Squashing a Bug
Will doctors win the battle against anti-resistant "super germs"? That depends on what you read.
On the same day in October, three different publications arrived in our mail, each carrying the same dire message. The front page of Consumer Reports on Health warned, "Dangerous Bacterial Infections Are on the Rise." Newsweek mentioned "Staph Fears" on the cover. And The Commercial Appeal chimed in with a story headlined, "Super Germ's Infection Rate 'Astounding.'"
Clearly, every man, woman, and child on the planet is doomed.
Or are we?
"It's certainly not the end of the world," says Dr. Steven Buckingham, a pediatric infectious disease specialist with UT Medical Group. "We have been dealing with this problem for years now."
The main culprit is a microscopic bacteria called Staphylococcus Aureus — staph for short — which has infected humans for centuries. Buckingham explains that the first effective antibiotic against this common germ was penicillin, developed in the 1930s.
But this so-called miracle drug soon developed problems. "Staph quickly became resistant to it," says Buckingham. "Just by the exposure to the antibiotic, the bacteria learned how to avoid it, basically, by producing an enzyme that destroys the penicillin molecules."
At the same time, "semi-synthetic penicillins," the chief one being methicillin, continued to work against staph. For a while. In the 1960s, doctors began noticing staph infections that were becoming resistant to the new drugs as well. They began to label these MRSAs, or Methicillin Resistant Staphylococcus Aureus.
"MRSA is something we had traditionally seen in hospitals," says Buckingham, "in patients who have other health problems, on dialysis, or following surgery." What has changed is that in the past 10 years or so, doctors have reported MRSA infections in "community settings" — locker rooms, gymnasiums, and schools.
And this has made people jittery. A recent government report claims that 90,000 Americans each year could be infected by a so-called "superbug" that is resistant to all antibiotics. Fueling the flames is an editorial in the October issue of the Journal of the American Medical Association that calls the infection rate (estimated at 23 out of 100,000 patients) "astounding." Even the normally complacent Consumer Reports cites an infectious disease specialist in Virginia who says, "I fear we are at a tipping point — on the verge of returning to a pre-antibiotic era, when none of our antibiotics may work at all."
But in Memphis, Buckingham insists this is "kind of old news to us. When people talk about a 'superbug' they mean MRSA infections." And he points out that 23 out of 100,000 is not necessarily high compared to other ailments, such as heart attacks or strokes.
What's more, the vast majority of these infections are not deadly. Staph germs usually cause skin infections or boils, though in rare cases they can lead to pneumonia or other internal infections. Even so, says Buckingham, "The truth is that we do have antibiotics that are active against MRSA infections in general. We have other antibiotics that can beat these things."
It's a controverial issue, and the severity depends on what you read. But the irony is that many of these infections are, in fact, caused by our society's obsession with cleanliness.
"Consumers have contributed," says Consumer Reports, "by insisting that their doctor prescribe antibiotics for viral infections such as the flu or common cold, even though antibiotics work only against bacterial infections." And sometimes doctors prescribe antibiotics "just to be safe or to satisfy an insistent patient." The result is that the bacteria can — but not always — develop a resistance to all these medications.
Even the ever-present use of antibacterial soaps and hand cleaners can cause problems: "Their widespread use," says Newsweek, "may make antibacterial soaps less effective for people who really need them, such as hospital and nursing home staff."
Buckingham agrees that antibiotics are often overused, but doesn't think soap is a problem: "First of all, it's almost impossible to find soap that is not labeled 'antibacterial' these days. But the truth is that these soaps are fundamentally different from antibiotics. They are actually closer to antiseptics."
Besides, as Newsweek points out, it's entirely possible we are eliminating too many "bugs" from our lives. Some bacteria can actually fight off infections caused by other bacteria.
In an article titled, "Caution: Killing Germs May Be Hazardous to Your Health," the authors note: "As antibiotics eventually lose their effectiveness, researchers are returning to an idea that dates back to Pasteur: that the body's natural microbial flora are . . . crucial components of our health." What we need, says Newsweek, is to expose ourselves to the "good germs" (such as the bacteria that live harmlessly in our colons and help us digest food). "The job of medicine in the years to come will be sorting out the good microbes from the bad."
So the truth about staph infections and superbugs may depend on what you read, and what doctor you talk to. Even though JAMA considers the infection rate "astounding," infectious disease specialists like Dr. Buckingham in Memphis say, "It's sort of business as usual from our standpoint."
Let's hope he's right.