Germs develop
a deadly defense.
Drug-resistant bacteria discovered in Detroit
BY EMILIA ASKARI FREE PRESS STAFF WRITER
A
40-year-old Detroit area woman had endured painfully infected
foot sores for more than a year.
Doctors
gave her numerous antibiotics, but nothing worked.
Finally,
last April, they amputated one of her toes -- and made a frightening
discovery. Her sores were infected with a virulent new strain
of the bacterium staphylococcus aureus, or staph aureus.
By
stealing genetic material from another bug, the new strain
became totally resistant to vancomycin, the longtime drug of
last defense against it. Health officials would not identify
the metro Detroit woman or what hospital treated her.
The
infection was the first of its kind in the world and
a landmark defeat for doctors and public health officials
in the fight against growing antibiotic resistance.
It
also was evidence that the Detroit area has become an incubator
for resistant strains.
"From
a scientific point of view, it's probably one of the most
remarkable and significant events in my lifetime," said Dr.
Steve Lerner, vice chief of infectious diseases at Detroit
Medical Center.
Added
Dr. Fred Tenover of the federal Centers for Disease Control
and Prevention in Atlanta: "This is an organism that could
cause very serious disease if it was in the community."
Staph
aureus is a common pathogen that infects about 400,000 U.S.
hospital patients a year. About one-quarter of them die. For
decades, scientists have been dreading -- but expecting --
a staph aureus strain to emerge that is resistant to vancomycin.
Staph
aureus can live innocuously in the nose of a healthy person.
About 5 to 10 percent of Michiganders have it and don't know
it, said William Brown, a Wayne State University pathology
professor. If it infects the blood, however, it can quickly
become fatal, particularly if the person has another medical
condition.
Some
experts postulate that eventually, so many bacteria will
develop resistance that antibiotics won't work and hospitals
will be filled with people dying from infections, as they
were in the 1920s.
In
the 1920s, British scientist Alexander Fleming discovered penicillin,
the first antibiotic developed from mold. By the mid-1950s,
about a decade after penicillin came into wide use, most staph
aureus strains in this country were resistant to it. So the
pharmaceutical industry came up with methicillin and a series
of related drugs. Also developed in the late 1950s, vancomycin
had a lot of side effects and was not widely used. Methicillin
and its kin were much more popular -- and the bacteria soon
began growing resistant to them.
For
years, some physicians held out hope that vancomycin was a
super drug, one that would never be outsmarted by bugs. The
first indication that staph aureus was becoming resistant to
vancomycin came in 1997 in Japan, a country known in medical
circles for its liberal use of antibiotics. Vancomycin still
could kill the strain discovered there -- but only at a much
larger dosage. Later that year, the world's second case of
staph aureus with partial resistance to vancomycin was found
at Oakwood Hospital in Dearborn.
The
bacteria causing the Detroit area woman's infection this
year was even more virulent. The emergence of a vancomycin-resistant
strain has medical experts concerned that the number of U.S.
patients who die from infections may soon exceed 100,000
a year.
"In
the scheme of public health threats, this has to rank close
to the top," David Ropeik, director of risk communication
at the Harvard Center for Risk Analysis, said of antibiotic
resistance. "It's a serious threat now, and it's getting
worse fast. It's dramatically more of a public health threat
than pesticides on food."
To
combat resistance and ensure drugs work when needed, health
officials want people to do without antibiotics when infections
are not life-threatening, said Matt Boulton, Michigan's state
epidemiologist. "We have to change consumer attitudes," he
said. "There should not always be an expectation that you'll
leave the doctor's office with antibiotics."
Aggressively
keeping patients with resistant infections in isolation has
helped several Scandinavian countries slow antibiotic resistance
dramatically. Doctors there also prescribe the drugs only in
extreme circumstances. Many health professionals hope that
following this summer's discovery of vancomycin-resistant staph
aureus in the metro woman's foot, Americans will be scared
enough to accept limited use of antibiotics.
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