When a skin infection is as deadly as a heart attack

In an epic webinar last week on why it’s important to focus on antibiotic stewardship and why it’s important to save these “frankly miraculous therapeutics” (antibiotics), Brad Spellberg, MD, Chief Medical Officer at the Los Angeles County-University of Southern California Medical Center, began his address by reminding us, using a true story, of how bad things were before we had these miracle drugs.

In December of 1942 a healthy 4-year old girl tripped while going downstairs. She cut her cheek and developed a Staphlococcal infection on her face which spread to her blood. The infection on her face spread relentlessly over 3 days. The evening of the third night her face and neck became so swollen she couldn’t swallow her own saliva. On the morning of the fourth day when she was gasping for breath her parents in a panic rushed her to the Mayo Clinic. This is what she looked like on arrival at the hospital. These are the actual photographs taken on admission to the Mayo Clinic.

Spellberg W3

Her admitting physician told her parents she would be dead within 2 days and there wasn’t anything anybody could do to stop that. Imagine, said Spellberg, being told that about your 4-year old who 4 days earlier had been perfectly well.

But she was very lucky because the treating doctor was one of the very few people who could access penicillin before the end of WWll. It was all going to the army. But he had experimental vials in his lab and so he grabbed those vials and began to treat her with penicillin. And you can see in the bottom pictures what she looked like after a few days of penicillin therapy.

Antibiotics, Spellberg emphasized, are the only drugs, the only medical intervention, that can take a girl that looks like this on the top panel and turn them into a patient who looks like the little girl on the bottom panels, in just a few days.

In fact, in the pre-antibiotic era a simple cellulitis (a skin infection) had an 11% mortality rate – an 11% chance of death. By comparison, a 1988 study found that death by myocardial infarction (a heart attack) was 12%. Which means, Spellberg says:

[T]hat the death rate from cellulitis in the pre-antibiotic era was the same as the death rate from myocardial infarction. Who remembers that? Who remembers that a simple skin infection was as deadly as an MI? That the reduction in death you get when using a beta-lactam to treat a skin infection is far greater than the reduction in deaths you get from aspirin or clot-busting drug treatment of MI.

Just think about how insane that is compared to what we see today with effective therapy. And the reduction of death that you got with penicillin was immediate and dramatic.

Drug resistance was always with us, but Spellberg warns it has caught up with us now that we’ve stopped coming out with the next generation of “gorillacillin.” So much so that with respect to some gram-negative pathogens:

We have organisms that have become resistant to almost all available therapies and, in some cases, quite literally to all available therapies.… [T]he reality is…. [w]e are making things up. We are putting together regimens that we know will not work individually and hoping by some magical combination phenomena that we can treat an otherwise untreatable infection. And that’s not the way medicine is supposed to be in the 21st century …. This is 1934 medicine. We have set the clock back 80 years to the pre-antibiotic era.

An era when a skin infection was as deadly as a heart attack.

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