Don't Bug Me!
Make no bones about it, superbugs will inherit the earth, or at least our hospitals, for the time being. There is no escaping them. Go into the hospital for one thing, and come out with something entirely different, if not in a pine box. So, those hallowed halls of healing are slowly but surely becoming more known for what ails them, than for what ails us. Methicillin-resistant Staphylococcus aureus (MRSA), an antibiotic-resistant bacterium, has passed from the exception to the rule in the 1970s to a predominant “mover and shaker” on the Ten Most Wanted list of our nation’s hospitals. The organism lives harmlessly on the skin, but just grant it access to and safe passage through a portal into our bodies, and all hell breaks loose. Its close companion and fellow hit man, Clostridium difficile, an intestinal bacterium, is no less troublesome, and is a force to be reckoned with that even that age-old “bug slayer,” alcohol, cannot neutralize.
There you have it. It’s bad enough that the out-of-the-ordinary causes your hospitalization, without being further insulted by a totally unexpected bug brigade. Unexpected is a poor choice of words, however, as each year 90,000 Americans pick up hospital-acquired infections that kill them, and many more suffer the ravages of diarrhea and other unpleasantries so severe that even Montezuma’s heirs would most likely disown them. It has been estimated that in 2008, on an average day, 7,200 hospitalized patients or 13 of every 1,000 were colonized or infected with Clostridium difficile, and 300 did not survive it. Add those numbers to the toll of MRSA infections in patients with weakened immune systems, or those requiring catheters, intravenous lines, or ventilators, and we become witness to a mathematician’s worst nightmare, that being the formula for a lethal one-two punch.
And to think, in many cases we brought this on ourselves! While the young and very old are often the first and foremost to be “bugged” in the hospital setting, whoever dreamed that the very antibiotics conceived of and developed to thwart any number of serious infectious maladies might boomerang, strip our guts of friendly, protective organisms, and, as a consequence, fertilize the terrain for florid Clostridium difficile growth and proliferation thereafter. MRSA, on the other hand, being a normal inhabitant of the skin, has a tendency to congregate around cuts and scrapes, where it is held in check by a healthy immune system. Impairment of the latter is an open invitation to bloodstream incursion, with resulting sepsis a formidable foe to even the most heavily reinforced arsenal of antibiotics and antimicrobials. The death toll and morbidity rates generated by MRSA and Clostridium difficile come at a stiff price in greenbacks also, to the tune of an estimated $250 billion a year.
The story doesn’t end there, however. The profuse diarrhea incited by Clostridium difficile is the vehicle of a riot or a wildfire, if you’ll allow for literary license, facilitating spread of the bacterium onto hands, bed rails, sheets, IV poles, and uniforms. Person-to-person transmission, from patients or medical equipment to the hands of health care workers and then onwards to other unsuspecting souls, is the name of the game. In short, the bug is spread everywhere. MRSA, for its part, while far removed in its mechanism of action from a potential enrollment in a “defecatory duo” spearheaded by Clostridium difficile, is nonetheless anything but innocuous. In fact, about 250,000 Americans a year receive a nasty surprise when catheters inserted into their large veins to provide fluids or medications become the sources of bloodstream infection with MRSA. One in four of these unlucky souls meets his or her Maker, and just for having been in the wrong place at the wrong time.
So, what’s the solution? How do we stop superbugs in their tracks? What measures can be taken against an MRSA adversary resistant to penicillin and other antibiotics? Is diarrhea lasting longer than 24 hours and accompanied by weakness, a racing heart, or blood in the stool a sign of something as sinister as Clostridium difficile infection or just symbolic of a bad night on the town and a cheap Chinese restaurant? Frequent hand washing, limited use of antibiotics to only cases absolutely necessary, the wearing of sterile gloves and gowns by medical personnel, the use of antiseptics and sterile drapes and dressings to protect patients, and even a probiotic, helpful yeast called Saccharomyces boulardii (or commonly Florastor®) taken orally can go far to checking the advance, if not exterminating entirely, the superbugs. Government and state oversight, public scrutiny, and state laws requiring hospitals to report infection rates to the public can also be strong deterrents to harmful laissez-faire attitudes on the part of health facilities. Case in point, preventives measures, both voluntary and imposed, were instrumental in reducing the rate of MRSA bloodstream infections by about 50 percent from 1997 to 2007.
Superbugs may one day inherit the earth, but not on our watch, as long as actions speak louder than our collective “Don’t bug me!”
ã 2009, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
9/07/2009 12:22:00 PM
0 Comments:
Post a Comment
<< Home