We turn on the news and see constant reports of nations fighting with other nations. But recently, the threat of antibiotic resistance is finally being recognized by world leaders for the major threat that it is; a “nightmare” as the director of the U.S. Centers for Disease Control recently called it.

A “catastrophic threat as serious as terrorism,” was how Sally Davies, the U.K.’s Chief Medical Officer, described the urgency of the situation in a report that was recently released on antibiotic resistance. In an interview, she warned of the grim circumstances we will face unless we act urgently, where healthcare will be similar to that of the early 19^th century; a place where minor and routine surgeries will become life-threatening.

Professor Dame Sally Davies, the U.K.'s chief medical officer.

The lengthy report, co-written by U.K. researchers and representatives of the U.K.’s Health Protection Agency, attributes resistance almost entirely to antibiotics.

Antibiotic resistance poses a catastrophic threat to medicine and could mean patients having minor surgery risk dying from infections that can no longer be treated.

Antibiotics have typically been used as prophylaxis to prevent healthcare-associated infections in patients undergoing routine hip-replacement surgeries since the advent of the procedure. In a recent article, it was investigated how dramatic of an impact the removal of antibiotics would have on the population of patients undergoing routine hip-replacement surgery. It was found that with the removal of antibiotics, postoperative infection rates would increase by up to 50% and deaths by up to 30%.

In other words, just as the largest and most athletic generation history has ever seen would be reaching the age where such surgery is needed, approximately one-sixth of individuals undergoing the routine procedure might die if antibiotic resistance continues to go unchecked.

Over the past two decades, antibiotics have undergone what is known as a “discovery void,” meaning that diseases have evolved faster than the drugs used to treat them. There are several things that can be done to help in the fight against antibiotic resistance, including increased surveillance to keep track of resistant superbugs, proper use of antibiotics, putting more of a focus on the development of new antibiotics, and engaging in the prevention of infections.

It is going to take a collaborative effort to curb antibiotic resistance. Society needs to become more aware of the serious threat of infections and antibiotic resistance. It astonishes me how few people still recognize how serious of a problem these things are. People need to know that antibiotics won’t help with the common cold; by hounding your doctor for a prescription, you are essentially contributing to antibiotic resistance. We need to be aware of the lessons others learned the hard way—like how I lost my father to these preventable superbugs—so that we can pave the way for a safer future.

We’re living in a world consumed by blockbuster zombie thrillers, terrorism, and nuclear threats, but the fact of the matter is that antibiotic resistance is something that we need to worry about here and now. These resistant microbes truly pose a catastrophic treat, as they do not discriminate upon race, religion, country of birth, or any such distinguishing factor we as human beings many impose upon one another.

According to an infographic created by Pew Charitable Trusts, human antibiotic use has leveled off at 7.7 million pounds, while antibiotics sold for meat and poultry products has reached a record level of 29.9 pounds in 2011. That’s almost four times as much.

Translation: nearly four-fifths of antibiotics used in the U.S. are being routed into the livestock industry, Mother Jones reported.

The infographic is based on the latest data released by the FDA in 2011.

And that’s not all.

According to an email sent to Mother Jones by a Pew spokesperson, the American Meat Institute reported was a 0.2 percent increase in total meat and poultry production in 2011. However, the email also points out that that increase was accompanied by a more substantial 2 percent bump in antibiotic consumption.

So, you may be asking yourself what the problem is with this. Aside from the fact that it seems gross to be eating meat pumped full of antibiotics, this just means you’ll never get sick again, right? Wrong.

All that this means is that the cow that’s about to become a juicy bacon cheeseburger sitting on a bed of curly fries is immune to certain antibiotics – or at least the bacteria that lives inside it are. And by taking a big bite of that yum-tastic burger, you are too.

According to the same Mother Jones article, Pew went even farther, and crunched the numbers on another data set based on the latest findings by the FDA’s National Antimicrobial Resistance Monitoring System (NARMS).

Pew commented on some of the data in another email to Mother Jones: 78% of the Salmonella in ground turkey was found to be resistant to at least one antibiotic, an increase from 2010, and nearly three quarters of the same bacteria found in chicken breasts were resistant to at least one antibiotic. Of the samples tested, nearly 12% were contaminated with Salmonella.

Antibiotics are given to poultry for two reasons: to make them grow faster, and to prevent disease when they are all crammed together. (For more information on what kind of antibiotics are used in meat production, check out this article by Wired).

But what these numbers mean is that if by any chance you handle or taste raw poultry and contract Salmonella, the bacteria will be that much harder to fight off.

Last year, the FDA proposed a set of guidelines that was supposed to reduce the amount of antibiotics injected into the meat industry. Unfortunately, the agency is still hemming and hawing about how it should be implemented, leaving our steaks, stir-fries, roast chickens, and tacos teeming with pathogen-resistant bacteria.

Who’s hungry?

There are good and bad kinds of bacteria. Good bacteria are the kinds that live in your non-fat Greek yogurt. Bad bacteria are the kind that makes you sick.

Staphylococcus aureus is a staph bacterium commonly found in the nose. In certain cases, certain strains become resistant to antibiotics, resulting in Methicillin-resistant Staphylococcus aureus (MRSA). This is like the Darth Vader of infections. You do not want to get it, especially if you’re a patient about to get surgery. In fact, MRSA is commonly found in hospitals, a study found that 1 in 3 nurse bags carry this deadly superbug.

But another study conducted by Marilyn C. Roberts and her colleagues at the Department of Environmental and Occupational Health Sciences of the University of Washington might change the way we think about where MRSA can be found. Roberts found evidence to suggest that dental clinics and MRSA colonized dental students might also be reservoirs for transmission to other students, patients and personnel.

Using a sample of 7 clinics, Roberts examined five areas for MRSA: the uncovered areas of the dental chair and armrest, the floor beneath the chair, the sink next to the chair, the towel dispenser next to the chair and finally, the counter next to the chair. Basically, anywhere you sit, touch or see when you visit the dentist.  Four out of those seven had positive MRSA samples.

In addition to all that, Roberts took nasal samples from 61 volunteer dental students volunteers from the University of Washington Dental School. Of those students, 13 (21%) were MRSA positive.

According to a post written by James Steckleberg for the Mayo Clinic’s entry on MRSA, the bacterium spreads by skin-to-skin contact, or by touching contaminated objects.

Roberts’ study is the first to look at MRSA colonization in dental clinics outside of a hospital setting.  To make things even more cheerful, all the MRSA positive surfaces were for strains resistant to several types of antibiotics.

“But wait,” you could say, “does this just mean that University of Washington dental students are gross?” Well, no. The issue is larger than that. Roberts and her colleagues recently cultured the same kind of surfaces in a community dental center in the Pacific Northwest. Two of the 16 samples were MRSA positive.

Roberts admits not knowing the actual risk level associated with these findings, but that these results are very probably not restricted to the Pacific Northwest. “Further studies are needed from more dental and clinic surfaces, dental patients, dental personnel, and students from diverse geographic locations,” Roberts writes in the study.

Going to the dentist is challenging enough for some people.  Even as the daughter of a dentist, the sound of the drill is enough to conjure up images of Lawrence Olivier’s evil Nazi dentist in Marathon Man.  But the thought of creepy crawlies (even figurative ones) waiting to infect my skin is almost too much to bear.

So what can you do to protect yourself?

One essential way is by reducing the unnecessary use of antibiotics. Don’t pop a pill because you feel the sniffles coming on, and don’t give your child antibiotics unless prescribed by a doctor.

According to the Mayo Clinic, MRSA infections can heal after being drained if caught early.  If your infection doesn’t heal, your doctor may be able to prescribe antibiotics that are still effective. More extreme cases might call for hospitalization, as the infections can be life-threatening.

But most importantly, if you suspect a MRSA infection, DON’T try and self-treat.  Look what happened to Obi-Wan when he tried to take on Darth Vader alone.

With genetic sequencing becoming more cost-effective, our ability to trace the underlying genes involved in resistance, is improving—as is our ability to geographically pinpoint where superbugs come from.  Using whole genome mapping, which catalogues genes for an entire organism, English scientists have been able to trace the course of deadly, antibiotic resistant c. difficile, back to North America, for example— with two of the most deadly strains emerging from Pittsburgh and Montreal.  Interestingly, the genetic research also shows that the two strains developed resistance to first-line antibiotics independent of one another.  Using such detailed metrics, it’s not hard to imagine tracking and containing a deadly mutation before it becomes the next superbug.

Currently, c. difficile is a challenging illness for hospitals and long-term care facilities.  As well as being resistant to most antibiotics, its ability to form defensive spores even makes it particularly hard to kill with antiseptics, such as alcohol hand sanitizers.    In spore form, c. difficile has the ability to survive, dormant, for years—much like its unpopular cousins, tetanus and c. botulinum (the bacteria responsible for botulism).  With spores able to persist on surfaces for such long periods, it’s little wonder that the bacterium has become such a persistent problem.

C. difficile infection occupies a very specific niche, because it most often occurs after antibiotic treatment.  Built to survive, resistant strains take advantage of the loss of good intestinal bacteria and are able to multiply without competition from other species.  As the resistant c. difficile population increases—unchecked by first-line antibiotics— it secretes higher levels of bacterial toxins that directly damage intestinal walls.  For many, including the man I met, long-term disability, or even death, is a very real possibility.

Although the development of new classes of antibiotics may not be possible at the moment, increased tracking and identification of different strains may help prevent new mutations from spreading beyond their point of origin.

A doctor, too busy to watch any single baby for hours on end, cannot monitor every subtle change. Instead, the monitor’s computations grant the doctor the luxury of being alerted; they are then able to concentrate their time on deciding whether to proceed with treatment or to monitor more closely. This early action can be much more important to the baby’s survival than treatment administered after becoming infected.

This project, dubbed Artemis at its birth at Sick Kids in 2009, is still in the research and testing phase.  A research collaboration between Dr. Carolyn McGregor – Canada Research Chair in Health Informatics at the University of Ontario Institute of Technology – Toronto’s Sick Kids Hospital, and IBM Canada, it is said to only be one third complete, and is projected to run another seven years of trials. Twenty percent of neonatal intensive care beds at Sick Kids are now hooked up, and other hospitals in China and the U.S. have even begun sending data to Dr. McGregor’s laboratory for analysis. There is only upward movement in the future of this project.

One of the most revolutionary aspects of such a device is the surety that it will be of great use in preventing infections in premature babies in remote communities, “where access to neonatal intensive care units is rare. If this research works we can monitor a premature baby in the North, analyse the data in the city, and talk to the pediatrician and say ‘Look, an infection might be developing,” points out Dr. McGregor. Where before the only option was treatment after the fact for these babies waiting days for a plane, now we can beat the bacteria to the baby. The implementation of this technology will limit that of bacterial infections, across hospitals and across the country. “In this case, technology is the enabler” says Aditya Pai, healthcare managing consultant with IBM. Technology and people are working hand in hand to prevent infection in premature babies, and coming out ahead.

A recent study investigating the public perception of the treatment suggests that while most individuals do view the treatment as rather off-putting, most would utilize the procedure if necessary. This is especially true in cases where the procedure is recommended by the patient’s doctor. This small study is helping researchers to better understand the reasons behind some doctors’ refusal to utilize fecal transplants as a treatment method. Such doctors generally blame the patient’s own refusal to undergo the procedure as the main reason for not embracing the option.

There are three different methods that can be used to introduce donor stool into the recipient’s system, all of which involve stool that is diluted with saline. The first method requires the insertion of a tube through the nostril and down the esophagus, where the transplant matter is allowed to drip into the stomach. Another option involves inserting the transplant material into the lower bowel through a sort of reverse enema procedure. Finally, another method pumps the matter into the intestine using a scope, as used for colonoscopies.

Regardless of which method is used, evidence suggests that upwards of 90 percent of individuals suffering from C. diff infections are reportedly cured by fecal transplants. In most cases, only one transplant is required. This is extremely promising, considering the fact that antibiotic misuse and overuse play such an important role in the development and onset of many C. diff infections. Such estimates are so far only based on case studies, as no randomized controlled trials have been published. While several randomized controlled studies are expected to soon be released, a problem researchers are running into involves finding patients willing to participate. This is not because of the grossness of the procedure, but rather because those who have endured such suffering do not want to take the chance that they could be placed in the control group, meaning that they would receive a placebo rather than the actually treatment.

While fecal transplants may not be the most appealing topic to discuss, there is no doubt that such procedures are a promising way to combat the destructiveness and suffering associated with C. diff. Taking into consideration how serious of an issue antibiotic resistance is becoming, fecal transplants provide a possible alternative to antibiotic treatments. This may not be a topic that you want to discuss over dinner with friends, but at the end of the day, it is a major step in the fight against C. diff.

Some readers may remember that Aimee’s troubles began after suffering a zip-line laceration that required more than 20 staples to close.  Unbeknownst to anyone at the time, the wound was contaminated with Aeromonas hydrophilia— an organism common in brackish waters of the Tallapoosa river, near where Aimee was swimming.  Before anything could be done, the infection had already begun to take root and within three days time, Aimee knew something was very wrong.   “My entire leg was a dark purple colour.  I wasn’t able to walk. I wasn’t able to speak. The only thing I was able to babble was, ‘I think I’m dying.”

Necrotizing fasciitis, or the flesh-eating infection, is known for the speed and relentlessness with which it kills. After a certain point, antibiotics are only partially effective, and must be combined with surgery—sometimes amputation. Studies have shown that mortality rates vary according to the type of bacteria, but are generally high.

While seemingly rare and exotic to most people, Aimee’s experience mirrors events in my own life.   Just recently, a close acquaintance of mine suffered a similar ordeal after contracting flesh-eating disease from the more common bacterium, Strep.  A normally healthy 75-year-old, my acquaintance awoke one day to severe pain in the area surrounding her thumb.  Caulking it up to carpal tunnel syndrome, she ignored it as long as she could… until the pain became overwhelming and the fever set in.  Disoriented, and in agony, she was rushed to the emergency room, where a quick assessment of the situation lead to an immediate cocktail of IV antibiotics and emergency surgery to debride—or remove—the infected tissue.  Even with some of the most powerful antibiotics and advanced surgical techniques available, it took several days for her condition to stabilize.  Even then, she was in the hospital for three full weeks.  While she managed to escape with only mild disability, including the loss of tissue around her hand and wrists, she now lives in chronic pain due to nerve damage.  She is currently seeking the help of a pain specialist.  Despite all this, she counts herself lucky.  Her doctors remarked that if she had waited any longer for treatment, she would have lost an entire arm and quite possibly her life.   As with many cases of flesh-eating disease, the source of the infection was never found; it seemed to occur spontaneously.

Because of the short window of time involved, knowing the warning signs of flesh-eating disease can literally mean the difference between life and death.  According to Medicine Net, early symptoms include: redness, swelling, pain, and blistering in the affected area– as well as fever, nausea, vomiting, and flu-like symptoms.  Severe pain, beyond what is considered normal for an injury, is also a key warning sign; for my acquaintance, this symptom was the tipoff.  Later symptoms can include gangrene and tissue death, along with scaling, discoloration or peeling of the skin.  The longer an infected patient waits for treatment, the less effective antibiotics become.

Although Aimee has lost much more than the tissue surrounding her hand, she is adjusting well to her new circumstances.  A true survivor with an unstoppable attitude, Aimee is working hard to relearn daily tasks many of us take for granted: such as getting dressed or using a cell phone.  All in all, Aimee is very happy, despite the circumstances.  While her story is a sad, cautionary tale in many ways, I also find it inspirational.  In Katie’s own words: “I love life… it’s a beautiful thing… even more so now.”

The UK’s reporting data on healthcare-associated infections is decidedly more reliable than many other countries, such as the US and Canada. While overall deaths in the UK have been declining, mortality rates, for both genders and both bacteria, have increased with age. Where males under 45 years suffer 2.3 deaths per million from S. aureus and 4.3 per million from MRSA, those over 85 are looking at a 230x and 96x increased risk of infection respectively. Females generate a similar pattern: there are, on average, 1.7 deaths per million for S. aureus and 0.5 per million for women under 45, but after 85, they are at a 150x and 395x increased risk of developing an infection. Another trend, surfacing in the preceding statistics, is that of consistently higher mortality rates among males than females. Where the UK male population’s MRSA decline has been by 20%, women have seen a 30% decline.

S. aureus has been noted 24% of the time as the underlying cause of death. In comparison, MRSA has been the culprit 17% of the time. The below graph shows the relatively stable proportions that have stuck with the bacteria.

Looking further into the bacterias regression, England and Wales’ health officials have perceived a social aspect. The disparity between the UK’s highest and lowest quintile is growing with respect to cases of MRSA. From 2001 to 2005, there were 6.7 fewer MRSA-related deaths per 100,000 in the least deprived quintile of England’s population than in the most deprived. From 2006 to 2010, that difference widened to 8.0 deaths. This increase in variation between the top and bottom quintiles is statistically significant, so much so that some wonder where all the aforementioned efforts are going. Deaths are down, but is inequality up?

Sources:

MRSA-related deaths down but mortality rate rises with deprivation

MRSA and C. diff deaths falling

MRSA is a term used to describe the several stains of Staphylococcus aureus that have become resistant to certain antibiotic treatments, meaning that they are harder to treat and especially threatening for individuals with compromised immune systems. MRSA is a common healthcare-associated infection, an infection acquired while receiving medical care, and is also a common cause of sepsis if allowed to enter the bloodstream.

Like many healthcare-associated infections, MRSA can live on the human body without causing any serious problems. This is problematic when patients enter hospitals for surgical procedures, which can present the opportunity for the bacteria to enter the patient’s body. Some individuals can also be carriers of the pathogen, passing it on to other people and thus causing problems for those whose bodies are unable to fight of the bacteria.

It is important to make the distinction that MRSA is a bacterial pathogen, whereas AIDS is caused by the human immunodeficiency virus, also known as HIV. In the last 30 years, significant improvements have been made in the fight against HIV/AIDS through various campaigns to raise awareness and other public health strategies. The progress that has been made to bring an end to the AIDS epidemic proves that when people are made aware of the problem at hand, as well as what can be done to prevent it, lives can be saved.

Another important distinction to be made between these two life-threatening pathogens is the various methods of transmission. HIV is transmitted through blood and bodily fluids, whereas MRSA is transmitted a number of various ways that may not be as apparent as with HIV/AIDS. For example, MRSA can be transferred through skin contact with an infected person, or any objects or surfaces that have been touched by an infected individual. As previously mentioned, some individuals can even be carriers of MRSA. Because such individuals do not have an active infection, they will more than likely remain unaware of their status as a carrier unless they are tested for MRSA, or develop an infection in an open wound.

It is important to reiterate that MRSA can occur in virtually any environment, not just hospitals. Any individual can develop an infection from MRSA, even without any knowledge of coming in contact with the bacteria. Comparing this killer to HIV/AIDS, we can learn that public awareness and general knowledge of the disease and what can be done to prevent it are of first and foremost importance in combating the epidemic.

http://www.cdc.gov/hiv/resources/factsheets/us.htm

http://www.webmd.com/skin-problems-and-treatments/news/20071016/more-us-deaths-from-mrsa-than-aids

Usually scared, nervous, and uncooperative, children are given bubble solutions for therapeutic play to calm their nerves. These bubble solutions create supposedly create bubbles that float effortlessly through the air: who doesn’t like bubbles? A study conducted by Dr. Valsan Verghese, from Edmonton, proves that these solutions can be dangerous to our kids. In the study, which was presented at the AAMI-CACMID microbiology conference this year, seven separate bubble solutions were cultured on blood (BAP), MacConkey and Phytone agars. The solutions with positive growth were subcultured for identification, then five new bottles of the same solution were acquired and cultured for further confirmation. Also, the Hospital Infection Control database was cross-referenced for healthcare-associated infection due to the agents isolated.

All of the tested bubble solutions from the hospital contained both Achromabacter xylosoxidans and Pseudomonas pseudoalcaligenes bacteria, while none of the purchased bubble solutions showed any bacterial or fungal growth. These bacteria can cause healthcare-associated infections, which are acquired during the course of treatment at, or a visit to, a healthcare facility. Such infections are given the name HAI once it has been proven that the patient did not enter the healthcare facility with the present infection. Children that visit hospitals often have weaker immune systems than adults; therefore they can be at a higher risk of developing infections. To ensure that hospitals and other healthcare facilities reduce the apparent risk to children, the study suggests changing brands of bubble solutions to one without bacteria or fungal growth, and regular microbiological surveillance of the bubble solutions.

This study concluded that all the bubble solutions from the hospital contained Pseudomonas pseudoalcaligenes – a bacteria belonging to the Pseudomonas aeruginosa family. The latter is a prominent cause of infection, a frequent cause of healthcare-associated infections, as well as one of the most common pathogen isolated from patients who have been confined to a healthcare facility for longer than one week. Essentially, Pseudomonas aeruginosa is a bacterium we prefer our children not come in contact with. By giving children these bubble toys, we are increasing the child’s chance of developing an HAI – something that should be unacceptable and only reemphasize the dire need of superior infection control practices.