Map of life expectancy at birth from Global Education Project.

Friday, August 21, 2009

A harmonic convergence

It can be difficult to come up with something intelligent to blog about every day (as you have no doubt noticed) but sometimes the posts write themselves. First thing this morning I had a meeting with a colleague who is a resident in internal medicine here so I asked her what bugs are going around. She said oh, I feel like I must be covered in MRSA. After backing away slowly to a safer distance, I allowed the conversation to continue. She said she's paranoid every time she gets a pimple.

MRSA, in case you didn't know, is Methicillin resistant Staphylococcus aureus, which is just good old staph except that eats antibiotics for lunch, in particular the most commonly used family of antibiotics, called beta lactams, which includes penicillin-like drugs and many others. It used to be mostly found in hospitals but it's all over the place now and my colleague spends much of her typical 34 hour day trying to kill it with exotic chemicals.

Then I found in my e-mail a message from Whisker of Iraq Today about three Canadian soldiers returning from Afghanistan who have been isolated with drug resistant Acinetobacter baumannii. This too was previously thought of as a nosocomial infection, i.e. one associated with hospitals. However, soldiers wounded in Iraq started showing up with A. baumannii infections that were sometimes nearly impossible to eradicate, and now we're seeing it with Afghanistan vets as well. The consequences can be ugly:

Staff Sgt. Nathan Reed was escorting a CBS news team through Baghdad for a Memorial Day visit in 2006 when the car bomb went off. Reed survived, but his right leg was severely injured. He was rushed to military hospitals in Iraq and Germany, then to Brooke Army Medical Center in San Antonio. The injured leg developed an infection from a bacterium called acinetobacter baumannii. Reed had to decide whether or not to have his leg amputated. He consulted his doctors. He weighed his options. Finally, after getting all the information he could, he went ahead with the surgery. "The Iraqibacter pretty much sealed the fate for my amputation," he says.

The bacterium nicknamed the Iraqibacter is an increasingly multi-drug-resistant supergerm that is plaguing wounded soldiers who served in Iraq. The Infectious Diseases Society of America (IDSA) has put it on a short list of six dangerous, top-priority, drug-resistant microbes. Doctors are running out of ammunition to fight it. The Iraqibacter joins on that list a better-known and more common supergerm, methicillin-resistant staphylococcus aureus (MRSA). Though less virulent than MRSA, acinetobacter baumannii is more drug-resistant. Not only does it possess a number of resistant genes itself, it also accepts resistant genes from other bacteria.

And I had another message from, of all people, the American Meat Institute. (Hey bub, do you have any idea who you're e-mailing?) Anyway, they very much want me to tell you that the so-called "swine flu" has nothing to do with swine and it is "not caused or spread by pig production nor is the virus transmitted to humans by eating pork." Okay, Janet M. Riley, Senior Vice President, Public Affairs, you're right about that. However . . .

According to the Alliance for the Prudent Use of Antibiotics:

* Use of antimicrobials in food animals contributes to the growing problem of antimicrobial resistance in human infections. Transfer of bacteria from food animals to humans is a common occurrence.
* The amount of antimicrobials administered to animals is comparable to that used in humans. Unlike use in humans, however, much of the antimicrobial administration to food animals is to large groups at low doses, for non-therapeutic purposes such as growth promotion and disease prevention.
* The elimination of non-therapeutic use of antimicrobials in food animals and agriculture will lower the burden of antimicrobial resistance in the environment with consequent benefits to human and animal health.

Selected Recommendations
Based on its assessment of the scientific evidence, the Scientific Advisory Panel strongly urges implementation of policy reforms in a timely fashion. Specific changes called for are:

* Antimicrobial agents should not be used in agriculture in the absence of disease.
* Use of antimicrobials in food animal production should be limited to therapy for diseased animals or prevention of disease when it has been documented in a herd or flock.
* Use of antimicrobials for economic purposes such as growth promotion or to enhance feed efficiency should be discontinued (with the exception of ionophores and coccidiostats, because current evidence indicates that use of these antimicrobials does not affect resistance in human pathogens).
* Because of their critical importance to treat human disease, fluoroquinolones and third generation (or higher) cephalosporins should not be used in agriculture except to treat refractory infections in individual animals.
* Antimicrobials should be administered to animals only when prescribed by a veterinarian.
* In many cases, legislation by Congress or direct changes in policy by the US Food and Drug Administration, US Department of Agriculture, US Environmental Protection Agency, or other government agencies will be necessary to implement the recommendations of the Panel. The ecology of antibiotic resistance should be considered by regulatory agencies in assessing human health risk associated with antibiotic use in agriculture.

Unfortunately, Janet M. Riley has successfully blocked any such legislation. Therefore, she is making us sick and even killing people.

Unnecessary prescribing of antibiotics by doctors is another big reason why we have a growing problem of antibiotic resistance. APUA will give you the whole story. This is yet one more reason why physicians need to have government bureaucrats come between them and their patients, by establishing clear practice guidelines that will get them to stop handing out antibiotics for common upper respiratory tract infections.

And while we're on that subject, UK doctor Des Spence writes:

I wandered through the museum at Scapa Flow in Orkney, meeting the gaze of servicemen and women in fading black and white photos, a generation who gave their lives defending the values of democracy and fighting totalitarianism. We have never forgotten the generosity of the United States, which helped our nation in its darkest hours. Since then, we two nations have become married together—through sickness and health. Through right and wrong, we continue to battle together to defend commonly held values of democracy and freedom.

Therefore the US should appreciate the real pain and anger that recent attacks on the NHS by US politicians have caused. These comments have been so wantonly ill informed as to be downright stupid. The NHS was founded after the second world war, a horror beyond comprehension. The NHS was forged not of socialism but of patriotic service—put simply, our people deserved better.

But, according to U.S. politicians, our own people don't deserve better.


kathy a. said...

wow, interesting set of topics. my stepmother and father were both hospitalized for mrsa in 2003 -- she had it much worse, requiring surgery on over a dozen sites. [it looked like spider bites at first.] dad probably picked up a tad from her, since he had cancer and she was his caretaker. at the time, stories were just emerging about non-hospital-acquired mrsa.

you would think that after 6+ years, there would be stronger measures in place to fight drug-resistant bacteria. i do think that doctors are being more careful with antibiotics, but obviously the meat industry isn't. it remains difficult to find liquid hand soap that is NOT antibacerial. [far as i can tell, hand sanitizers are reasonably effective germ-killers without contributing to antibacterial resistence.]

Marcie Hascall Clark said...

Acinetobacter baumannii that the soldiers and Civilian Contractors are repatriating with them via the military evacuation system is still a nosocomial infection.
The original strains match those from Germany which just happens to be where Landstuhl is and where medical equipment was shipped to field hospitals.
It was noted that dirty equipment was shipped to the field hospital Dogwood which is where my husband landed after being blown up in July 2003.
The strain my husband picked up was still susceptible to imepenum and only colonized so he was fortunate.
Steve Silberman of Wired Magazine did an excellent investigation story on Acinetobacter baumannii at
and I have a website that has tracked Ab infections as they spread throughout the US and every country in the "coalition of the willing".

Cervantes said...

Yes, there have been sample of A. baumanni recovered from medical equipment in field hospitals and up the line from there, but it's still not clear where it comes from originally. It was originally thought that antibiotic resistant A. baumanni was living in the desert sand and we actually can't rule that out. It is, for unknown reasons, a particular problem for wounded military and not a very common nosocomial infection in U.S. hospitals. Perhaps we'll learn more in the future.

Marcie Hascall Clark said...

The US Government went to war in Iraq in 2003 ill prepared to deal with the consequences.
The entire military evacuation and health system was overburdened from day one.
The military itself has proven and admitted that the Acinetobacter baumannii strains effecting wounded soldiers were from the field hospitals.
Did it possibly exist in the sand somehwere in Iraq at sometime? I doubt it but anythings possible. It was investigated in depth in 2004 and there was no Ab found anywhere in the soil in Iraq. It was found in an AC condensation drip at a field hospital.
Was this outbreak caused by Ab in the soil in Iraq? No. It was spread by a lack of following basic infectious disease protocal, understaffing, over booking.
Until everyone stops pretending that nosocomial infections are caused by anything more than a lack of attention to cleanliness, persons, equipment, bedding, etc. we'll get nowhere.
So far these strains from the military have killed thousands of innocent people who were no where near a war zone.
Ab is a huge problem in hospitals all across this country.
I really appreciate that you've brought some attention to this.
It's been breaking my heart for years, six to be exact.