My Personal Experience with a Superbug
Imagine a World that is Antibiotic Resistant
I left Austin on a clear morning, bags packed and excited to be back in school at the National Capitol Region campus of the Naval Postgraduate School (NPS) in Harper’s Ferry, West Virginia. I always look forward to seeing my classmates and discussing the intricacies of our assignments that we completed during our distance learning.
This trip for my two week in-residence was particularly exciting because after the first week, two of my sisters from the Carolina’s were going to meet me on a tour of the White House that two of my Secret Service classmates had graciously arranged for our class. The NPS degree I’m working through at the NPS’s Center for Homeland Defense and Security exposes me to many diverse aspects of homeland security and I am trying to soak up the amazing educational experience like a sponge. We’ve discussed everything you can imagine in homeland security, including bioterrorism, natural disasters, terrorist group dynamics, cybersecurity to critical infrastructure of the U.S., just to name a few topics.
The first week went fine and I got reacquainted with all the classmate news and began two new courses that I looked forward to with anticipation.
On Monday of the next week, things started to get a bit complicated. I had noticed a small bite on my right foot. Thinking it was a typical Texas fire ant bite, I thought nothing of it. Fire ants are a common occurrence in Texas.
On Tuesday, after class I took my shoe off and my foot hurt. The “bite” now was a lot angrier and I surmised that the bite might have been from a spider. I put some Neosporin on it and a band aid and said grace over it.
By Thursday, I knew something was really wrong. I went to the local Doc-in-a-Box in the small town of Harper’s Ferry who prescribed Bactrim, a broad spectrum antibiotic. I took it for two days and things got even worse and by the time I had hobbled my way through the White House tour, I made my way to the nearest Emergency Room, which happened to be at Georgetown University Hospital. I was expecting to get a different antibiotic by mouth and meet my friends later for dinner.
But things took a sudden turn. One look at the “bite” and an attempt to lance it, I was admitted to the hospital for four and a half days on IV Vancomycin, the last resort medication for many superbugs. Mine was diagnosed as MRSA, or methicillin resistant staphylococcus aureus.
For the first two days of my hospital stay I was on IV Vancomycin and oral Cipro, but my foot did not get better. After consulting with the doctors, they convinced me I needed to go into surgery to open the infection and flush it. This resulted in an open wound that will take many weeks to close with oral antibiotics.
If you have not heard of MRSA yet, you will very soon. MRSA used to be found only in hospitals, but as a result of 50 years of prescribing penicillin-related antibiotics for infections, the bacteria that cause staph infections have mutated and grown resistant to common antibiotics. Those resistant bacteria, MRSA, have presented themselves in the form of a new “super bug” that has moved quickly into the general public. And it’s a super bug that’s much more difficult to kill than previous staph bacteria. The Centers for Disease Control (CDC) says that community-acquired MRSA is “most often present as a skin or soft tissue infection such as a boil or abscess.” People commonly describe it as a “spider bite.” The affected area can be swollen and red in color and have pus or other drainage present. If not treated immediately, MRSA staph infections can continue their march all over the body and even infect the heart and lungs and cause pneumonia. If the lungs become infected, symptoms such as shortness of breath, chills, and fever could appear.
According to Dr. Mark Christensen, Associate Professor at the Oregon State University College of Pharmacy, public awareness of community-acquired MRSA first began to take shape in the late 1990s, when the CDC released a report chronicling four MRSA-related deaths of children in the Midwest. After the report, community-acquired MRSA kept a low profile and stayed out of sight until about 2000. At that point, a trickle of cases started appearing. However, in the past few years, the number of staph infections in the general population due to MRSA has exploded. MRSA is a ticking time bomb, ready to detonate.
Even Our Healthiest Citizens are Getting Infected
I consider myself a fairly healthy person. I eat healthy, I walk, bike and swim, don’t smoke and attempt to keep my weight down. But, even the healthiest among us can be brought down my MRSA. The St. Louis Rams and the Cleveland Browns have had high-profile cases of MRSA infections within their football programs. Part of the challenge for professional football players, and collegiate players for that matter, is the fact that MRSA bacteria can enter the body through a minor wound such as a turf burn. The MRSA bacteria can live on towels, walls, floors, and other surfaces—such as, theoretically, artificial turf. And even though these men are world-class athletes, a staph infection can debilitate one of them within hours. Brian Russell of the Cleveland Browns is a prime example of how MRSA can stop a great athlete in his tracks. A recent Associated Press article reported that Russell said he went from “being in tiptop shape, to a few hours later, being knocked on my butt and having surgery.” It doesn’t matter how strong or healthy a person is—MRSA can bring him or her down. And as Brian Russell can certainly attest, a MRSA infection can spread within hours.
Community Acquired MRSA (MRSA-CA)
Whether it spread from the hospital into the community or developed as a separate strain outside the hospital is a mystery, says John McGowan, professor of epidemiology at Emory University. Recent genome studies suggest the MRSA strain circulating in the community is significantly different from the strains that are typically found in hospitals.
“There are differences in the sequence of the community strain that may make it more virulent, more able to affect people with healthy immune systems, and with biological differences that make it spread readily.”
MRSA has become so common that in many hospitals more than half of all staph infections tested are drug-resistant. That’s changing the way doctors treat these common infections.
“When a patient comes in with a staph infection, we assume it’s resistant until proven otherwise,” says pediatrician Sheldon Kaplan of Texas Children’s Hospital in Houston, where MRSA rates have gone from 33% of all staph tested in 2000 to 75%. What we’re seeing is the emergence of a new epidemic strain of the MRSA in the community,” says Daniel Jernigan, medical epidemiologist at the Centers for Disease Control and Prevention (CDC). Staph aureus is the most common cause of the estimated 12 million skin infections each year in the USA. Another study of 11 emergency rooms across the country found that almost 60% of skin abscesses tested were caused by MRSA, Jernigan says. It’s literally all over the country.”
University of California researchers who sequenced the genome reported in the March 4 issue of The Lancet that the strain contains genes that make it hardy and able to cause “unusually invasive disease” such as severe blood infections and necrotizing pneumonia, in which lung tissue is destroyed.
Hospital Acquired MRSA (MRSA-HA)
Hospitals are hotbeds of viruses and bacteria, and infection is a common complication after surgery. In a healthcare setting, such as a hospital or nursing home, MRSA can cause severe problems such as bloodstream infections, pneumonia and surgical site infections. HA-MRSA infections occur frequently in hospitals and healthcare facilities, where patients undergo invasive medical procedures or have weakened immune systems. HA-MRSA is a growing health problem, increasing from 2% to 63% of total Staph infections between 1974 and 2004.
Dr. John Bartlett, a professor at Johns Hopkins University School of Medicine, treated three young Baltimore area women this year who got pneumonia from this community-acquired resistant staph. All had to be put on breathing machines, and one died.
The group has been warning that drug companies aren’t developing enough new antibiotics to avert a crisis.
Some Case Studies:
• In Los Angeles, doctors at UCLA Medical Center treated 14 people with necrotizing fasciitis, informally known as “flesh-eating bacteria,” over a 14-month stretch through April. Three needed reconstructive surgery and 10 spent time in intensive care.
“This is about as serious an infectious disease emergency as you can get,” said Dr. Loren G. Miller. “We don’t know how these people got the infection — there doesn’t seem to be a common thread.”
• In Corpus Christi, Texas, doctors at Driscoll Children’s Hospital saw fewer than 10 cases a year of community-acquired resistant staph infections in the 1990s, then saw 459 in 2003, with 90 percent in healthy children. Half were admitted to the hospital to get intravenous antibiotics; a few developed life-threatening lung and heart infections or toxic shock syndrome.
• A Centers for Disease Control and Prevention study shows another new twist: The resistant staph strain caused pneumonia in 17 people, killing five, during last year’s flu season. Only one had any risk factors for the infection.
“Nobody dreamt when we were in medical school that this would ever enter the community,” said Dr. Rajendra Kapila of University of Medicine and Dentistry of New Jersey in Newark. He has treated several patients with the infections at University Hospital there, including an itinerant golf caddie who kept getting abscesses on his neck until he landed in the hospital two years ago. Kapila linked the infections to abrasions from the man’s golf bag strap. In August, a man in his 40s with severe back pain turned out to have such a severe staph infection in his spinal cord. He was paralyzed permanently.
1 in 10 patients die from staph infections
A New Challenge to Long-Term Care Facilities: A New strain: CRE
Community hospitals in the southeastern United States have seen a fivefold increase in the number of cases of a dangerous drug-resistant superbug during the past five years known as Carbapenem-Resistant Enterbacteriaceas, or CRE.
CRE infections are most commonly seen in people with exposure to healthcare settings like hospitals and long-term care facilities, such as skilled nursing facilities, and long-term acute care hospitals. In healthcare settings, CRE infections occur among sick patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators, urinary catheters, or intravenous catheters, and patients who are taking long courses of certain antibiotics are among those at risk for CRE infections.
According to the World Health Organization, CRE bacteria are resistant to most commonly used antibiotics and are considered “one of the three greatest threats to human health.” CRE bacteria can cause infections in the urinary tract, lungs, blood and other areas.
The death rate from CRE infections is nearly 50 percent.
Researchers found that almost all of the 305 CRE infections identified in a recent study were health care-related. Greater use of broad-spectrum antibiotics is one of the factors associated with the growing number of CRE infections. Another factor is increased transmission between long-term acute care facilities and community hospitals.
Dr. Joshua Thaden, in a news release for the Society for Healthcare Epidemiology of America, “This dangerous bacteria is finding its way into health care facilities nationwide. Even this marked increase likely underestimates the true scope of the problem given variations in hospital surveillance practices. A CRE epidemic is fast approaching. We must take immediate and significant action in order to limit the transmission of these dangerous germs throughout our hospitals and acute care facilities.”
What is truly scary about this superbug now and in the future is that the aging baby boomers will be utilizing all these healthcare settings at staggeringly high rates from now until 2050.
The UK just announced the Longitude Prize will award £10 million to whoever comes up with a plan to address “one of the greatest issues of our time.” The prize panel this year will be looking for “cheap, accurate, rapid and easy-to-use point of care test kit for bacterial infections.”
Need for New Antibiotics: Hello, is anybody home?
Antibiotic resistance, one of the biggest threats to modern medicine is happening right now in every corner of the world, but the scariest thing about the drug-resistance crisis: barely anybody is working to create new, more effective antibiotics to treat this new crop of deadly diseases.
Tom Frieden, from the Centers for Disease Control said this week, “From a strictly business standpoint, the terrible thing about antibiotics is they cure people.” For this reason, many lament the fact that the “drug pipeline is dry.” Only a handful of new antibiotics have come on to the market in the last decade, and health organizations—such as the Infectious Diseases Society of America—worry that progress on new drugs is “alarmingly elusive.”
Non-Pharmaceutical Solutions: Ultraviolet Robots
In the United States, about 5 percent of patients develop infections while they’re in the hospital. This equates to somewhere in the neighborhood of 1.5 to 2 million infections per year and an estimated 100,000 deaths. So this is a really big deal. Given the lack of research into new drugs, healthcare providers are beginning to turn to technology for solutions.
Xenex, an Austin, Texas based company claims that its bot is 20 times more effective at eliminating bacteria than common cleaning procedures used in hospitals, but the real test is how it measures up to bleach, the tried-and-true method for disinfection. A recent study showed that the Xenex bot is superior to bleach at destroying one of the most concerning pathogens in hospitals, the resilient Clostridium difficile (C. diff) that can survive for months on surfaces. While cleaning with bleach only destroyed 70 percent of the pathogen in rooms, a 15-minute treatment using the pulsed UV treatment eliminated 95 percent, leaving six-times fewer bacteria around. Additionally, a recent investigation produced results consistent with these findings for the common antibiotic-resistant Staphylococcus aureus (MRSA).
One Hospital’s Experience
Using a pulsed-xenon UV lamp, the portable bot shoots out 120 flashes of light per minute. Each pulse lasts a thousandth of a second each, and a typical treatment runs for 10 to 20 minutes. The UV-C rays pass through the outer wall of a bacterium and damage its DNA, making it impossible for it to mutate or reproduce. This stops the pathogen from propagating or being harmful.
Additionally, a system of reflectors allows the light to be focused on areas that have high-touch surfaces, such as door handles and light switches. In case someone enters the room when the bot is in operation, a motion detector halts operation to prevent accidental exposure to humans.
A study conducted by M.D. Anderson Cancer Center in Houston concluded that the device is 20 times as effective in killing dangerous pathogens as traditional cleaning methods. After the study, M.D. Anderson bought the device.
Cone Health in North Carolina reported zero cases of MRSA, or staph infection, in its intensive care units after using Xenex. Cone projects it has saved $2.3 million in six months because of the reduced number of bed-days and personnel required to treat infections.
How UV-C rays work to destroy bacteria and germs.
At the hospital level, super-cleaning robots are another ripe area for development. “Even after the best humans clean the room, they still find C.difficile spores hiding on the ceilings or around the room,” said Kevin Outterson, a health law professor and antibiotics expert at Boston University.” If you have a problem with multi-drug resistance in the hospital, one idea is get more antibiotics. Another is to get a super-cleaning robot.” Since five percent of US hospital patients acquire infections during their stays on the ward every year, these automated super-cleaners could theoretically help avoid some of those infections and the need for more drugs to treat them, though their impact remains to be seen
Given my personal experience with a super bug, I cannot imagine a scarier scenario than a world susceptible to diseases for which we have no medicines or other ways to attack them. Treating these infections will require a systematic approach of educating the public, changing the way we consume antibiotics, developing new drugs, utilizing innovative technology and practicing strict infection control procedures in hospitals and community communal settings.
