British Prime Minister David Cameron Warns us of the Growing Crisis of Antibiotic-Resistant Bacteria

While Canada and the United States were celebrating national holidays last week, British Prime Minister David Cameron was hard at work addressing the problem of antibiotic resistance. He announced that Britain would be taking a lead role in trying to solve what he says is a global crisis:

“We are in danger of going back to the dark ages of medicine to see infections that were treatable not be treatable and we would see many thousands of people potentially die from these infections. So it’s a very, very, serious problem and one that we have to grip, and we have to grip it globally because this is a problem that’s going to affect every country in the world.”

In concrete terms we are returning to an era when many women died after childbirth after developing a simple bacterial infection, and where a whole raft of surgical procedures would be imperiled, from hip replacements to cancer chemotherapy and organ transplants.

In an interview with London’s Guardian newspaper Cameron went on to say that, “When we’ve had these problems in the past, whether it is how we tackle HIV and Aids, how it is possible to lead the world and get rid of diseases like polio, Britain has taken a lead and I think it is right we take a lead again.”

Cameron is not going out a limb on this; rather, he is giving political voice and leadership to a growing global crisis identified as such by the world’s leading scientific bodies such as the World Health Organization who announced this year that it’s “…a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.”

So, too, the U.S. Centers for Disease Control and Prevention: “Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections;” the Public Health Agency of Canada: “More than 200,000 patients get infections every year while receiving healthcare in Canada; more than 8,000 of these patients die as a result;” and the New England Journal of Medicine: “arguably the greatest risk . . . to human health comes in the form of antibiotic-resistant bacteria.”

So Cameron is exactly right to do what he did. Now imagine the traction we could get if Prime Minister Stephen Harper and President Barack Obama would add their voices as well.

A Hospital Outbreak of MRSA Affects People at Home Too

A hospital outbreak of MRSA impacts the whole community. One example is a pregnant women - and her family - who will have to go to the affected hospital to give birth.

A few weeks ago a MRSA outbreak struck the Brantford General Hospital in Ontario. A total of 15 people in 3 wards caught the bug. It was deemed an outbreak because at least 3 new patients in each ward were diagnosed with MRSA in just a single week.

The hospital understandably framed the issues from their perspective: they told us how they responded to the outbreak and about the extra financial costs they incurred.

Which is fair enough, however a closer look reveals that a MRSA outbreak has a greater and more insidious reach than just that. For example, what is the effect on people who are waiting to go that hospital for surgery, say, or for outpatient treatment, or to see their doctor?

Take the case of a pregnant woman about to give birth. Here are the concerns one such woman expressed to an online website for expectant mothers, upon learning of the outbreak at BGH:

“I’m due in 27 days and found out yesterday that there is a large outbreak of MRSA at my local hospital. The outbreak is currently on three different floors that they know of, and I have to pass all three floors to get to the labour and maternity floors. The next closest hospital is the Children’s Hospital 45 minutes away, but if I’m in labour, and my labours are quick, I’m not going to be able to drive myself out there, and my family is an hour away in the opposite direction.

I’ve been leaning towards a homebirth, and this outbreak is pushing me more towards definitely having one, but in the time between now and going into labour, the hospital is where I would have to go for NST’s and monitoring.

How dangerous, exactly, is MRSA to pregnant women and newborns? I really don’t want to risk exposing myself or my newborn to it.”

She received this response from another pregnant woman: “I am supposed to deliver at BGH soon and it’s scaring me as well.”

And from a nurse she received this advice: “I personally would recommend staying away from that particular hospital. If your [sic] uneasy by the hospital now, think how you would be during labor?”

So the women are are being warned away from BGH, they’re scared and they’re not sure where they should give birth.

Meanwhile, news accounts of the outbreak are reporting that some people are more vulnerable than others when it comes to catching MRSA: those who are frequent hospital visitors, are antibiotic users, have open wounds, suffer from poor nutrition or poor hygiene, or are elderly. All told that can be a large swath of the community.

So if women about to give birth are feeling scared and anxious about going to the affected hospital, how many other people in that community might be feeling the same way?

MRSA gets Messy: The Story of NFL Player Lawrence Tynes

Lawrence Tynes in healthier days.

It was only an ingrown toenail – how bad could that be?

It belonged to NFL player Lawrence Tynes of the Tampa Bay Buccaneers. This was the summer of 2013 and by then Lawrence had been playing pro ball 12 years. He had 2 Super Bowl Championships under his belt and figured he had five maybe six more seasons left in his 35 year old body – Lawrence was a placekicker. That would about do it and then he, his wife Amanda, and their two 7-year old twin sons would be set. They could see the finish line.

Except the toe got angry. It became red, swollen, and was oozing pus. No problem, team doctors would give him an antibiotic and that would do the trick. But it didn’t. Then a test came back. Lawrence had MRSA. Okay, so they would switch up the antibiotics – a total of 5 more times – but none of them worked out either.

His infection surrounded the bone but so far the bone hadn’t been penetrated. If that were to happen Lawrence would be looking at amputation – and the end of his career. Because as luck would have it this was his kicking foot.

Next came the operations, 3 in all, but that still didn’t get the MRSA out.

In response to the Bucs' claims that Lawrence is "responding well" to treatment, Amanda Tynes, Lawrence's wife, tweeted this picture of her husband along with the following: I hear my husband is responding "well" to treatment. LOL! He's NOT responding at all yet. This is our #bucslife.

So it was back to the antibiotics but this time it would be different. Lawrence would be hooked up to what’s called a PICC line which stands for “peripherally inserted central catheter.” Powerful, potentially toxic antibiotics were dripped into a plastic tube that was inserted into his right arm. The tube was pushed through a succession of veins until it was resting just inches from his heart – all the better to pump the drugs hard throughout his whole body. Lawrence was going to have to live this way for several months which meant that he probably wouldn’t be playing football that season.

So his employer, the Tampa Bay Buccaneers, made a business decision. While they agreed to pay him his base salary they decided he was not entitled to health or other benefits that his contract provided for, and thus the 2013-2014 season would not count towards his pension. Their reasoning was simple: the MRSA he contracted had nothing do with playing football or with the club’s facilities – in other words, it was not an on-the-job injury.

Except for this: 2 other Buc players and the team trainer had also come down with MRSA; Tynes had been training at the facility every day in the off-season and throughout the summer; and when other NFL players were stricken with MRSA in the past, the teams had always honored their contracts.

So with the backing of the NFL Players Association Lawrence filed a grievance against the Bucs to get them to honor the entirety of his contract.

How is Lawrence doing through all this? “I’m really scared,” he said. “I’m scared for my health, primarily, but when you think about football, I was going to be the Bucs’ kicker until I contracted MRSA. It’s the humanity of it – [the Bucs] not accepting blame and then trying to sugarcoat it with the salary,” he said. “That was their PR cover-up: ‘At least you’re getting paid.’ “That’s not the point. It’s wrong.” I don’t know what else is next.”

What came next was that on March 11, 2014, Lawrence was released from the Bucs.

His grievance is still pending.

And MRSA is messy.

Now That’s Heroic

This is Danielle Ripper today.

It’s not supposed to happen that way. Sixteen year old skateboard-loving boys are not supposed to be lying in the hospital facing death. But that’s what happened to Daniel Ripper of Birmingham, Michigan, after MRSA somehow got into his brain. Daniel didn’t die, but neither did he leave the hospital without paying a price – the MRSA left him blind: “When you get out of the shower and you look at the mirror and it’s all foggy – that’s what I see,” he said, in an interview with his local newspaper. “It’s all lights.”

Today, 2 years after MRSA struck  him, Danielle is not just back skateboarding, he is taking classes and eventually plans to open his own skate park. “I couldn’t play video games or watch TV, so I started skateboarding. It gets me out of the house and clears my mind up. As bad as it is, I know it could be worse, he said. I realize I might not even be here. I can’t see but I can still have fun with life.”

Every year in the United States over 80,000 people suffer from severe MRSA infections just like Daniel does. That’s another reason his story matters. It reminds us that MRSA doesn’t just come and go like the illnesses most of us experience. Instead, it leaves its mark: an amputated limb, a removed organ, a disfigured face. And it makes you pay a heavy psychological price too, because the people who’ve had it once are more likely than those who’ve never had it to get it again. So you have to learn to live not just with your blindness, as in Daniel’s case, but also with the dread that it may return. And when you’re a MRSA patient in the United States, you also know that it will kill over 23,000 Americans every year.

But this coming Saturday, on June 14, Daniel Ripper and those close to him will have something else on their minds. A fundraiser for Daniel is being held at the Birmingham skate park to raise awareness about MRSA and to help out Daniel financially. There will be food, a raffle, art, and music.

And there will be plenty of skateboarding.

If you would like to see videos of Daniel or contribute to his fundraiser, click on the first link above.

The Coffee Cure: Drinking Coffee Cuts Nasal MRSA Rates in Half

Why does hot coffee or tea reduce MRSA colonization? Perhaps because they decrease iron absorption and iron is needed for growth of S aureus. We also know that compounds in those drinks have antimicrobial properties.

I don’t know about you but it seems every time I want coffee from a Starbucks or a Tim Hortons that’s located inside a hospital, I have to queue up at the end of a long line of health care workers. Well, here’s some research that suggests we just might want to be a little more tolerant of those long lines.

It says that people who drink hot coffee or tea are 50% less likely to have MRSA in their nose, compared with people who did not drink hot coffee or tea. And the more coffee or tea you drink, the lower your risk for MRSA.  Soft drinks and iced tea had no significant effect on nasal MRSA risk.

This is according to a study published in the journal Annals of Family Medicine by researchers at the University of South Carolina, Charleston.

The researchers describe this effect as “robust” and if you dig into the study a little bit you can see why.

To begin with, the paper points out that their finding is not entirely new. Rather, it’s consistent with a line of research that has shown coffee and tea to have had antimicrobial activity against other types of pathogenic bacteria. For example, against E. coli, Salmonella, and Staphylococcus aureus – i.e., staph that are susceptible to antibiotics.

Second, the researchers discuss a study where bedridden patients underwent treatment for their MRSA-infected pressure ulcers. One group of patients had their ulcers treated (flushed) using green tea while the other group had their ulcers treated with a saline solution. After one month, the patients whose ulcers were treated with green tea experienced a marked decrease in ulcer severity, and the MRSA had disappeared in half of these patients – the exact same finding we have with the nasal MRSA. In the patients treated with salt and water, ulcer severity was unchanged, and all of the ulcers were still infected with MRSA.

All told, this is strong evidence and so the question is, how does it work?

The researchers aren’t sure. They think what’s happening is that certain compounds in coffee and tea have antimicrobial properties which destabilize and weaken the MRSA. And the reason the liquids can’t be cold is so these antimicrobial compounds can be breathed in via the vapors from piping hot cups of coffee or tea.

So back to those long coffee lines at the hospital. In an interview with WebMD, one of the authors of the study, Dr. Eric Matheson, an assistant professor of family medicine at USC, Charleston, offered us some free medical advice: “If you don’t drink coffee or tea and work in a health care setting, you may want to start as this may decrease your risk of carrying MRSA in the nose,” he says. “It couldn’t hurt.”

Cigarette Smoking Enables MRSA

Dr. Laura E. Crotty Alexander. Her research establishes that cigarette smoking causes your MRSA bacteria to become way more virulent.

Let’s start with what we know. The number one way to legally ruin your health is to smoke cigarettes. However strong your body was before you took up the habit, you are only half as strong now because smoking weakens the immune system. So for example, smokers are two to four times more likely to develop pneumonia than non-smokers. You will get the flu more often and it will be more severe, and so on.

But Laura E. Crotty Alexander, M.D., assistant professor of medicine at the University of California, San Diego, had another idea. What if the problem isn’t just that cigarette smoke weakens the immune system, what if it actually makes your bacteria stronger? In other words, does cigarette smoking both weaken your body and strengthen your bad bugs at the same time?

Apparently so. Dr. Alexander tested her idea with MRSA. She found that when you inoculated mice who had MRSA in their lungs with cigarette smoke, that the MRSA bacteria had a survival rate four times greater than the MRSA in mice who weren’t given the cigarette smoke. Thus you are better able to establish infection in the body and cause more severe disease in mice who “smoked.”

And because of the booming market in e-cigarettes, Alexander wondered if e-cigarette vapor would have the same effect. So she ran parallel studies and found the same pattern of increased virulence: MRSA bacteria in mice inoculated with the vapor had a survival rate three-times greater than mice that weren’t inoculated with the cigarette vapor.

Dr.Alexander reasons that cigarette smoke puts stress on bacterial cells, just as it does on human cells, and that the bacteria respond by protecting and arming themselves, thus becoming less vulnerable to attack.

Smoking, then, is a triple-whammy. First, it weakens your immune system. Second, as Dr. Alexander’s work shows, it strengthens the bad bugs that invade your body. Thus, these first two cases increase the likelihood you’ll need an antibiotic. Third, a newly discovered side-effect of taking antibiotics is that it leaves you more vulnerable to infection because it kills not just your “bad” bugs, but you “good” ones too, those that help fight infection.

So then, what’s the true cost of that pack of cigarettes?

Annals of Evolution: From the Handshake to the Fist Bump as a Way to Prevent the Transmission of Disease in Hospitals

Seth Meyers and Amy Poehler demonstrating proper doctor patient contact. Who knew?

So it has come to this: in what conjures up images of a sketch on Saturday Night Live, the prestigious Journal of the American Medical Association this month recommended the banning of the handshake between doctors and patients. Instead, JAMA says, we should replace it with the fist bump, or a wave (think of the Queen as she passes by in her motorcade), by placing your hand on your heart, or bowing, or … well, this is where SNL could surely offer up something good.

What’s going on? It’s not just that health care workers’ hands are hotbeds for germs and so they end up spreading disease throughout the hospital, it’s also the fact that doctors (especially) and nurses aren’t following hand hygiene rules: JAMA reports compliance rates as low as 40%. One of the best known superbugs, MRSA, is alone estimated to kill around 19,000 people every year in the United States – far more than HIV and AIDS – and a similar number in Canada and Europe. And the problem is likely to get worse. Three weeks ago the World Health Organization released a landmark report saying we’re headed for a post-antibiotic era (i.e., we have overused antibiotics for so long now that germs have found ways to overcome them) in which common infections and minor injuries which have been treatable for decades can once again kill.

So because antibiotics are failing us, we’re scrambling to figure out other ways to prevent the spread of infectious disease. However, the proposed handshake ban does not look promising. In an online pole of healthcare workers seeking a response to the JAMA article, 54% of them said that they “Should not stop shaking hands” with their patients. Which is suspiciously close to the 60% who already don’t comply with existing hospital hand hygiene rules.

So if we can’t rely on health care workers who can we turn to? The JAMA article recommends “widespread media and educational efforts, as well as the development and promotion of effective alternatives,” as a way of overcoming resistance to their proposal to ban the handshake. And who are the Masters of the Media? Well, here’s the contact information for SNL. Since Seth Meyers and Amy Poehler were ahead of the curve on the fist bump, perhaps they and their colleagues could lend us a hand (again).

Pet-MRSA

Guess who else has MRSA?

We have just learned that our cats and dogs can get MRSA. And they get it not just from other animals but from you, their owner; and, should your pet contract MRSA from somewhere out there, it can then be passed on to you.

And it’s not just cats and dogs, it’s all “companion animals:” your pet rabbit, parrot, and turtle; horses and, um, your bats (bats?).

So says a study out of Cambridge University in England published this week. Researchers gathered MRSA samples from animals in veterinary hospitals throughout the United Kingdom over a 4 year period and compared them to human cases of MRSA.

Two other findings from the study are interesting because they also show similarity between us and our pets.

Even though there are hundreds of strains of MRSA in the environment, each veterinary hospital the researchers drew samples from had its own unique strain, “suggesting that as in human hospitals, MRSA can be readily transmitted in veterinary hospital settings.” And, “It’s a reminder that constant vigilance and high levels of hygiene are just as important when treating cats and dogs as with humans.” Thus proving once again that the hospital – whether human or animal – is an inherently dangerous place.

Second, just as with humans, the study says that it’s the vulnerable who are at risk. Healthy pets are not likely to become infected with MRSA from their human companions unless their health is already compromised. Conversely, vulnerable humans – the elderly, infants, or someone who is ill – are more at risk from becoming infected from a pet carrying MRSA.

One more thing. MRSA has traditionally been associated with hospitals, and now with this Cambridge study, veterinary hospitals. But U.S. research published last month makes it abundantly clear that MRSA should no longer be thought of as just a hospital-bound phenomenon – simply put, it has also taken root in our homes. Specifically, the researchers found that MRSA had become “endemic,” i.e. regularly found, in private homes, and that the home plays a critical role as “reservoirs for transmission and diversification.”

So as it turns out we share more than just the house with our cats and dogs, we also share each other’s germs; in this case, MRSA. It’s what we have suspected all along: they are part of the family.

Bioprospecting

The new age prospectors - bioprospectors - Drs. Lauren Paul and William Fenical went to the ocean floor to discover anthracimycin, which might be effective against MRSA and anthrax.

There’s an interesting report by the BBC about the recent discovery of a potentially new antibiotic, anthracimycin, that “seems to be” effective against MRSA and anthrax. The antibiotic was extracted from bacteria that had been collected from the bottom of the Pacific Ocean off the coast of California.

But what are scientists doing making the grand effort to dig up bacteria buried in muddy ocean floors? They call it “bioprospecting,” which is the search in far flung places (think of prospecting for gold in the 1800s) like caves, rain forests, and ocean floors, for natural occurring organisms that have medicinal properties. In this case the naturally occurring organism is a kind of bacteria whose medicinal property fights MRSA and anthrax.

The reasons scientists are engaged in bioprospecting in the first place are important to understand. It’s not because it offers them an exciting life and makes for good conversation over a round of beer. It’s because, contrary to conventional thought, most drugs are not made from scratch in the lab. They’re found in nature and “refined” for popular use in the lab. For example, most antibiotics are extracted from tiny creatures found in the soil. And if you look at the 10 best-selling drugs last year – for things like cancer, arthritis, heart disease, and so on – you find that 7 of those drugs come from nature, not the lab.

But there’s a problem. Why are infectious disease scientists having to scour the ends of the earth to find compounds with antibiotic properties? If most of them are found in the soil, why can’t they just go and dig up the backyard? The answer is because the backyard has been picked clean over a roughly 40 year period beginning in the 1930s. This explains why no new classes of antibiotics have been developed since the 80s; all we’ve done since then is find the same kind of molecules over and over again. In other words, we have long-since picked all the low-hanging antibiotic fruit.

Which leads us to the next problem: antibiotic resistance. Since we’ve been using variations of the same antibiotics for decades now, the bad bugs have figured out ways to beat these drugs thereby rendering them useless. So much so that the World Health Organization announced last week that we’re on the cusp of a worldwide post-antibiotic era in which even common infections and minor injuries which have been treatable for decades can once again kill.

Hence the urgent need for our scientists to pack up their tools and head for some deep cave in an Amazon rain forest to find us some brand new molecule with antibiotic properties. After all, these hidden organisms haven’t been exposed to antibiotic drugs so we know they couldn’t possibly have developed resistance to them … right?

Well that was the theory and a pretty reasonable one at that – until yesterday when we got some bad news: it turns out that most of these exotically located organisms cut off from the rest of the world are in fact already resistant to our antibiotics; it’s as if they were just “born” that way, millions of years ago.

The researchers looked at data from 71 places around the world, everywhere from Antarctic ice to the bottom of the ocean and found antibiotic resistance in every location. A similar study carried out by Dr. Gerry Wright, a self-proclaimed bioprospector and microbiologist at McMaster University in Ontario, dug up bacteria in a New Mexico cave stretching some 1,600 feet underground. He found that, as reported in the New York Times, most of the bacteria were resistant to some antibiotic and others could resist 14 commercially available antibiotics. In other words, antibiotic-resistant bacteria are not just the product of modern medicine, they’re an ancient part of nature.

So if we’ve pretty much found all the molecules in nature that have antibiotic properties and the once promising hope of bioprospecting is not only coming up empty but is uncovering a world full of organisms already resistant to our antibiotics where does that leave us? In polite terms we’ll just say we’re not sure, other than to observe that no antibiotic cavalry seems likely to be coming to our rescue any time soon.

As for the discovery of anthracimycin, that rare and recent bioprospecting success story – it’s still undergoing testing to see if it can be developed as a drug for general use.

We Were Warned

Britain's Chief Medical Officer, Dame Sally Davies, warned us a year and a half ago of a post-antibiotic era that would involve an "apocalyptic scenario."

We have now been officially warned by the World Health Organization of a coming post-antibiotic era where our ability to perform surgery and treat cancer is severely compromised, and where common infections and minor injuries which have been treatable for decades can once again kill.

But how is the average person supposed to evaluate such a claim? Is it to be believed in whole or in part or is it hyperbole? After all, we live in an Age of Suspicion where the pathology of politics distorts even the sciences, from the debate on man-made climate change to whether human genes can be patented, thus turning them into  private property and vehicles for corporate profit.

One way to evaluate the WHO claim of a coming post-antibiotic era is to understand that they’re not saying anything new; rather, they have merely – and finally – put their seal of approval to a position that has been staked out for years by leading scientists around the world.

For example, Britain’s most senior medical adviser, Dame Sally Davies, has warned that the rise in drug-resistant diseases could trigger a national emergency comparable to a catastrophic terrorist attack, pandemic flu or major coastal flooding. She said the threat from infections that are resistant to frontline antibiotics is so serious that the issue should be added to the government’s national risk register of civil emergencies. She describes what she calls an “apocalyptic scenario” where people going for simple operations die of routine infections “because we have run out of antibiotics.” And she has been saying this since at least January, 2013.

In the United States, the Centers for Disease Control & Prevention issued Antibiotic resistance threats in the United States, 2013, a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health. The report begins with these introductory remarks: “Antibiotic resistance is a worldwide problem. New forms of antibiotic resistance can cross international boundaries and spread between continents with ease. Many forms of resistance spread with remarkable speed. World health leaders have described antibiotic resistant microorganisms as ‘nightmare bacteria’ that ‘pose a catastrophic threat’ to people in every country in the world.”

In Canada, the Chief Public Health Officer’s Report on the State of Public Health, 2013, called infectious disease, “the never-ending threat,” noting that more than 200,000 patients get infections every year while receiving healthcare in Canada; more than 8,000 of these patients die as a result, and that these numbers are rising. For example, the healthcare-associated MRSA rate increased more than 1,000% from 1995 to 2009 (the last year for which numbers are available).

Sir Alexander Fleming, the guy who ushered in the antibiotic age, warned us right from the start not to become addicted to antibiotics.

Canadian scientists are even more pointed. For example, Dr. Bob Hancock, Professor and Canada Research Chair in Microbiology at the University of British Columbia, in an interview this March on the CBC science program Quirks and Quarks, was asked by the host what he thought the odds are of facing a worst-case scenario of a life “beyond antibiotics.” His reply: “I would say right now, unless something changes it looks inevitable.

Let’s remember, these scientists and their organizations are notoriously cautious entities. For example, when the CDC Threat Report says that 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections, they emphasize that these are the “minimum numbers.”

Let’s end at the very beginning with the words of an internationally renowned scientist given in his Nobel Lecture: “But I would like to sound one note of warning … It is not difficult to make microbes resistant to penicillin … The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily … by exposing his microbes to … the drug make them resistant.”

These are the words of warning of none other than Sir Alexander Fleming, the scientist who discovered penicillin and who launched the antibiotic era.

The year was 1945.

So yes, we were warned.

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