Resistance: An Antibiotic Documentary

In 1928, a bacteriologist working at St Mary’s Hospital in London noticed that the bacteria Staphylococcus aureus could be destroyed by a kind of mold called Penicillium notatum, accidentally discovering antibiotics in the process. His name was Alexander Fleming.

85 years later, you could very well die from the same bacteria that he helped fight.

Antibiotic resistance is a growing, and much under-hyped problem.  According to Wired, Methicillin-resistant Staphylococcus aureus (MRSA) kills an estimated 19,000 Americans a year. That’s slightly more than HIV, and more than pneumococcal disease, meningococcal disease, H. influenzae and group A Streptococcus combined.

Because we’re so used to thinking of antibiotics as the miracle cure-all that we can just take at any time, for any ailment, we often take them for no good reason. Think of all those times you had a slight sniffle and your mother gave you a dose “just to be sure.” Not good.

What’s more, coming up with new antibiotics have not been high on our priority list.

(For more background on the growing threat of antibiotic resistance, check out our post here).

To raise awareness about the issue, Michael Graziano, co-founder of Uji Films, decided to make a movie about it. Titled “Resistance,” the film explains the threat of microbial resistance, providing historical and economic context.

Graziano launched a Kickstarter project to raise funds to finish the film. Unfortunately, the project fell short of its goal and was unsuccessful, perhaps proving the point that microbial resistance is a silent killer. Past Uji films have aired on The Documentary Channel, NYC-TV, and at a variety of festivals.

In an opinion piece on Civil Eats, Graziano appealed to the public on the importance of the issue, comparing antibiotic resistance to food consumption:

“Imagine that we had developed an affordable way to grow healthy, nutritious, food that, as long as we kept it fresh and did not eat too much of it, could revolutionize the quality of human life on earth. Now imagine that instead of conserving this miracle food we consumed it recklessly and with very little understanding of the long-term implications of doing so. Then add to this equation a variable dictating that once one of these foods tips over into being unhealthy, or at least not pro-health, there is almost no way to recuperate it’s health-inducing properties. I know, hard to imagine such a thing happening to our food supply (sigh), but replace food with antibiotics in the scenario above and that is essentially the current state of affairs.”

The film features interviews with leading experts such as Rep. Louise Slaughter (D-NY), who has not only been extremely outspoken on the problem of antimicrobial resistance but is also a trained microbiologist; Maryn McKenna, journalist and author of the book and the WIRED blog “Superbug, » and Dan Glickman, former US Secretary of Agriculture for the Clinton administration (click here for the full list).

Check out the trailer below:

When it comes to MRSA, are we doing enough to protect our Seniors?

The question is timely because of the recent release in Canada of ground-breaking research reported this past May in the medical journal Infection Control and Hospital Epidemiology

For the first time ever, scientists investigated the prevalence of Superbugs in Canadian hospitals. They wanted to know how many hospitalized adults were colonized or infected with the antibiotic-resistant organisms MRSA, VRE (vancomycin-resistant Enterrocus), or CD (Clostridium difficile). They examined patient records in 176 hospitals in all 10 provinces and the Northwest Territories.  What they found was powerful: that a total of 2,895 patients were positive for MRSA, VRE, or CD. MRSA turned out to be the major offender because 1,930 of the patients – 67% – were positive for it. The report goes on to say that this means 1 in every 12 adults in hospitals across the country were either colonized or infected with at least 1 of the 3 Superbugs. The powerful nature of the 1 in 12 number is understood if you consider that if the same statistic were found in the population at large it would be considered an epidemic.

A careful reading of the study tells us that the 1 in 12 figure is actually an underestimate. First, the researchers only looked for 3 kinds of Superbugs and we know there are several more than just those that exist. Moreover, there are more powerful Superbugs that can’t be treated by any means whatsoever; for example Klebsiella, Acinetobacter, Enterobacter, and Pseudomonas. Second, the researchers didn’t do their own detective work with patients to discover the prevalence of the pathogens; instead they examined hospital records to see what had already been reported. In other words, if a hospital didn’t screen for 1 or all of these organisms or if colonization or infection were left undiagnosed or misdiagnosed, then that sufferer wouldn’t have been included in the 1 in 12. So we can be confident that at least 1 in 12 adults in hospitals across Canada are colonized or infected with a mean-spirited pathogen that is resistant to treatment.

This, however, is where a deeper story begins. I was curious to know who these 1 in 12 adults were. Is it a cross-section of the public, or, perhaps, is one demographic more prevalent than others?  The answer came buried in the back of the study in a page long table of statistics (Table 3). And what it said was shocking:

It said that the average age of the 1 in 12 hospitalized Canadian adults who contracted MRSA was 70.

And that the average age for those who contracted VRE was 71, and for CD it was 75.

In other words, it is our seniors who are falling prey to Superbugs in Canadian hospitals. And for some reason this isn’t being talked about. The researchers themselves did not discuss the issue in their paper. And while the major media outlets gave headline coverage to the ‘1in 12’ number, they, too, did not report on the age of the sufferers.

Not giving full voice to the plight of seniors and Superbugs, unfortunately, appears to be thematic. For example, the Public Health Agency of Canada’s website has a Fact Sheet on MRSA with an inside heading that reads, Who gets MRSA? They describe that it’s more common in healthcare settings and in people with weakened immune systems; however, there’s no mention of how vulnerable seniors are.

Attitudes towards Superbug infection within the medical community may be further cause for concern. A 2009 report in the Winnipeg Free Press told us that between 2006 and 2008 in the Winnipeg region there were 803 patients and 609 hospital staff that were infected with MRSA, VRE, CD, and Novovirus. The comments of Dr. John Embil, Director of infection Control for the Winnipeg Region, are instructive: “For reasons that are beyond the control of routine heightened infection-control measures these germs spread. This is all old news. Quite honestly, this is no news. It happens, it’s the reality of taking care of sick people” (emphasis mine).

So today we know that at least 1 in 12 adults – seniors – in Canadian hospitals are colonized or infected with just 3 Superbugs. But what do we know about tomorrow? Is there reason to hope that things will change for the better? We appear to have an answer for this question too. It comes to us from the same researcher, Dr. Andrew Simor, who led the ‘1 in 12’ study.  He wanted to know whether or not the rate of MRSA in Canadian hospitals had levelled off or if it was increasing. His team studied the problem over a 12 year period between 1995 and 2007. And what they found was dramatic: that the incidence of MRSA colonization or infection had increased 17-fold during that time.

We know, too, that the baby-boom generation, which represents the largest age demographic in the country, is moving towards its senior years. Given the rapid expansion of MRSA, our current and future seniors have serious cause for concern should they require a hospital stay. Notice, for example, in the Winnipeg Free Press report mentioned above, that of the 1,412 people who were infected in Winnipeg regional hospitals, that 609 of those people were hospital staff – the very people that we rely on for our day to day care.

We all have parents or grandparents near the age of 70. Whether we continue with our tolerant “stuff happens” approach to seniors and Superbugs tells us something about who we are as a people and as a nation. This column is being written on Canada Day. Across the country we will proudly sing our national anthem which concludes with some familiar words: Oh Canada we stand on guard for thee. Perhaps we should take a moment and ask ourselves if we really do stand on guard for thee – when it comes to our seniors.

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