new disease appears in the US, killing hundreds, then thousands, then tens of thousands per year. The death rate closes in on 100,000 people per year. People are terrified, the medical community launches a massive campaign to control and eradicate the new pestilence, the federal government creates a new bureaucracy, a special arm of the CDC to deal with this growing death toll.
Here’s the weird thing. It’s here, and we may well top 100,000 dead per year soon in the US. There is no media outrage, no massive federal programs, and precious little available public information at all about it.
The disease? MRSA: methicillin-resistant staphlyococcus aureus. This “superbug”, a virulent strain of staph, has a chilling death rate: about 20-30% of the people who get it die from it. This is a highly variable statistic, because most of these infections are occurring in hospitals, and the people who are there are already very ill, and often immune-compromised. This so-called health-care-associated MRSA (HA-MRSA) is to be distinguished from the growing number of cases of community-associated MRSA (CA-MRSA) which account for around 15% of the incidence.
In fact, getting the total US death toll number is rather difficult to do, because hospitals don’t want to report these deaths and have actively lobbied against state laws requiring them to do so. In California, I am happy to say, The Governator signed into law in September a bill requiring such reporting (though he killed such a bill a year ago!) As of October, only half the states in the country had such laws. (Interesting aside: in 2003, then-Illinois state senator Barack Obama championed such legislation and got it passed.)
Maybe the media is finally getting the story. The Seattle Times recently had an editorial on the subject, lashing out at the hospital industry for bring this pestilence upon us, after an investigative report.
Okay, so what about that 100,000 number? Okay, I made that up. But in 2005, it is documented all over that there were about 19,000 deaths in the US, and infection rates were climbing very, very rapidly. In California the Department of Health Services estimated about 9,600 deaths from hospital related infections, which extrapolates to around 80,000 deaths nationwide. Not all of these are MRSA, clearly. But I am going to take a wild guess that the 9,600 number was low-balled. It is striking that we don’t know how many people are dying from MRSA, but it could become the fifth or sixth leading cause of death soon.
There are a lot of things that need to change, not least of which:
- There need to be more media stories; people need their awareness raised.
- The government, and the CDC in particular needs to get very serious about getting accurate statistics out and available openly.
- Hospitals need to put in place whatever measures they can, from copper door knobs to better MRSA screening on intake, to better staff education (no pun intended) on infection control.
- There should be a major research effort launched to understand the new-gen superbugs like MRSA, C. difficile, and the lovely new one from the Iraq battlefield, A. baumanni.
I guess what I find most chilling here is the almost unbelievable cynicism of the hospital/health insurance companies who actively fight against having to report statistics on MRSA infection rates. To me, it just underscores a general conclusion that I have formed in the past several years: our health care system should not be managed by organizations that have a profit motive. Think about it: the free market has not produced an efficient, responsive health care system. The profit-based health insurance industry has only created an enormously expensive bureaucratic layer whose main effect has been to drive up health care costs at quadruple the inflation rate while continually restricting actual health care services, and has left 50 million Americans with no health care coverage at all.
I blame them.
December 3rd, 2008 at 7:10 pm
I caught CA-MRSA about 2 years ago. Thought it was a spiderbite on my forearm. The next day, I thought it was a spiderbite that had got infected. Since the dollar-coin sized circle of sensitive red around the spider bite was new to me, I made an appointment to see the doctor–when I described my symptoms, they let me come in that day.
Then, I went on a course of old fashioned antibiotics, sulfonamide-based (which aren’t in general use because everyone ends up being allergic to them). Well, I was able to tolerate the sulfa drugs long enough to kill off the MRSA, with no lasting consequences . . .
Other than I’ve gotten rid of all the antibacterial soaps, creams, and handwashes in my life. You all should do the same. If you routinely dose yourself with antibacterial hand washes, I urge you to stop. You’re just killing off the good bacteria, leaving yourself open to colonization by MRSA and variants thereof.
December 3rd, 2008 at 7:35 pm
This experience with MRSA is not out of line with previous outbreaks and emergent pandemics. The recent history with the AIDS outbreak is case in point, where the Reagan administration and congressional allies dismissed it as “gay cancer.” The religious right said God was exacting punishment. Even with the outbreak of the black death in 1348, a Papal council was convened over the matter early on, but it was dismissed as due to an astrological conjunction. There is a long history of people ignoring these problems until they get completely out of hand, usually once friends and family start dying from it.
This is to be contrasted to threats from other people, particularly if those “others” are of another race, religion, nation etc. The militant reactions are fast and furious. This is not a manifestation of recent times, but appears as old as history. To be honest, I suspect we humans are neurally wired this way.
Lawrence B. Crowell
December 3rd, 2008 at 8:10 pm
Iatrogenic illness is nothing new, but the dimensions of the problem of multi-drug resistance certainly is, and MRSA is just the tip of the iceberg, I’m afraid. The religious right fears evolution, but for entirely the wrong reasons. One of the greatest advances in public health was the widespread use of soap. Soap. Now, laced with antibacterials and a tub of Purell on every desk, the bugs just get stronger, and, ironically, our immune systems increasingly turn on us for lack of habitual exposure to more benign pathogens (e.g. the increasing rates of allergy and asthma, though I would be remiss if I did not also point out the role of pollutants in this disturbing trend). Having ICUs “bombed” is an increasingly prevalent strain on our health care system, and it’s little wonder hospitals are reluctant to draw attention to something so terrifying.
December 3rd, 2008 at 8:12 pm
I had no idea the numbers were that high. As far as the media goes, well responsible reporting isn’t as sexy as following the likes of Paris Hilton around hoping she will do something stupid they can catch on film. Very sad.
December 3rd, 2008 at 8:22 pm
Interestingly, I read a long story about this – which seems (correct me if I’m wrong) so far mostly an US phenomen – in a German newspaper some time last year. It seemed funny to me that I hadn’t previously heard about it on the other side of the ocean. I’ve been wondering though whether this is deliberate, to avoid panic?
December 3rd, 2008 at 8:45 pm
For what it’s worth, coverage has been huge here in the UK. Though much of it so sensationalist that I assumed it was blown completely out of proportion. Seems it might be a more serious problem than was apparent back then.
December 3rd, 2008 at 9:00 pm
Most of the blame for all these resistant germs is put to overuse of antibiotics by humans. However, cattle get antibiotic-laden feed and I’m sure this breeds resistant germs (happening to be in their gut, regardless of how specifically cross-pathogenic) which then get around. There is political pressure to let this go on, but the rest of us could consider exerting political pressure the other way …
December 3rd, 2008 at 9:09 pm
The key to surviving bacterial infections such as those described above is early detection and treatment. I’ve had two surgery related infections this year (out of 6 procedures overall) – one serious and one not (hopefully, it’s still in progress!). In the serious case, I noticed a sharp pain accompanied by some redness just before going to bed one night. I called the cancer center the next morning and they said to monitor it and check for fever (I had none). It got a bit redder during the day (still no fever) and I debated whether I should call the hospital again or not. At the insistence of a friend, I did. They had me come straight in, took one look, and told me I would be staying there awhile. All told, I was hospitalized for about a week, getting doses of the top-shelf anti-biotics every 4 hrs. This was after my first chemo treatment and I was highly neutrapenic. I was told that if I hadn’t received treatment when I did (like if I had waited another day to call back) I could have died.
So, the key is to very, very closely monitor yourself after any medical procedure. And don’t be afraid to make a pest of yourself with your medical team. One thing I’ve learned is that the patient themself plays a very big role in the quality of their medical care.
Frankly, I don’t blame my hospital. I go to Stanford, which is one of the best medical centers in the world, and they take every single precaution that they can. Sometimes these things just happen. One of my surgeons said he averages 2 serious cases (not necessarily MRSA) of infection each year. Good doctors will tell you the risk of infection, and if they don’t, it is up to you, the patient, to ask questions.
Oh – I guess I also want to say that I’m against a huge media panic over this. I think the media is too alarmist as it is.
December 3rd, 2008 at 9:54 pm
I certainly don’t intend to incite a media panic, nor am I asking for sensationalism…but a few thoughtful and in-depth articles would be in order, and I have been looking for a couple years now and I am not seeing them appear. It certainly seems that this problem is being covered up, deliberately, and people should know more about it. We need an answer to the simplest questions: how many people are being infected, and how many are dying? We don’t know.
I am glad that you we able to beat your infection, JoAnne, but not everyone is that lucky, especially when immune-compromised by chemo, or HIV, or old age.
As far as I can tell Stanford is an independent not-for-profit entity, though I imagine they have strong task masters at the insurance companies anyway. And, if Stanford hasn’t switched to copper door knobs, light switches, bed rails, sink handles, etc. then they are not really doing everything they can. I think their endowment can handle that one.
December 3rd, 2008 at 10:19 pm
Let me preface this by saying that I know next to nothing about MRSA or medicine, and only epsilon about biology. But it seems to me that we ought to be adopting a randomized strategy against bacteria. If we use deterministic treatments (the same treatment every time), it will be much easier for bacteria to learn via evolution what defenses work against that treatment. A randomized strategy is best against such an adversary. Does anyone know if we use this idea in modern medicine?
December 3rd, 2008 at 11:39 pm
John: I have spent the last year either in Doctor’s offices, in hospital, or in support groups with other women who have spent their year in Doctor’s offices and hospitals. And I can tell you that from my experience, this is not the pandemic, or even upcoming pandemic that you present it to be. Yes, these infections do happen, and it’s terrible when it does. But, no, they do not happen frequently. You are in much more serious danger by biking around Davis. Or by taking an airplane to Chicago.
And, the point of my comment above, is that generally folks who are in danger, need to be vigilant. Hospitals do have the top-shelf anti-biotics that can deal with this, IF it is caught in time. That was my case, and indeed, I was severely immune-compromised by chemo. At that point, my WBC was essentially zero.
Infections generally occur during surgical procedures, when the body cavity is breached. Changing doorknobs on patient rooms doesn’t hit at the root of the problem.
Lastly, the two things that I have learned this year are (i) insurance companies (not hospitals) are shit-faced douche-bags and (ii) the patient is just as responsible as the doctor for their medical care.
December 4th, 2008 at 12:49 am
The article on copper doorknobs killing the nasty bugs includes the quote “the number of cases of MRSA and C difficile is falling”. If that’s the case, is there still cause for concern, or is the problem being adequately handled already? (The article also mentions that the research showing the usefulness of copper was funded by the copper industry, which doesn’t necessarily mean it’s flawed, but needs to be reproduced by neutral studies.)
December 4th, 2008 at 1:04 am
Steve, I’m no expert on the subject, but I’m pretty sure a randomized strategy would be no better at overcoming the problem of horizontal gene transfer among bacteria, which is a significant source of drug resistant strains.
December 4th, 2008 at 1:19 am
As a graduate student in Public Health Infectious Disease and former student employee in a Staphylococcus lab on an academic campus, I’ll offer my two cents.
MRSA was a problem waiting to happen. By exposing S. aureus, a normally harmless bacteria native to the skin of ~30% of humans to antibiotics, it was only a matter of time before resistance was developed. It’s a product of a complicated process called “Natural Selection.”
Hospitals typically spawn MRSA because of the high prevalence of antibiotic use in healthcare settings. Hospitals can’t be blamed for “unleashing an epidemic” as the Times article suggests, this is very sensationalized. Believe me, I believe antibiotic resistance is a problem, but this article is overly alarmist and attempts to blame anyone and anything it can think of for the consequences of antibiotic use, which we all agree is valuable.
Testing any admitted patient to a hospital for MRSA costs about $20 before you pay for extra lab workers and huge expansions in lab capacities. And it takes 18-24 hours to grow S. aureus, not to mention assay it for Methicillin (penicillin-family) resistance. Let’s be conservative and say it might cost every hospital patient $200 more for every visit to have them screened for MRSA on admission. Explain why we ought to charge this to every single patient, even though many don’t even carry non-resistant S. aureus on their skin, and many aren’t admitted for invasive surgery, which is when a problematic MRSA infection can occur (When the bacteria can enter the blood and produce toxins). Costs would soar.
And the problem is there is no “random” treatment. MRSA is resistant to most drugs we have against S. aureus. There are ~5 other drugs we know of that might kill off systemic MRSA. As we use them, resistance will develop, there is absolutely no question about that. The solution is to develop new antibiotics to stay one step ahead of the evolution of bacteria. Sadly, there is no market to develop new drugs, they simply are not profitable like viagra or xanax.
And lastly to JoAnne, At least take comfort in this:
My mentor has devoted his career to the study of Staphylococcal enterotoxins known as superantigens. These toxins trigger a massive cytokine release resulting in uncontrolled T-cell proliferation and febrile response. This uncontrolled proliferation is very energy taxing on the body, and usually leads to extreme fever, hypotension, and fatigue unless it is treated very promptly. I’m no MD, but if your leukocyte count was near 0, you probably didn’t have an MRSA infection.
Thanks for reading my horrendously long post.
December 4th, 2008 at 4:03 am
There’s been a huge number of MRSA cased in UK hospitals too. Unfortunately we might only be scratching the surface of the hospital outbreak problem. No matter what policies are put into place, the real stats are constantly manipulated from the ward to government. Nobody wants to admit to this issue. Occasionally, a few million is spent on ward “clean-ups”, but their impact is slight at best, purely a PR stunt.
You are probably correct that the real number could be surpassing the 100,000 mark, but we only get to know a small number of cases. And the “superbug” issue isn’t only with MRSA, there are many other antibiotic resistant beasties out there, but as MRSA has become synonymous with antibiotic resistance, the other bugs are overlooked.
December 4th, 2008 at 5:22 am
Echoing others above, I’ll note that there has been a major media panic about MRSA in the UK, which appears to have generated a lot more heat than light (as these things do), with a lot of political grandstanding, and Initiatives, which have not necessarily been useful to the healthcare trusts dealing with the problem.
I don’t want to suggest that there isn’t a real problem here, but my understanding is that a significant part of the solution (rather unexcitingly) concerns good old fashioned ward hygiene, and healthcare workers being reminded how to wash their hands properly, like they were shown how to back in first-year.
But like others, I admit to knowing few of the details. Only, be careful what you wish for, in terms of stimulating media interest.
> our health care system should not be managed by organizations that have a profit motive
Oh yes. Even though I have paid my double-premium travel insurance to include trips to North America, I’d still be very nervous if I fell ill on a trip there.
Another aspect to this is that antibiotics are used to treat acute conditions, so there isn’t the same level of incentive for pharmaceutical companies to throw R&D money at their development, as there is for treatments for chronic conditions such as heart disease, cancer and the like.
December 4th, 2008 at 6:28 am
The Athenians in 430, after deciding to wall themselves away from the invading Spartan Army, suffered a loss of 33-66% of its population due to plague
http://en.wikipedia.org/wiki/Peloponnesian_War
The events that followed eventually led to the condemnation and death of Socrates.
Just food for thought.
December 4th, 2008 at 7:30 am
Just yesterday I’ve watched an old episode of House in which one of the lead characters “killed” his patient, a young woman, by not recognizing that she had infection. They couldn’t diagnose here (even genius House) and gave her “full body irradiation” betting that she had cancer. This destroyed here immune system and she died. Through autopsy they found that it was what they called staph infection. Just wandering how realistic was this show and if that’s the bug we are talking about here.
December 4th, 2008 at 9:31 am
[...] Fear the Reaper | Cosmic Variance | Discover Magazine Just how many people is HA-MRSA killing and what are hospitals doing about it? (tags: medicine medical healthcare usa politics) [...]
December 4th, 2008 at 10:37 am
I know this is long but PLEASE take the time to read:
100,000 per year would get them in a panic? It’s already past that and those that do survive the treatment usually end up with life-long ailments. Just a decade ago it was called “necrotizing staph” or “flesh eating bacteria”, and finally they had to give it the title MRSA so it could be discussed in the halls without sending patients and families into a panicked tailspin because they found out the patient across the hall was infected.
This is one of the many reasons I don’t like “Blogs” on MSM websites…if an actual reporter were to pontificate on this, the very first step would have been to casually call up a few hospitals and interview healthcare professionals…what would you find? Well, get ready to accept your hypothetical for factual:
Everything from “pneumonia”, to “auto-immunity”, to “complication from existing”, to “unknown” is listed as the cause of death when MRSA isn’t readably visible on the OUTSIDE of a patient. I know people in the healthcare field and the cases of MRSA are RAMPANT and out of control. The hospitals are all very quietly changing their sterilization techniques, yet still can’t get it under control.
If you have a hard time believing me just go to a critical care, post-op, or intensive care floor, and the number of people in “private rooms” is staggering. They say “private” but it is really ISOLATION. MRSA is THE #1 problem post-op, and it affects a VERY large number of HEALTHY and unhealthy patients alike.
I do not know the percentages, but I do know that MRSA infections are coming in from dentists, gyms, locker rooms, clinics, prisons, and anywhere a “sterile public environment” is required by law.
Ya wanna know why this is hush hush? It has NOTHING TO DO WITH THE OVER-PRESCRIBING OF ANTIBIOTICS. Got that? It IS the “anti-bacterial” chemicals we use in our everyday lives, and the “industrial anti-bacterial” products used in hospitals. The makers of the “anti-bacterial” chemicals can sue me if they want since I have nothing and it would get the CDC, WHO, and independent research into the courts that specifically warns about the creation of superbugs from the over use of these products. You can even try it at home if you don’t believe me: take an anti-bacterial product, mix with water in a petri dish, let it sit for a week, and then look at it under a microscope. RESULT: the cell walls of the surviving bacteria are THICKER. They adapt so readily it is phenomenal! The bacteria that comes in contact with the chemical but doesn’t die “evolves” and multiplies with a natural defense resulting in a “superbug”(a high school kid did that very experiment for a school science fair and it blew peoples’ minds! remember it’s effective on “99.9%” of all household bacteria, while bleach, hydrogen poroxide, and rubbing alcohol are 100%)
Sorry to ramble, but I feel it neccessary to warn people when this topic comes up. The epidemic is already here. GET RID OF ALL “ANTI-BACTERIAL” PRODUCTS. YOU are making these superbugs on your own skin. Talk to your doctors before surgery about their sterilization proceedures. And just go back to using a mixture of bleach and hot water to clean your home: it is MORE effective than anything created in a lab and it will save you tons of money. Use alcohol wipes for hand sanitizers. (MUCH cheaper than the gel stuff and more effective…why do you think they still use them before a shot instead of using the “anti-bacterial” products!?) And cover ALL open wounds before going out in public no matter how small or superficial the cut!
Lastly, I’m not a lawyer, but if a family member “suddenly dies” after a surgery DEMAND an independent autopsy and test for MRSA. Heck, if Tom Brady and Eli Manning can get MRSA (the “shocking” news stories about their “infections” had all the signs IN MY OPINION), what makes you think you or your loved ones can’t.
Again: If you can’t VISIBLY see the red, black, green, and yellow sore on the OUTSIDE of a patient they will give the cause of death as something akin to what I listed above, bacause it was in the bones, muscles or organs and many times it pops up AWAY from the op-site.)
God help us all, because if you have a surgical proceedure (even a tooth cleaning, doctor check-up, or gym membership) you ARE coming into contact with MRSA. This is a smoldering health crisis and we need to demand the FDA and CDC start investigating this NOW.
December 4th, 2008 at 11:27 am
We already the epidemiology of MRSA to an acceptable extent. It spreads through the community on the skin and in the anterior nares of carriers. People touch carriers, or items touched by carriers and the bacteria is harmlessly planted on a new person’s skin. It only becomes a problem when it becomes a systemic infection!
If you take all antibacterial products out of your life, you’re still at risk for carrying MRSA through your everyday life by coming into contact with people and going to places like gyms, hospitals, etc. You are at risk for an MRSA infection any time you get a cut or wound and give your normal dermal flora a chance to enter your bloodstream. No doubt antibacterial products contributed to the rise of MRSA, but antibiotics are probably the main cause.
Just recognize that bacteria are a formidable opponent to humans, and they are much smarter than we are. They evolve to dodge our defenses, and in order to stay ahead we need new drugs to treat infections. You could throw $700 billion/year at investigating the epidemiology of MRSA but the result would be the exact same as it would be had you not spent anything: Eventually ~99% of staph infections will be methicillin, and eventually vancomycin resistant.
It’s a function of time and natural selection. Don’t pretend that you are being victimized and that hospitals need to be held responsible or CDC isn’t doing anything about a disease that’s killing thousands. New drugs are the only defense we have, plain and simple.
December 4th, 2008 at 11:39 am
I worked in a hospital as a “Transporter” for 4 years. My primary duty was to move patients from there rooms to their tests to surgery to anywhere. We were warned about MRSA, and its less popular yet more contagious friend VRE (Vancomyacin-resistant bacteria)sp? anyway, as a worker on the lower end of the cache system i can tell you that it is not the techs, not the transporters nor most anyone on our level who is contributing to the spread of HA-MRSA. Nurses and more so I think Doctors are the surprising worker bees who pollinate the bacteria. Now MRSA is not something i’m worried about, i’ve come into contact with it hundreds of times and the precaution is, 1) wear gloves, 2) bag charts, 3) Don’t let people touch patients or visa-versa. This is something we behind the scene workers knew and did, ALWAYS. However I have seen countless doctors and the occasional nurse enter a patients room with MRSA, ungloved, perform a checkup involving skin to skin contact and then leave, sometimes not wash their hands and walk into an uninfected patients room to perform a check-up. I feel that some doctors (not accusing everyone) have a feeling of immunity because they are, well doctors, they fix the sick. However, this is how it spreads, carelessness. It isn’t airborne, it won’t leap off the bed and cling to you, It is CONTACT borne. All this i suppose is to say two things, 1) Don’t be wreckless, follow the precautions and 2) if you are a patient in a hospital, ALWAYS request that the person about to check you washes there hands there in front of you, and take no excuse.
December 4th, 2008 at 11:41 am
We’ve had articles on it, too, such as the editorial at http://www.sciam.com/article.cfm?id=meet-resistance-head-on.
George
December 4th, 2008 at 11:54 am
I agree completely. The fears we have of conspiracy are entirely a function of the coverup, not the crime, which makes those who attempt to keep a lid on the bad news appear much more guilty than they are. Health care consumers have slowly adopted the attitude that near-flawless treatment is a Human Right. I’ve little interest in debating that ethical point, but to the extent we have that expectation, we hold the providers of drugs, care, and insurance, who we pay dearly for those services, responsible for phenomena that, at best, they must fight a constant rear-guard battle against. Since they require funds to function, and since consumers withhold those funds when they feel services are substandard, providers are strongly motivated to appear as desirable to the consumer as possible, to the point of distortion. It’s simple market pressure at work. But those who told us TB and the Plague are things of the past were terribly mistaken. We CANNOT, as organic beings, win the ultimate war against bacterial pathogens, and at best we can hope to wipe out a select few viral pathogens. Well, we could eliminate them all, perhaps, but we’d have to render our environment quite inhospitable to animal life to do so.
It’s a tough, perhaps impossible, balance to strike. We need to maintain a realistic assessment of risk, assign blame appropriately, motivate our medical-industrial complex to do its very best to keep us well, yet hold them only so accountable as to remove any motivation to be dishonest.
December 4th, 2008 at 11:55 am
Uh, I should say I agree with Goldy Gopher, who, when I started, was the last post in the thread.
December 4th, 2008 at 1:16 pm
jonny: Ya wanna know why this is hush hush? It has NOTHING TO DO WITH THE OVER-PRESCRIBING OF ANTIBIOTICS. Well, I find that very hard to believe since why would the problem come up specifically of “methicillin-resistant” bacteria? Sure, maybe something that thickens cell walls could make bacteria more resistant to antibiotics (but the bacteria still have to ingest nutrients, and antibiotics (versus “antiseptics”) work by “poisoning” the metabolism and not scalding the surface (like using nerve gas instead of mustard gas in war.) Maybe the study you’re thinking of was http://www.cdc.gov/ncidod/eid/vol7no3_supp/levy.htm? It is called “[dubious – discuss]” in Wikipedia.
But just looking at antiseptics: We have been using antiseptics like alcohol, NaOCl, NH3 (BTW an unsung hero that is effective in strong concentration and less damaging to many materials than chlorox), H2O2, phenol, iodine, Merthiolate, gentian violet (another great stuff that is underused, likely from the purple stain) etc. for decades. (BTW some of them like H2O2 harm tissue also and aren’t really a good choice except for emergencies involving deep/dirty wounds – but not burns – where cleaning action helps, etc.) Since MRSA etc. problem is getting worse recently, I am skeptical of the claim that antiseptics in general make bacteria resistant to themselves or antibiotics to any great degree. Is it the use of new higher-order antiseptics like Triclosan? I’ve heard complaints against that substance for various reasons, and see Wikipedia.
December 4th, 2008 at 1:37 pm
Low math said: We CANNOT, as organic beings, win the ultimate war against bacterial pathogens, and at best we can hope to wipe out a select few viral pathogens.
————–
That is very true. In fact by and large this planet is a bacterium affair, and they coordinate almost as if some biological internet. It is also 3.5 billion years running — and still going strong! Given that we humans, as well as our food crops, livestock etc, are assemblies of biochemicals useful to bacteria we will always have trouble. Some innocuous bacteria species might right now be mutating into some form which can enter some somatic cells in some human tissue and kick our whole world in a bucket by next year this time! All it takes is for some gene for a neurominadase to transform, or to be transposed into the bacteria by some “vector,” and voila you might have a new disease.
Last summer my son was playing a web game where you “design” a disease organism and evolve it along to do maximal damage. When I checked his “bug” had wiped out about half the human race. The problem is that something like this might indeed happen at some point in the future. We are after all about 7 billion nutrient rich water bags for some opportunistic organism to make its living on.
Lawrence B. Crowell
December 4th, 2008 at 1:43 pm
BTW here is another reminder, about the issue of antibiotics in cattle feed – no one picked up on that yet but it is surely a major factor, true? (Or, even if not positively established it is a likely risk. Likely risks are part of risk assessment and control too.)
December 4th, 2008 at 1:43 pm
Dear GUT! It sounds like those doctors live in the times of poor Semmelweis (whose name I’d forgotten, but found by googling “carbolic acid” – I love the 21st century).
December 4th, 2008 at 4:38 pm
MRSA: Scary stuff!
“…our health care system should not be managed by organizations that have a profit motive”
Amen to that!
December 4th, 2008 at 5:27 pm
Read your blog regarding the MRSA superbug. The Microcyn technology has been developed that can in fact eradicate MRSA and all other antibiotic-resistant strains of bacteria. And it’s available in the US market now, but the company can’t talk about its antimicrobial impact since it only has 510k FDA clearances in the U.S. But US doctors are using it and starting to talk about it.
It’s something people need to know about! They don’t have to live with the threat of death or amputation from MRSA and other bacteria or viruses. But it’s the best kept secret around. You can view some of the US MD stories here: http://www.oculusis.com/us/otc/
December 4th, 2008 at 8:40 pm
Neil,
No, I don’t think antibiotics in cattle feed are a problem, at least concerning the narrow issue of MRSA. Staph doesn’t persist in intestines, human or bovine, which is where antimicrobial resistance is developing in cattle. The only time these resistant microbes would become a problem for humans is if they get food poisoning from eating undercooked meat with the resistant organism.
Now I know VRE (Vancomycin Resistant Enterococcus) can live in both cattle and human guts. It has been hypothesized that VRSA acquired its resistance through gene transfer from a resistant strain of Enterococcus at some time, whether that may have occurred in the gut I don’t know, but I highly doubt it.
I think this is more the result of human antibiotic use.
And I’m extremely skeptical of the aforementioned Microcyn technology. It is by no means a cure and it does not at all protect one from “the threat of death or amputation from MRSA.” It’s a topical ointment, and it’s immediate application to open wounds are probably equally if not less effective as using any other antibiotic ointment. If it were a new miracle drug that could cure a systemic infection, it’d be a marketed antibiotic, and would be published about non-stop, plus there’d be more than phase II or III clinical trials out there. There is soooo much more profit in marketing a clinical antibiotic than making an obscure otc product available online only.
This reminds me of a story that occurred last year inmy metropolitan area. After a high-schooler got MRSA, his school was shut down and locker rooms disinfected by a local company promising to be able to completely eliminate MRSA from the locker room. The problem? They claimed thier active ingredient was H202…a compound S. aureus neutralizes with peroxidase. Perhpas if they included a surfactant, it might have been effective, but when questioned which surfactant they were using, their answer was “time.” D’oh! there was literally no science behind the disinfection, and the district was shelling out $1500 biweekly to clean out the locker rooms. They didn’t realize that even if the locker rooms WAS disinfected, the first time an MRSA carrier walked into the room the place would be contaminated all over again, which likely happened on a daily basis!
Goldy Gopher warns against the dangers of pseudoscience! He is ready to be proven wrong by Microcyn supporters!
December 4th, 2008 at 10:05 pm
My sister(immune compromised) and my ex MIL both died from MRSA this year. Neither the hospital or nursing home would take any responsibility for it.
December 4th, 2008 at 10:17 pm
Feeding antibiotics to cattle is a problem! This is done largely to bulk the animals up, and each animial is fed lots of the stuff. The antibiotics will runoff, get into rivers, water supplies and so forth. It will be in the meat we eat, end up in our garbage and in the sewage. Even with waste water treatment lots of drugs are now known to end up in rivers, which include antibiotics. In such large quantities we are selecting for a wide range of bacteria for resistance. It is one of the stupidest damned things going on today.
Lawrence B. Crowell
December 5th, 2008 at 12:05 am
Lawrence,
I believe the concentrations of bovine ABs in the water is inconsequential compared to the amount of ABs we put through the American population every year. I work for the state health department and interview persons who suffer foodborne illnesses, and an astonishing number of them report being given ABs by their primary care physicians before an organism is even isolated as a causative agent. When an organism is isolated, they are put on a new drug, and many patients simply stop taking the first drugs without completing the course. Not to mention that almost everyone stops taking ABs altogether once they feel slightly better. (A side effect of many ABs is stomach discomfort and diarrhea due to the AB wiping out one’s normal intestinal flora.)
And I believe waste water treatment actually does a pretty good job of removing drugs from the water supply. If you’re going to bring the issue up in the context of MRSA, worry about human ABs that are being flushed, not bovine food ABs. We aren’t manufacturing drugs that are useful for humans and feeding it to cattle, especially in the case of MRSA, beta-lactamase inhibitors. Bovine ABs are an unrelated class of ABs and their minute presence, if any, doesn’t bother me in the context of emerging MRSA or really even VRE.
I’ve posted far too much on this thread, but it is pretty dear to me.
December 5th, 2008 at 3:39 am
What’s up with nurses, doctors, etc. wearing their scrubs out in public ? I see them out and about town, at the restaurant, at the coffee shops, running errands, in the same scrubs that they wear while at work. There is something wrong with that. I can only imagine what those scrub sleeves that drag along the patients in the hospital (even if they wear their gloves) look like from a bacteriological point of view. This practice should be legislated ! Leave your scrubs in your locker, use them at work and have them boiled in-house, and wear a different set of clothes to and from the hospital. There should be some sort of procedure in place to minimize the cross contamination from the hospital floors to the rest of the community. Any comments from the (scrub wearing to the supermarket) medical professionals reading this ?
December 5th, 2008 at 3:52 am
Goldy Gopher,
I don’t understand why this is an argument against a randomized strategy. Consider, for a moment, if hospital X prefers drug A of those five or so drugs that still work. That virtually guarantees that the germs that are hanging out around hospital X will gain resistance to that particular drug. More explicitly, it guarantees that those variants of the bug that are resistant to drug A are the ones that will survive more and more. If the hospital moves on to drug B, then it will just develop resistance to drug B in addition to drug A, and we will have fewer and fewer drugs.
If, on the other hand, the hospital tries to make use of all five drugs as evenly as possible, then no particular variant of the beastie that is resistant to any one of these drugs will be allowed to succeed. Instead, for evolution to favor the bacteria, they will have to develop resistance to all five antibacterials simultaneously. And that is a [i]drastically[/i] more difficult task than to just develop resistance to one of them. So it seems to me that we should be using a randomized strategy [i]in conjunction[/i] with the development of new antibacterials.
December 5th, 2008 at 7:33 am
Insurance companies are one of the purest forms of evil, and their greed should not be tolerated under the name of free market etc.
Something really needs to be done.
December 5th, 2008 at 7:40 am
Gopher,
I am not of course that familiar with this subject. Yet it does seem to me that bovine ABs can end up heavily in the environment, such as when they wash out feedlots etc. I agree that AB use in humans has been over the top, and this is clearly a sort of unintended selection experiment at work. ABs, hormones and other drugs and compounds are showing up in detectable levels in rivers.
L. C.
December 5th, 2008 at 8:02 am
I see your point, Jason.
While there is no universal protocol for treating an MRSA infection (as all strains present different susceptibilities to different drugs), Vancomycin is predominantly used to treat infections. Now I’m not a clinician, but I am quite sure of this. The problem with randomly selecting one of 5 drugs is that you’re exposing a nosocomial staph population to all 5 different drugs at varying pressures, and there is inherently a greater risk for resistance to develop resistance against all 5 at the same time. Some drugs like Rifampin just don’t get used a lot because clinicians need to preserve a “last-line” defense.
Resistance can take decades to develop or it can occur upon the first application of an antibiotic. By using one antibiotic at a time, you are leaving a greater hope that if a strain develops resistance to one drug (ie vancomycin), it will not have even been exposed and will be 90-100% susceptible to the other drugs until new treatments are approved.
There just might be one or two more drugs out there, but the only drugs I can name off the top of my head for MRSA are Vancomycin, Daptomycin, and Rifampin. MRSAs are increasingly becoming VISA (Vancomycin-Intermediate), and will become VRSA. These are usually treated with Daptomycin. I have heard of incident cases from state hospitals during my time at the health department of patients who are treated in house for an MRSA infection, get discharged, and return 2 weeks later with strains that are somehow resistant to two of the three aforementioned drugs. While they are rare, they are out there, and if selection favors those strains (which it does upon being exposed to ABs), they will slowly spread throughout the community.
So as I understand it, it’s not so much an even use of the last remaining drugs we have as it is a strategic deployment.
December 5th, 2008 at 9:57 am
Well, right, I can definitely see the desire to hold some antibiotics in reserve. But if a hospital cycles which drugs are used, then won’t it prevent any strains that develop resistance of one of them from thriving? I suspect that it will take much, much longer for a strain to evolve resistance to a suite of drugs if it has to be exposed to all of them at once than it would take to evolve resistance to them when exposed in sequence. Provided, of course, those drugs are always administered at therapeutic levels. If the bacteria in question manage to survive in areas of the hospital where sub-therapeutic levels of the drugs in question exist, then, well, that could easily cause resistance of all strains to appear quite rapidly.
So I suppose the argument as to whether to use drugs in sequence or to mix them up depends largely upon where the particular bacteria that develop resistance develop said resistance. If the primary location is within patients, then it seems to me that using a variety of drugs is best. If the primary location is outside of patients in places of the hospital that have sub-therapeutic amounts of the drugs (e.g. sheets, door knobs), then I suppose the response would be to use one at a time.
December 5th, 2008 at 10:39 am
Jason,
You may be right. What is obvious from our conversation is the value of ICPs or Infection Control Practitioners in healthcare settings, who review the susceptibilities of isolates and develop specialized plans for reducing antimicrobial resistance in nosocomial infections.
From my state health department, of 136 CA-MRSA isolates in 2001:
75% susceptible to ciprofloxacin
82% susceptible to clindamycin
42% susceptible to erythromycin
99% susceptible to gentamycin
100% susceptible to TMP-SMX
100% susceptible to rifampin
94% susceptible to tetracycline
and 100% susceptible to vancomycin.
Those numbers have almost certainly decreased since 2001.
December 5th, 2008 at 1:43 pm
Potential ‘green’ bullet??
http://www.sciam.com/blog/60-second-science/post.cfm?id=whoa-the-stuff-in-pot-kills-germs-2008-08-27
December 5th, 2008 at 5:09 pm
I read somewhere that soap used to be *much* stronger than it is today, as suggested by the former name for washing powder, namely soap flakes/suds, which is presumably what it was. No wonder my granny, born in the 1880s, only took one bath a week, in the belief that more was bad for the skin!
In WW1 soldiers in the trenches could kill lice and their eggs hiding in the seams of clothes just by rubbing a bar of soap down them. I bet that wouldn’t work with today’s soaps, which are little more than lumps of perfumed lard by comparison, and doubtless weekened so the manufacturers can also sell deodorants.
I guess the problem is that, weak as modern soap is (or *because* it is so weak), people simply use it so often. Maybe some enterprising biologist could make a fortune by breeding genetically modified skin bacteria that make body odour smell of roses – Then we wouldn’t need to wash so much
December 5th, 2008 at 6:22 pm
I hope some of you will be able to check out this article from The Journal of Antimicrobial Chemotherapy at jac.oxfordjournals.org/cgi/content/full/45/5/639 The title is “Time-kill studies of tea tree oils on clinical isolates” by May, et al. I’d appreciate hearing what some of you think.
December 6th, 2008 at 10:55 am
Just saw an article that zinc is necessary for to form the biofilm of the bacterium
Pulling out the zinc disrupts the whole process.
http://www.sciencedaily.com/releases/2008/12/081204160602.htm
December 6th, 2008 at 11:07 am
[...] spreading faster than a California wildfire on a windy day. And I’m not alone – the folks at Cosmic Variance have an awesome post about this [...]
December 7th, 2008 at 2:38 am
this has been a hugley publicised issue in the UK for some time.
If you are in a hospital it is worth putting a 10 foot sign beside your bed that says “don’t even think about touching me, if you haven’t just washed your hands”
December 8th, 2008 at 11:54 am
Not MRSA, but here’s a study of Vancomycin resistant entercocci after the discontinuation of avoparcin in animals in Germany. It seems to indicate that levels of VRE went down in healthy persons after the ban on its use in animal feed.
http://www.scopus.com/scopus/record/display.url?eid=2-s2.0-0032951278&view=basic&origin=inward&txGid=ZIrL8ux6WjbaBFaK00fMIxq%3a2
It would seem to imply that the use antibiotics does have an effect on resistance. I’m not sure how closely related vanc and avoparcin are, but it’s interesting that they aren’t necessarily using the same drug the resistance was seen in. Of course this is gut bacteria.
December 8th, 2008 at 3:10 pm
The widespread use of antibiotics in animal feed almost has to have a deleterious effect on bacterial susceptibility. Even if the relevant pathogens aren’t directly in the cattle etc. gut, the antibiotics “get around” a lot and this is bad enough.
December 8th, 2008 at 6:11 pm
MRSA is regularly and successfully treated with Augmentin (amoxicillin clavulanate) and good old fashioned sulfa. The present problems are due to lack of early detection, relying instead on failure of regular treatment.
A secondary problem is the fact that once infected, a person can continue to carry it, in essence to be colonized by it, and be reinfected. I am one such person. After a 3.5 month ear infection which spread to my eye and some more sensitive mucosa, I found a doctor who was familiar with MRSA and its treatment. I now know to tell any physician treating me that I’m prone to MRSA and what to prescribe. Very few question me, but none refuse.
As for resistance due to antibiotic use, SciAm published an article showing that far more resistance occurs due to natural swapping of RNA between micro-organisms, and from their interactions with natural resistance compounds in various organisms. Resistance due to antibiotic overuse does occur, but it’s the minority case. Figure: ‘new’ diseases, including more virulent forms of existing ones, have been occurring far longer than antibiotics have been used, even if one includes “natural” antibiotics as studied in ethnobotany.
20% to 30% death rate? You’re running around with your hair on fire. For real data on things medical, always go to PubMed http://www.ncbi.nlm.nih.gov/sites/entrez … but pack a lunch and reading glasses. People who contract MRSA are twice as likely to be dead a year later than those who contract MSSA (methicillin susceptible staph, the normal kind), and staph contracted in a health care setting is twice as likely to be MRSA (but due to invasive procedures not found outside such settings, rather than setting-dependent prevalence). The mortality difference is due to the previously mentioned identification problem. SA infections altogether remain a very small minority of mortality causes.
The most promising news with respect to MRSA is that the staph proteome has been fully sequenced. New identification procedures, drugs and delivery methods are in the works.
December 9th, 2008 at 1:01 pm
Dr. McClain: thanks for the information and the link to PubMed. A quick search there wasn’t too helpful in learninga about either mortality rates or the national death rate. The point of my post is that this whole thing appears to have been systematically under-reported and, chillingly, actively suppressed by hospitals and insurance companies.
Clearly, though, many if not most people who contract MRSA in a hospital are probably very ill to begin with, so ascribing a true cause of death is debatable. But that it’s even 20k per year, officially, as it was in 2005,is too many. I don’t think you will argue that it’s actually less than that…
December 9th, 2008 at 10:26 pm
There is a product that has helped me and many more. Its not a cheap alcohol hand sanitizer but a real product now being used by many professional athletes. The product is called BACROBIAL and I have personally seen what it will do against MRSA. There is also another superbug that you may want to learn about. I saw it on the news the other night. It is called C.diff. The info I looked up says half the people who get it die.It releases spores when treated with antibiotics that may live on surfaces for up to two years. Now that is scary. Sam
December 10th, 2008 at 2:25 am
Any alcohol based hand cleaner is effective against MRSA and soap and water is effective against C.diff. In fact Soap and water if used correctly is the most effective way of preventing transmission.
C.diff does not release spores. It becomes a spore when it encounters adverse conditions and can live for long periods of time on surfaces. It is hard to kill but not impossible. As I said before wash your hands with soap and water.
C.diff is common enough and well known. Like MRSA a large percentage of the population is colonised with it and have no symptoms. it lives in the gut and in normal conditions is pretty harmless. The problem occurs when someone is on antibiotics that wipe out of damage the natural flora of the gut allowing C.diff to take over and become the predominant bacteria. Then it can be deadly and is much much harder to treat than MRSA.
December 14th, 2008 at 3:07 pm
We’re tracking new MRSA research and news here: http://drugresistantstaph.blogspot.com – please visit.
(No, we are not selling anything. This site is news-only.)
December 16th, 2008 at 1:40 am
Interesting comments but they are true. Media moguls self-imposed media blackout. This is mainly because there are two kinds of doctors, the ones who are treated as spoke person believe a miracle drug will soon appear and the others less known Microbiologist.
Advances in medicine were made possible after Penicillin and Intra-vascular accesses were introduced. Since disposable plastic device have been used, antibiotic resistant strains nosocomial bacterial infections have increased in tandem.
Now an army of six bacteria called “ESKAPE bacteria“ (Enterococcus faecium, Staphylococcus aureus, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species) are among the biggest threats of infectious diseases physicians face today. These bacteria are now resistant to most antibiotics, antibacterial wash and antiseptics used in hospitals.
Recently published data about hand washing makes it more difficult to recommend this to prevent spreading infections. Healthcare workers washing hands for more than ten times develop dermatitis and have higher bacterial count than the ones who wash less. Using antibacterial wash is making infection control more difficult.
We must first reduce routine invasive procedures and blood tests performed in hospitals to help reduce contaminated hospital waste that spread infections. People who consult doctors must also learn not to demand blood tests and antibiotics, if not this are likely to be a major war, which we will not win.
Please visit my website medifix.co.uk and keep posting. I’ve linked this page to help educate people.