Thursday, Apr 19, 2018
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Losing the 'bug' battle

There are more mean bugs out there making us sick, and we're to blame.

We're not talking mosquitoes. No, these tiny bugs are the bacteria that are growing ever more resistant to the antibiotics we throw at them.

The bug battle started during World War II when penicillin was used to treat Allied soldiers injured during D-Day. Since then, there's been an arms race as researchers try to develop more powerful drugs to fight bacteria that become resistant to older antibiotics.

Scientists have warned for years that the overuse of antibiotics - for everything from ear infections to sore throats - is making the situation worse.

"We're alarmed. In fact, it's much more alarming than the threat of bioterrorism or avian flu," said Dr. David Gilbert, past president of the Infectious Diseases Society of America. "It's much more likely you'll be infected with a resistant strain of bacteria than you'll get the avian flu. We're dealing with resistant bacteria every day."

What that means is someone might come down with something that seems innocuous such as an annoying skin rash. But that rash could end up being a resistant form of bacteria that begins to eat away at healthy skin.

"We're seeing much more of the resistant staph [infection]," Dr. Gilbert said. "And bacteria that normally live in the intestinal tract, like E. coli, they used to be sensitive to 10 different antibiotics. Now they're increasingly resistant to everything. You go to the cupboard [to find medication] and you don't have anything to treat the patient with."

Four years ago, the federal Centers for Disease Control and Prevention estimated that 2 million people contracted bacterial infections in the United States while in the hospital that year, and 90,000 of them died. Of those infections, more than 70 percent were resistant to at least one group of antibiotics commonly used to treat them.

It appears researchers in Ohio are getting another reminder of the growing problem of bacterial resistance.

A strain of intestinal bacteria known as Clostridium difficile, or C. diff, has become resistant to antibiotics and appears to be proliferating in some hospitals and nursing homes.

C. diff can cause fever, diarrhea, and more serious intestinal conditions. Though the disease has been around for years, what's happened is a strain of C. diff has evolved that produces toxins that are more potent than older strains - and it's resistant to some antibiotics.

So far, there's little evidence that C. diff has had much impact in northwest Ohio. Dr. Gilbert, who's director of medical education at the Providence Portland [Ore.] Medical Center, said it appears to him that Ohio is simply "catching up with the rest of the country" with C. diff.

Dr. Clifford McDonald, a CDC researcher who studies C. diff, said reliable national or state estimates aren't available but it appears C. diff is quickly spreading.

"Using hospital discharge data, which is not exact, but using that, it doubled between 2000 and 2003," he said.

Ohio officials have told hospitals and nursing homes to begin reporting cases of the illness so they can better track it. One concern is the disease could spread easily beyond the walls of health care facilities and become what's known as "community acquired." Dr. McDonald said there are some cases in the U.S. that appear to be community acquired, and England has reported many cases that seem to fit that description, too.

Toledo area health officials say that's already happened, both in our area and nationwide, with a form of bacteria known as Staphylococcus aureus. This bug is a common cause of hospital infections and can spread to the organs and bloodstream with fatal results if not treated. Penicillin used to work, but the bug quickly evolved, and by the 1960s penicillin was almost useless.

A new drug, methicillin, was developed with good results. In 1974, 2 percent of staph infections were resistant. Thirty years later, nearly 60 percent of staph cases were resistant to methicillin, and this strain of staph is now known as MRSA - methicillin resistant staphylococcus aureus.

"I think we're more nervous [about antibiotic resistance] than we were five years ago," said Dr. McDonald. "The scope and magnitude of the problem has really become more apparent. The C. diff issues [are] one, MRSA is another."

Dr. Luis Jauregui, head of infection control at St. Vincent Mercy Medical Center in Toledo, said the C. diff issue doesn't concern him as much as MRSA.

"The number of [community-acquired] MRSA cases has really exploded," said Dr. Jauregui, who studies new antibiotic treatments. "That organism used to be primarily found in locations such as hospitals. But it has now altered its pattern into community-acquired MRSA. ... We've been keeping track of this organism for the last 15 years, and the number of organisms from the community has increased about 14-fold since about 1988. It's a tremendous increase, and about 50 percent of that change happened in the last three years."

Jeanine Bailey, an epidemiologist with the Toledo-Lucas County health department, said her agency surveyed Lucas County hospitals last year to see how many cases of community-acquired MRSA hospitals were seeing. They discovered nearly 500 such cases were seen by hospitals in the last half of 2005.

Though new treatments are needed, public health experts say the most important thing that can be done is the wiser use of antibiotics.

Bacteria develop resistance to antibiotics because of what biologists refer to as "pressure." Simply put, antibiotics kill off most bacteria, but a few - because of natural resistance - survive and multiply. In addition, if those resistant bacteria are able to pass on their genes to other bacteria, perhaps bacteria that are more deadly, then this combination can spark a new strain of potentially lethal bacteria.

This antibiotic pressure comes from several areas. One area of concern is agriculture. The use of antibiotics in poultry and livestock production is widespread, and some public health experts worry that this will lead to resistant forms of bacteria that jump to humans.

Another source is within hospitals. Extensive use of powerful antibiotics in hospitals can create breeding grounds for tough, resistant strains of bacteria to develop. That's why it's so critical that nurses and doctors follow key precautions such as washing their hands frequently.

Finally, where most people encounter antibiotics is in their doctor's office. A sore throat, your child's ear infection, and a host of other ailments cause many of us to rush to the doctor's office and demand antibiotics. Unfortunately, in many cases those antibiotics not only don't do any good, they can contribute to the pressure that creates resistant strains of bacteria.

"The great majority of upper respiratory infections and sore throats are viral and antibiotics do nothing," said Bob Blumenthal, interim chair of the department of medical microbiology and immunology at the Medical University of Ohio. "Many ear infections are also viral ... the more that antibiotics are used, the greater the pressure we're putting on bacteria to become resistant. Eventually, bacteria will become resistant, the question is can we slow the process down enough."

The CDC, as well as Ohio and other states, have adopted campaigns to educate the public about appropriate antibiotic use. One popular campaign, known as the "Get Smart" campaign, focuses on helping the public recognize when symptoms are viral and thus not helped by antibiotics.

Some key messages from that effort include:

  • Antibiotics do not work for colds, most sore throats [except for strep throat], the flu, most chest colds, most cases of bronchitis, or for middle ear infections. All of these illnesses are likely viral.

  • The color of your mucus, such as yellow or green, does not indicate a bacterial infection.

  • If antibiotics are prescribed, take them exactly they way your doctor tells you to, and do not stop taking them if you feel better; take the entire course.

    Mr. Blumenthal said public health experts worry that drug companies have slowed or stopped research into developing new antibiotics. For one thing, the treatments aren't as profitable as other drugs - why create an antibiotic when you can produce Lipitor, a lucrative cholesterol-lowering drug someone has to take for the rest of his or her life? But this slowdown in research is dangerous.

    "It exposed a weakness. If bacteria are still evolving, but we stop developing the flow of new antibiotics, then we're in trouble," he said.

    Dr. Gilbert said that problem has already occurred.

    "Even if you could turn this ship around and convince companies that they really could get the job done, they have so dismantled their research machinery it would take us 10 years to get a new drug," he said. "That's why we're so concerned, and it's just going to get worse and worse."

    Contact Luke Shockman at: or 419-724-6084.

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