Bacteria now antibiotic resistant and extremely virulent

April 2, 2007
Dear Mr. Fikes
You wrote a super article with absolutely great explanations for the public on a growing national emergency.

Resistant bacteria are a frightening problem. In my father's time in high school in the 1930's, he remembers perfectly healthy classmates going home sick with a cough and being dead two days later. My mother-in-law's first fiancé died of a bacterial infection. My father-in-law who she met years later also nearly died of pneumonia but was saved by sulfa drugs and draining of his lungs with a giant hypodermic needle daily for a week.

Thanks for being brave enough to mention growth promoter antibiotic use in animals as a cause of resistance. Most journalist fear to touch on this topic.

But I beg to differ on one point. You said there is no ironclad proof that resistance is spreading from meat industry factory farms to humans. I believe this iron clad proof has been documented in studies done by The Union of Concerned Scientists. Workers in industrial hog farms have been shown to be full of the all kinds of bacteria with antibiotic resistant genes. The genes of which have been traced straight back to the resistance genes in the animals.

As you know, bacteria are promiscuous. They can swap genes between very different species of bacteria via the plasmid route. Bacterial are forever dropping off little packets of genes (plasmids) into their environment. (There is also bacterial “sex” that transfers these plasmids even between different species of bacteria). Other bacteria that happen to be in the same place engulf these packets and instead of digesting them, use the genes that are protective. Staph can transfer resistance to strep. Enteroccoci can transfer to Salmonella. The dangerous E.coli strain picked up a "suite" of toxin genes from Shigella in this way transforming a benign commensal in the intestines into a killer.

It has been known since the thirties that giving low levels of an antimicrobial over time causes the development of resistant strains. The Army in the thirties experimented on soldiers with the then miracle antibiotic, sulfa. One group was given low doses for months with the idea of keeping them healthier. Instead they began to develop infections that no amount of sulfa could kill.

The worst possible application of antibiotics is in low doses over time. This is exactly what the American poultry and pork producers have done for thirty years. Growth promoters are antibiotics given not to cure sick animals, just to add a few extra pounds to their weight. (No one knows why antibiotics promote growth, but somehow they do.) The extra weight is small but profitable. In the European Union this practice is outlawed. Here in the US where giant corporations without conscious rule our politics with billion dollar lobbies, these laws have no chance. The death of the Ramona boy is one consequence.

In February of 2006 I was given an antibiotic resistant pink eye bacterial infection (likely staph) from an unhygienic ophthalmologist’s assistant. Within less than 24 hours of not being treated, it went from my eye down the canal to my nose and started eating holes in my nasal mucosa. Blood started flowing freely from my nostril. It also started eating into my cornea. It took three different antibiotics and weeks to stop it. I feel lucky to be alive.

When it started eating into my nose, I felt like if we could not find and antibiotic to kill it then it would eat my face and kill me in a couple of days. The speed at which it grew was incredible and very frightening. It was like having millions of tiny invisible and invincible tigers eating me alive. Cancer may be scary, but at least you usually have weeks or months to say good bye and get used to the idea. These resistant bacteria work at light speed. In days you are dead.

I called the County Health Department thinking someone should know so that the opthamalogists office could be disinfected. I called a half dozen phone numbers--each long distance to San Diego. Not one person at the Health Department cared. There is no procedure for tracking resistant bacteria in our county or anywhere else in the US.

I got interested in the subject and found that a survey of nasal cavities of Californians done three years ago discovered over half of the Californian residents tested had MRSA in their nasal cavities--the highest rate in the nation. As you mentioned in the article the MRSA sit there under control but not killed lurking in our mucosal cavities including the lungs, until the flu or other viral pathogen opens up holes in the mucosal lining. Then the MRSA goes to town.

Lucky we had a mild flu season this year. The next severe flu season could see the death of tens of thousands of Californians. Most of us have MRSA sitting and waiting all over our skin and throughout are respiratory tracts. These tiny invisible tigers are hiding, waiting, biding their time, ready to pounce and destroy. As they lurk inside, we live in blissful ignorance.

In Holland the rate of MRSA infection is less than 2% of the population because the Dutch have an aggressive Community health search and destroy program for MRSA. If one person in a family gets a MRSA infection, all family members and close associates are tested with nasal swabs. Any one found to be infected is isolated and treated until the MRSA is eliminated. They have the lowest rate of MRSA infection in the world. Europe as a whole has a far lower rate than we do because they have outlawed the use of antibiotics as growth promoters.

The US could do what Europe and especially Holland is doing if we were to infest a bit of money. A penny of prevention would be worth many dollars saved in costs for treatments of MRSA and loss of productivity from hospitalizations. We simply need to stop all use of antibiotics as growth promoters and track and control all resistant strains of bacteria in the United States. As you know MRSA is simply one of a whole group of resistant bacteria. Many others are far more scary than MRSA say for instance XDR-TB.

Thanks again for the article. Hope I was not too garrulous. I am a former middle school science teacher. Sometimes I go on a bit more with science topics than some people can comfortably swallow. I figure you are a science writer. You have got to be interested.

Sincerely,
Peter Welch
darwindad@cox.net

Antibiotic resistance: The problem keeps multiplying

By: BRADLEY J. FIKES - Staff Writer
Before the discovery of antibiotics in the 1940s, little could be done for patients with bacterial infections. People either recovered on their own or died.

The problems of the past are returning gradually, courtesy of the new "superbugs," bacteria untreatable by most antibiotics. These bugs are the hardy few survivors among those who have been hit with antibiotics. The survivors multiply as only bacteria can do, and they grow more resistant over time.
A 12-year-old Ramona boy, Carlos Don IV, died recently from such an infection. His story is more than a family tragedy; it's an example of how difficult it is to tell the difference between an ordinary illness and something much more deadly.

Mystery illness

Carlos was an active, energetic child at Hanson Lane Elementary School. A winner of state motorcycle races, he wanted to be a professional football player. So getting some fun in the outdoors at Camp Cuyamaca, which he attended in mid-January, was totally in keeping for him.

But after Carlos returned home on Jan. 19, he fell ill, becoming short of breath. At first, it appeared as if he had a cold or the flu; there had been an outbreak of some illness among half the students at the camp. This was later found to be a flu outbreak.

However, this didn't explain Carlos' symptoms, which were far worse than those of his campmates. Over the next few days, it became clear that he was not getting well on his own. In addition to having trouble catching his breath, Carlos' heart began beating rapidly.

Carlos was rushed to an urgent care clinic, given antibiotics and taken home. He began to hallucinate, said Carlos Don Sr., his grandfather, who is acting as spokesman for the family.

Carlos was hospitalized at Rady Children's Hospital, where he was put on oxygen. It didn't help. By Jan. 25, doctors had figured out that he had contracted a notorious superbug known as methicillin-resistant staphylococcus aureus, or MRSA.

The question was, where?

MRSA is well-known inside hospitals, where it has been a known danger for years. One patient who contracts it can leave it behind to infect other patients, who by definition are usually not in good health. Medical experts have found that this superbug usually doesn't harm healthy people. Staphylococcus aureus is a common resident inside the nose, as is the antibiotic-resistant variety known as MRSA.

In most cases, MRSA infections can be traced to exposure in a hospital or other health care facility. But not in Carlos' case. He had what is known as "community-acquired MRSA," shorthand for saying its origin was unclear.

What became clear, said Carlos Don Sr., was that Carlos' immune system had been knocked down by the flu, making the lining of his respiratory tract more vulnerable to infection. Lesions left from the flu let the bacteria infect his lungs, causing pneumonia. And once established in the lungs, the bacteria coursed throughout his body.

Carlos was placed in a medically induced coma in an attempt to slow the infection. His legs became infected, killing tissue from the toes and spreading to the feet and up the calves. Doctors feared the legs would have to be amputated.

That fear was overtaken by events: Carlos died on Feb. 4.

What happened to Carlos was a combination of a lack of ability to quickly determine the cause of his illness and just plain bad luck, said Carlos Don Sr.

"We're just upset that they didn't have the right technology to isolate this sooner, or (have) the medicine," he said. "If we see some good come out of this, then it wasn't in vain."

Prevention as protection

It's still possible in some cases to knock down MRSA before it gets a firm foothold if the right antibiotics are given quickly. But doctors are reluctant to give antibiotics without a proper diagnosis. Overuse of antibiotics is what has helped speed the development of antibiotic-resistant bacteria. Also, some antibiotics have toxic side effects, so they're not used except in an emergency.

Improved antibiotics that can tame these superbugs are a long way off. A number of pharmaceutical and biotechnology companies are researching new drugs, but it takes years to find potential drugs and test them in cell cultures and animals before they reach human clinical trials.

And even then, it takes years to get marketing approval, if the drugs work. Most drugs fail clinical trials.

Public health officials say the best way to deal with the superbugs is by being diligent about good hygiene. Frequent hand-washing helps, as does being careful not to share personal items. Dishes should be washed in hot soapy water and dirty clothes laundered promptly.

Bacteria are normally present on the human body, including the "staph" species that can cause MRSA. Most of the time, staph is harmless. But when the skin barrier is broken, such as through a cut, staph can enter the body to cause an infection. Staph germs can also show their presence by causing a skin boil.

Staph infections differ in their ferocity from minor nuisances to life-threatening, depending on how virulent the particular strain is. Hand-washing and other hygienic measures help ensure that dangerous strains of staph or other bacteria don't get passed around.

If you've got a skin infection, especially a persistent one, see your doctor. Cover up the infection with a bandage or other dressing, and dispose of used dressings properly so the germs don't spread. More information about MRSA is available from the U.S. Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/aip/research/mrsa.html.

Urgent push

Many medical experts think antibiotic resistance is encouraged by the common practice of giving antibiotics to livestock to help them grow faster. Many bacteria that commonly inhabit animals can also infect humans. There is no ironclad proof that this happens, but the experts say it is a reasonable possibility, and as such warrants precautions.

The process never stops. As better antibiotics kill bacteria, the few that do survive become even harder to kill the next time around, and stronger antibiotics are needed.

The public should demand that the federal government put more of a priority on developing new antibiotics to kill the superbugs, said Victor Nizet, an associate professor of pediatrics in the infectious diseases division of UC San Diego School of Medicine.

"We'd like the pharmaceutical industry to be able to handle this on their own, but you can't wait for the market to catch up," Nizet said.

Contact staff writer Bradley J. Fikes at (760) 739-6641 or bfikes@nctimes.com.

Prevention is the key

Medical professionals stress that prevention is the best way to handle superbugs: Wash your hands frequently, don't share personal items and see a doctor if you get an infection, especially if it doesn't appear to be healing in a few days. And if you're prescribed antibiotics, take them all and don't stop just because you feel better. Start-and-stop antibiotic use contributes to antibiotic resistance.