NO NEED to picture a cape or other costume when thinking of superbugs. These villains are microscopic. And a long time ago, we had any number of means to defeat this enemy.
But over the years, they have evolved to become quite difficult to eradicate. Antibiotic-resistant (or drug-resistant) bacteria are becoming a significant public health problem around the world, especially in the United States.
It wasn't always this way.
Penicillin was discovered in 1928 and first used as an antibiotic in humans after World War II, and at that time, it could treat dozens of bacteria that cause infections.
Over the years, however, penicillin has lost its muscle, and many bacteria no longer respond. Bacteria evolve quickly, developing random gene mutations in response to an evolutionary pressure--the pressure is our overuse of antibiotics.
Once a gene mutation allows for the ability to withstand an antibiotic, bacteria can grow, thrive and even pass that gene to its neighbors (called plasmid exchange). This process of mutation and sharing among bacteria create colonies of bugs that will no longer respond to a single antibiotic or even whole classes of antibiotics.
We have saturated our environment with antibiotics--in livestock production and through frivolous visits to the doctor. We challenged bacteria to evolve, and the bacteria
A BIG LEAP IN PREVALENCE
The first drug-resistant bacteria was discovered in 1947, only four years after penicillin was first used.
Derivatives of penicillin --methicillin and oxacillin -- initially treated staph infections that were penicillin-resistant. But in 1961, MRSA (methicillin-resistant Staphylococcus aureus) was discovered and now, half of all staph aureus infections in the U.S. are MRSA.
This initially was an infection that was observed only in hospital settings, but between 1999-2006, cases of MRSA increased dramatically and began being detected in persons never hospitalized--the cases were also known as community acquired infections. Cases to this day continue to increase in frequency.
While the vast majority of community-acquired MRSA causes skin infections that can be treated successfully, there are 20,000 deaths each year from MRSA--usually in dialysis patients and those who have MRSA as a complication of surgery. This one bug has quite the price tag: Treating MRSA can cost $3,000 to $35,000 per infection.
There are several bacteria that are increasing their patterns of resistance, including streptococcus and E. Coli--both common causes of infections that are relatively mild. This changing pattern of resistance keeps infectious-disease doctors on their toes, constantly revising their advice to the medical community about which antibiotics to choose in a patient with pneumonia, a sore throat, or simple urinary tract infection.
Then there are the true superbugs--enterococcus, pseudomonas and acinetobacter--that are found only in hospitalized patients, but can be resistant to so many antibiotics that occasionally, no treatment can be found.
The discovery of penicillin once rendered the threat of bacteria to a laughable nuisance, but the increasing pattern of resistance is causing great fear now.
A WAY TO FIGHT THEM
Now that you are washing your hands and building your portable bubble, let me reassure you: There is hope to slow down the development of these superbugs.
Norway took action in the 1980s to dramatically curtail the use of antibiotics in doctors' offices in response to the rising rates of MRSA. As a result, today, only 1 percent of staph infections in Norway are MRSA, compared to estimates of 50 percent to 60 percent in the U.S. and a whopping 80 percent in Japan.
Doctors in Norway quickly isolate cases of MRSA, and health care workers who carry MRSA are not allowed to work until they are clear of the bug. Physicians tell their patients with low-grade fevers and the sniffles to take a Tylenol and tough it out.
Since this was a countrywide initiative, they successfully removed the evolutionary pressure on bacteria to develop resistance. The result is unique--Norway has the lowest rates of dangerous infections, while also having the lowest rate of antibiotic use in the world.
As a result, there are very few blond-haired, blue-eyed people worrying about superbugs.
The message of curtailing antibiotic use has reached physicians in the U.S., but there has been no effort to mandate the cessation of antibiotic prescribing on a mass scale.
PUT DOWN THE LYSOL
I can attest to the experience of the average American doctor--that we often feel pressure from our patients to prescribe antibiotics, even if we are confident they will not speed recovery. Aside from some usually minor side effects, giving an unnecessary antibiotic carries few short-term negative consequences. However, as we observe in Norway's example, the long-term damage
So please, do not circle your home with a perimeter of Lysol. Simply wash your hands, stock up on some over-the-counter cold remedies and toughen up the next time you have a cold or sinus infection. You don't need the antibiotics, and we don't need more drug-resistant bacteria.
For further reading, check out cdc.gov/getsmart/antibi otic-use/anitbiotic-resis tance-faqs.html.
Dr. Christopher Lillis is an internist with Chancellor Internal Medicine in Fredericksburg. He can be reached
Email: newsroom@freelancestar.com.