The rise of drug-resistant bacteria

(First in a two-part series)

“We are clearly in a public health crisis” Stuart Levy, M.D., Tufts University

The acronyms MRSA and VRE do not mean much to most citizens, but doctors, nurses and other health care professionals certainly understand what they mean. The acronyms refer to antibiotic-resistant strains of bacteria that increasingly bedevil hospitals, nursing homes, prisons, college dormitories, military barracks and even daycare centers. The bacteria are so prevalent, powerful and resistant to countermeasures that they pose a major health crisis in the United States.

Most hospital administrators are reluctant to talk about MRSA and VRE for fear of alarming patients and inviting legal problems. However, the problem is widespread. Every year in U. S. medical institutions, 2 million patients contract infections bacterial, viral and otherwise and 90,000 die. Their deaths occur in ones and twos; thus, there is no outcry from the population at large. HMOs, meanwhile, are quietly raising their premiums to cover the $5 billion cost of treating drug-resistant infections.

How did this problem come about? Researchers point to three factors: overuse of prescription antibiotics by people, poor infection control measures within the medical community, and widespread use of antibiotics in agriculture.

The overuse of antibiotics is the worst. Physicians are under intense pressure from patients to prescribe antibiotics for virtually every illness even viral infections such as the common cold. The Centers for Disease Control and Prevention (CDC) in Atlanta says that one-third of the 150 million outpatient prescriptions issued every year are unnecessary.

Penicillin, once thought to be a “wonder drug,” now has limited effectiveness in fighting infections. This drug, put into widespread use in the latter years of World War II, was prescribed indiscriminately in the decades following the war. Because of this, strains of penicillin-resistant bacteria began to appear. The biological principle of chance mutation was at work. Increasingly, people developed infections that would not respond to the drug. Scientists then devised methicillin, which seemed effective against the new strains, but that didn’t last more than a few years (enter MSRA). Then a powerful antibiotic called vancomycin sometimes called the “antibiotic of last resort” was synthesized and used against the drug-resistant bacteria, but even that gradually began to lose effectiveness (enter VRE).

The bacteria are often spread, ironically, by health care professionals who move from patient to patient without proper hand washing. Strains of the bacteria are also present on stethoscopes, bed handrails, linens, blankets, pillows, rectal thermometers, telephones and computer keyboards. The problem is most acute in intensive-care units (ICUs). In fact, Barry Farr, M.D., recently reported that the incidence of VRE among enterococcal infections in the ICU at the University of Virginia medical center to be nearly 100 percent.

Many people in hospitals come in contact with the three most common strains of drug-resistant bacteria E. faecalis, S. aureus and S. pneumo but they do not show ill effects if their immune systems are strong and if they receive prompt, aggressive treatment by their physicians. Others, however, are not so lucky. The bacteria invade their bodies during surgery or when they are recovering in an environment rife with sick people. The bacteria cause throat inflammations, persistent ear infections, bloodstream infections, heart problems, pneumonia, meningitis even necrotizing fasciitis. In the absence of effective antibiotics, the patients gradually succumb.

Next week: Antibiotics in agriculture and what the average person can do in the war against drug-resistant bacteria.

Gary Jacobsen lives in Woodbridge.

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