Huge amounts of antibiotics are consumed every year. In 1954, two million pounds of antibiotics were produced in the US. Today, that figure is more than 50 million [1]. One statistic released by the FDA suggests that ~30 million pounds of antibiotics are used by livestock for growth promotion and prevention (prophylaxis) [2].
This massive usage of antibiotics is having a toll on the environment as residual antibiotics from human and animal use can enter the environment in many ways. The 3 primary ways are [3]:
1) Wastewater effluent discharge
2) Human/animal waste run off from land
3) Leaching
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A New Delhi superbug has made its way into wards and minds of the United States.
A strain of the highly drug resistant common bacterium Carbapenem-resistant Enterobacteriaceae, or CRE, has been found in the Rhode Island Hospital. This particular strain is called Klebisella, and can cause pneumonia and other infections. Two Rhode Island patients have contracted the superbug (super in that it’s super hard to kill) and in doing so have clocked in as the 12th and 13th cases ever recorded in the United States.
I’ve only ever thought of travel as enriching our lives, but now it is being revealed as having jeopardized one. The story goes: a Cambodian woman who lives in Rhode Island became sick with lymphoma in May of 2011 while visiting her homeland. That December, she was hospitalized in Ho Chi Minh City before flying home and being admitted to Rhode Island Hospital for three months, receiving chemotherapy. This February, the woman suffered a bladder infection caused by a different bacterium.
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Our last post about Aimee Copeland was a sad one. A beautiful, loving, healthy 24 year old woman of Georgia suffered a devastating zip line accident that escalated from twelve staples in a deep leg gash into the amputation of her left leg, right foot, both hands, and part of her torso at the merciless hands of the flesh-eating bacteria Aeromonas hydrophila, commonly known as necrotizing fasciitis.
But now, it fills me with joy to be able to deliver good news about Aimee, to tell the beginning of a happy ending. After a fresh air-deprived 49 days inside the walls of the Doctor’s Hospital in Augusta, Aimee has ventured outside for the very first time. Less than a month ago, doctors gave her little chance of survival. Last Sunday, her condition was changed from “serious” to “good.” Last Monday, she was out in the sunshine with her parents. Fittingly, her father, Andy, remarked in his blog that “the sun has returned to her life,” noting that she had a bright smile and a “beauty of survival, of resilience.” This Tuesday, Aimee has been discharged from the hospital, and is headed to a rehabilitation clinic. In a whirlwind of good news, Aimee is well on the way to recovery.
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Think you’re safe and sound once you’ve been released from the hospital? Think again. Several recently released studies have found an alarming trend that appears to be occurring among individuals seeking medical treatment: post-operative readmission.
One study found that within 30 days of being discharged, 1 in 12 patients were readmitted to an inpatient hospital bed. This analysis, conducted by the Canadian Institute for Health Information concluded that over 180,000 Canadian patients were readmitted as a result of unforeseen circumstances in 2010. The most common causes for readmission were surgical wound infections, severe pain, and heart failure. For pediatric patients, the most common causes of hospital readmission included respiratory infection and pneumonia. Among surgical patients, it was found that nearly 1 in 10 patients were brought back to the hospital as a result of post-operative infection, commonly caused by antibiotic resistant bacteria such as MRSA. The findings among obstetric patients were even more startling: approximately 1 in every 4 patients were readmitted due to infection following a Caesarean section.
Socioeconomic factors found to be influential in this study included neighborhood income and location: individuals from lower-income areas, as well as those from rural areas, tended to face a higher risk of readmission. Another important factor for readmission found in this study was length of stay: those that deviated from the expected length of stay were found to be predictors for readmission. Other factors included age, preexisting conditions, and gender—male patients were slightly more likely to be readmitted than female patients.
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I couldn’t conceive of what it would be like for my daughter to lose her hands and the only other foot she has, as well, and that appears to be what is going to happen– Aimee Copeland’s Father
What is necrotizing fasciitis? The mention of this bacterial infection is often met with blank stares. However, those in the know, like Andy Copeland, will tell you of the horrific nature of the rare flesh-eating infection. Copeland’s 24 year-old daughter, Aimee, contracted the infection a few days after suffering a nasty fall off of a homemade zip line on May 1. The accident resulted in a deep gash on her left calf which required nearly two dozen staples.
Three days later, Aimee began to complain of severe pain in her leg and was rushed back to the emergency room. Aimee was quickly diagnosed with necrotizing fasciitis caused by Aeromonas hydrophila, bacteria commonly found in brackish waters, and was flown to Augusta for surgery. Unable to treat her using antibiotics, Aimee’s physicians were forced to amputate her left foot. However, the bacteria continued to spread and her hands and remaining foot now require amputation. Read More
The community-acquired bacteria has evolved further, and is able to maintain a higher level of toxicity while also resisting treatment from antibiotics, making it a much larger problem- Journal of Infectious Diseases
The highly infectious strain, MRSA USA300 , is resistant to many front-line antibiotics and has now been discovered in public places, such as buses and trains. Though people can avoid direct contact with a sneeze or cough, Professor Thomas from the University of Birmingham highlights the possibility of becoming infected from touching surfaces. In this way, every day settings and public surfaces act as viable means to contract an infection. According to the Daily Mail, MRSA USA300 has been called “flesh-eating” due to its ability to lead to large skin boils, abscesses, blood poisoning and even fatal forms of pneumonia that destroy lung tissue.
The Daily Mail reports Dr. Ruth Massey of the Department of Biology and Biochemistry at the University of Bath warns people to take care in guarding against MRSA, especially strains that carry genes for Panton-Valentine leukocidin (PVL). This cytotoxin can destroy white blood cells and cause extensive tissue necrosis. According to Massey, more than a thousand PVL positive-community-acquired cases were reported in England last year. Of these, 1 in 5 were caused by the USA300 strain. Read More
At the very heart of the growing MRSA crisis in North America is the concept of bacterial resistance to antibiotic therapies. MRSA has found its way into the popular media, and people are becoming accustomed to reading stories about bacterial infections that can’t be treated with standard antibiotics. These stories, however, often gloss over or completely skip one important part – how did these bacteria become impervious to our best medicines in the first place? I’m not talking now about why or how antibiotic overuse and improper use has increased the number of resistant bacterial strains in recent years. Not that that isn’t important, but it’s something I’ve addressed in previous posts. No, I’m talking about how, down at the nitty-grittiest level, one little bacterial cell decides one day that it will no longer be affected by the very poison that was designed specifically to kill it?
I’m going to try not to get too technical in discussing a subject that is inherently technical and scientific in nature. Many clinicians and researchers dedicate entire careers to studying mechanisms of antibiotic resistance, and the detail of understanding now goes right down to the molecular level. Firstly, it must be understood that in many ways a bacterial cell looks and works differently than a cell from our bodies. Bacteria still have a genetic code contained within DNA, but in bacteria some of this DNA floats freely inside the cell, often in circular structures called plasmids. The interesting thing about bacteria is that they can pass plasmids (and thus, genetic code information) amongst each other through a process called plasmid transfer. This process allows certain traits that a single bacterial cell might possess to be shared with nearby bacteria quickly. A second key difference is that a single bacterium can divide into two new cells on its own, without the need for sexual reproduction between two parent cells.
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Question – What do you do when bacterial pathogens are developing resistance to available medicines faster than new therapies are being introduced to take their place?
Doesn’t sound like a sustainable situation, does it? Unfortunately it’s a very real situation in developed countries around the world. Strains of bacteria like methicillin-resistant Staphylococcus aureus (MRSA) have evolved in both hospital and community settings, and while MRSA is currently getting most of the press, the scary reality is that other strains are emerging that are even more deadly. Today, even most MRSA infections can be treated using a last-line antibiotic such as vancomycin. The problem arises when drugs like vancomycin are used more frequently because they are the only effective alternatives available. Only slightly less sure than death and taxes, is the relationship between use of an antibiotic and the subsequent ability of bacteria to develop and pass on resistance to that antibiotic. This is why original life-savers like first generation penicillins are no longer generally useful to us for treating modern day infections. It’s also why we have to be very careful about the use of vancomycin and our other last-line antibiotics. Read More
It is often that hospitals in a region share patients. Up until now, most studies on methicillin-resistant Staphylococcus aureus (MRSA) have focused on one hospital or a small group of hospitals. A recent study published in Infection Control and Hospital Epidemiology shows the impact of a MRSA outbreak on all hospitals in a large metropolitan county. It was found that an outbreak of MRSA at one hospital can impact other hospitals in the same area.
The study used extensive data collected from Orange County, California. Collectively, the hospitals in Orange County serve a population of 3.1 million people. An agent-based model was used to simulate patient movement throughout 29 Orange County hospitals. Valuable information was gained from the results of this study. It was found that increasing MRSA prevalence at a single hospital resulted in an up to 46% increase in relative MRSA prevalence at other hospitals. This is cause for great concern as a MRSA outbreak at one hospital can affect all hospitals in the area. Hospitals therefore should not consider themselves an “island”, but part of an interconnected system.
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A few weeks back I wrote about the new (first) IDSA guidelines on MRSA treatment in hospitals. Not to be outdone, the Association for Professionals in Infection Control (APIC) has now released its second edition guidelines for MRSA treatment. APIC first put out guidelines on MRSA back in 2007, and with the recent explosion of MRSA-related research it was high time to take another look at new evidence and best practices in the field. Read More
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