By Ginny Graves
August 4th, 2009
When the swine flu burst onto the scene in April, the bug arrived with a few particularly ominous signs: The flu was resistant to a class of drugs often used to fight flu in the past, and experts were surprised that a nonhuman virus could have such rapid human-to-human transmission. Why was Swine Flu resistant to current medicines, and was this strain a new supergerm?
Flu bugs develop drug resistance when a virus mutates in a way that makes medications ineffective. Overusing and misusing antiviral meds can cause the problem. But mutations can also crop up spontaneously, even when the drugs aren’t overprescribed, says Anne Moscona, MD, a flu expert and an infectious-diseases physician at Weill Medical College of Cornell University and New York Presbyterian Hospital.
“Swine flu seems to respond to Tamiflu, but we weren’t sure at first. And we’re seeing more strains of other types of flu, including some bird flu, that are resistant to it. That’s been sobering for lots of people in public health because Tamiflu is the drug the country has been stockpiling for a possible pandemic,” she says. “The issue we’re facing now is ‘What do we do if the drugs we’re counting on don’t work?’”
This question is being asked with increasing urgency these days, as more and more bugs, including some truly nasty bacteria, become impervious to the effects of our best drugs. Acne and some STDs aren’t clearing up the way they once did.
More worrisome, methicillin-resistant Staphylococcus aureus (MRSA)—bacteria that are resistant to methicillin, a common antibiotic—now kills more people in U.S. hospitals than HIV, AIDS, and tuberculosis combined. And, scarier still, the bug is becoming increasingly common outside of hospitals, affecting everyone from infants with ear infections to young, healthy athletes. And MRSA, experts warn, is just the tip of the drug-resistance iceberg.
“Drug-resistant bacteria have developed in large part because of our overuse and misuse of antibiotics—and it has led us to a crisis point,” says Helen W. Boucher, MD, a specialist in the division of infectious diseases at Tufts Medical Center in Boston. “We’re even seeing bugs today that are resistant to all antibiotics.”
But while some germs may be outpacing our ability to kill them, we’re not completely defenseless. In fact, there are plenty of things we can do to slow their spread. Here, five of the scariest threats right now, and what you can do to keep yourself—and future generations—safe.
Scary strains of flu
In 2005, two teenage girls in Vietnam died of avian (bird) flu. The news was alarming because both had been treated with Tamiflu, the drug governments stockpile to fight the avian virus. In fact, lab tests showed both girls had developed Tamiflu-resistant viruses. More bad news came in January of this year when researchers at the University of Colorado announced that more than 30% of the bird flu samples they analyzed were resistant to adamantanes, older antivirals doctors might use if Tamiflu doesn’t work.
As of May this year, bird flu had killed 261 of the 424 people who have been diagnosed with it worldwide since 2003, according to the World Health Organization. “It’s incredibly deadly,” Dr. Boucher says. “It doesn’t spread efficiently from person to person—at least not yet—but a pandemic flu still tops the list of scary health nightmares, even in the United States, because there’s the potential for a highly contagious flu to sweep through the population before we can contain it.”
Such a flu could kill thousands—if not hundreds of thousands—of people, especially if the strain is resistant to Tamiflu. “It makes sense for countries to start adding Relenza, another newer antiviral, to their stockpiles, just in case we see a Tamiflu-resistant strain that’s highly contagious,” Dr. Moscona says.
Even if there are drugs that work against a virulent flu, they can’t necessarily be relied on to contain an epidemic. “Antivirals only work if you take them within two days of the first symptoms, and they’re much more effective if you take them in the first 6 to 12 hours,” Dr. Moscona says.
Some good news: Researchers recently identified human antibodies that seem to neutralize some flu viruses, including the bird flu strain—a finding that could lead to more-effective treatments. In the meantime, not getting the flu in the first place is a far better bet than trying to treat it. (In the United States, about 36,000 people die from the flu every year.) To avoid it:
* Get an annual flu vaccination. The viruses in the vaccine (based on the type or strain of flu researchers think is most likely to hit) change every year, so get vaccinated each year—and early. It takes about two weeks for flu-fighting antibodies to develop, so get vaccinated in September or early October to protect yourself from early-arriving bugs.
* Wash your hands. The flu virus can live for up to 72 hours on surfaces like doorknobs, light switches, and TV remote controls—and if you get it on your hands and touch your eyes or nose, you could get sick. That makes hand-washing the most effective daily defense. Wash briskly with plain old soap and water for 30 seconds.
* Fight the flu with vitamin D. “One study found that people who took vitamin D supplements were less likely to have cold and flu symptoms,” says Michael F. Holick, PhD, MD, professor of medicine, physiology, and biophysics and director of the Vitamin D, Skin and Bone Research Laboratory at Boston University School of Medicine. Dr. Holick says 1,500 to 2,000 I.U. of vitamin D not only bolsters the immune system but also may help prevent infection.
Methicillin-resistant Staphylococcus aureus (MRSA)
In December 2005, when 14-month-old Bryce Smith came down with a cold—his first ever—the pediatrician told his mom he’d feel better in a few days. He didn’t feel better, and by New Year’s Day Bryce was in the emergency room. An X-ray showed that he had pneumonia, and a CT scan revealed something even scarier: His right lung was filled with a thick, gelatinous fluid.
The doctors rushed the baby into surgery, where they discovered he was infected with MRSA—and the infection was so severe that it had eaten a hole through his lung. After 40 days on vancomycin, a superpotent antibiotic that can affect kids’ hearing, Bryce pulled through. “But we’re still worried about his hearing and how much damage the bacteria did to his lungs,” his mom says.
Bryce’s story is scary because it reflects a trend. “It’s most worrisome that MRSA can infect completely healthy people with healthy lifestyles, something that was almost unheard of 15 years ago,” Dr. Boucher says. About 12% of infections strike people who aren’t hospitalized, a percentage that is likely to increase as MRSA becomes more widespread.
Currently, about 40% of us have staph bacteria on our skin—and it rarely causes a problem. But about 60 to 70% of staph in U.S. hospitals has developed resistance to methicillin. Worse, a small percentage of the bugs are now resistant to vancomycin, the drug that saved Bryce’s life.
Although MRSA can cause pneumonia and blood infections and has recently been linked to children’s ear and sinus infections, it most often causes skin and soft-tissue abscesses. A MRSA infection looks like a pimple, boil, or spider bite, but it may quickly worsen into an abscess or pus-filled blister or sore. To protect yourself …
* Shun the staph. Wash your hands, especially after you’ve been in public places and touched handrails, grocery-cart handles, and other frequently handled objects. Experts estimate that staph is present on 2 to 3% of surfaces in public places—more in hospitals. Regular soap and water will remove most germs. Alcohol gels or wipes and antibacterial soap work, too, but there’s a chance that antibacterial soap contributes to antibiotic resistance, so it makes sense to avoid it.
* Cover up. Bandage all cuts, even paper cuts and blisters. Sterilize the stetho. Researchers recently found that one in three stethoscopes used by emergency-medical-service providers was contaminated with MRSA. Ask your doc to swab his scope with alcohol.
* De-germ the gym. Use a disinfectant wipe to swab the handlebars of equipment, and drape a clean towel over shared yoga mats and sauna and locker room benches. After each workout in a group environment, take a shower, soaping up thoroughly—and be sure your kids who play sports do, too.
* Don’t share. You’re at increased risk of MRSA if you share razors, soap, towels, or other personal items. Schools, day-care centers, and gyms may harbor the germ—one reason it’s important to get children in the hand-washing habit.
Clostridium difficile (C. diff.)
Amy Warren, 41, thought she was dying when, several weeks after giving birth to her daughter, she began having severe abdominal cramps and dozens of daily bouts of diarrhea. After several medical tests, a doctor identified her infection as C. diff., a gut bug that, thanks to its virulence and prevalence in hospitals has earned it the distinction of being called “the new MRSA.” (It sickens about a half-million people in the United States every year and contributes to between 15,000 and 30,000 deaths.)
Warren, who finally beat the infection after six months and three rounds of the potent vancomycin, says, “I had never even heard of C. diff. before. I’ve never been so sick in my life. I live in fear of getting this thing again.”
C. diff. is one of the most aggressive killers of hospitalized patients. But it’s increasingly affecting people in the community, and one of its most frightening qualities is that it can develop even after you’ve taken a single dose of antibiotics—for a sinus infection, say, or a urinary-tract infection—if the toxic bacteria is in your gut. “The drugs wipe out the healthy bacteria, which allows C. diff. to proliferate,” Dr. Boucher says.
The bacteria can produce toxins that destroy the lining of the gut, causing everything from mild diarrhea to a deadly condition known as toxic megacolon, in which the colon walls become so thin they rupture. The type of C. diff. Warren had—a mutated strain known as NAP 1, which has only appeared in the last decade—is particularly dangerous, producing roughly 20 times the amount of toxin as older strains and responding less favorably to antibiotics. To stay safe:
* Bust out the bleach. The bacteria’s hardy spores can survive for months on most surfaces (even dry ones) and aren’t killed with most cleaners. “You can only kill them with bleach,” says Stuart Levy, MD, president of the Alliance for the Prudent Use of Antibiotics and a professor of microbiology and medicine at Tufts University School of Medicine. On your hands, alcohol sanitizers do little to get rid of spores, but the friction of soap and water may remove it from your hands. “The best you can do is try to wash it down the drain,” says Louis Rice, MD, an expert on resistant bugs and chief of medical service at Louis Stokes Cleveland VA Medical Center. Also, be particularly vigilant about hand hygiene if you visit a hospital or extended-care facility; both are places where the toxin-producing bacteria thrive.
* Be proactive. If you have to take an antibiotic, take a probiotic at the same time to build up the healthy bacteria in your gut. “It might help protect against C. diff.,” Dr. Boucher says.
Drug-resistant gram-negative bacteria
Last year, Mariana Bridi da Costa, a 20-year-old Brazilian model, was diagnosed with a urinary-tract infection, and within weeks a bacterial infection had spread throughout her body. In an attempt to stem the infection, her hands and feet were amputated. But complications from the infection killed her.
In 2007, Ruth Burns, 67, of Columbus, Ohio, had surgery to relieve a pinched nerve. “She was supposed to be in and out in 24 hours, but she developed pneumonia and meningitis,” her daughter, Kacia Warren, says. Although she was treated aggressively with antibiotics, Burns died 17 days after her surgery. The cause of both deaths: drug-resistant gram-negative bacteria.
“These are some of the most antibiotic-resistant bacteria out there, and they can cause all sorts of infections,” says Barbara Murray, MD, director of the division of infectious diseases at the University of Texas Medical School. Although most infections occur in hospitalized patients, such as Burns, the numbers are quietly escalating in people who are not hospitalized, elderly, or immunocompromised.
“It’s a problem that’s poised to spin out of control,” Dr. Boucher says.
The germ that killed Burns, Acinetobacter baumannii, is nicknamed “Iraqibacter” because it has caused deadly infections in soldiers wounded in Iraq. Until a few years ago, most strains of Acinetobacter could be killed with a variety of drugs; for those that couldn’t, doctors relied on broad-spectrum antibiotics known as carbapenems.
Now, more and more strains of this bug are showing resistance to carbapenems—as are other gram-negative bacteria, including Pseudomonas aeruginosa, which killed Bridi da Costa; some strains of E. coli, the bug responsible for most urinary-tract infections; and Klebsiella pneumoniae, a strain of bacteria that causes a particularly severe type of pneumonia.
“The carbapenems are the best drugs we have against these bacteria,” Dr. Boucher says. “Without them, we’re looking at something pretty scary because there’s almost nothing in the pipeline—and gram-negative bacteria can be killers. They actually chew up the antibiotics used against them.” To fight back:
* Practice infection-protection. If you’re having surgery, ask the surgeon about infection rates. “Surgeons know their rate of infection for various procedures, and you have a right to know, too,” says Betsy McCaughey, PhD, founder of the Committee to Reduce Infection Deaths.
* Stay clean at the hospital. If you’re visiting a hospital, wash yourself and your clothes right after. Don’t use bar soap in any hospital bathroom or set your purse on the floor.
* Be pushy. Ask medical personnel to wash their hands. Don’t be falsely assured by gloves, McCaughey warns. “If caregivers have pulled on gloves over dirty hands, the gloves are contaminated, too.”
By Ginny Graves