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Wednesday, July 24, 2002In Illinois, the Tribune identified 4,712 cases during 2000 in which individuals contracted hospital-born germs without setting foot in a hospital or other medical center--a 1,000 percent increase in the last decade, an analysis of state patient records and public health reports show. Last year, at least 200 people in Illinois died after contracting drug-resistant germs in their homes, at work or during leisure activities. Victims developed strains of pneumonia, blood poisoning and dozens of other infections rarely identified outside hospitals as recently as five years ago. And again, the newspaper doesn’t share the details of their methods or of their results. They only share their conclusions, and their dramatic anecdotes: -Gershenson, owner of a medical supply company, believed he had a lingering cold-weather flu, his wife said. For five weeks, mild fever and nausea flared every few days, then disappeared. By November 2000, symptoms became so constant and severe that he went to the emergency room at Illinois Masonic Medical Center. He died less than 30 hours later. -In July 1997, a 7-year-old girl from Minnesota who complained of fever and a pain in her right groin died from MRSA. -In January 1998, a 16-month-old girl from North Dakota arrived at a local hospital in shock, with a temperature of 105 degrees. She died within two hours of admission. MRSA was found in her lungs. -In January 1999, a 13-year-old girl from Minnesota was taken to an emergency room after complaining of fever and spitting up blood. MRSA was found in her blood. She died seven days later. -In February 1999, a feverish 12-month-old boy from North Dakota was taken to the emergency room after repeatedly vomiting. MRSA, which was found in the lungs, resulted in pneumonia. The boy died a day later. The culprit in each of these vignettes, MRSA, is a bacteria known as methicillin resistant staphylococcus aureus. Staphylococcus aureus is a common bacteria that inhabits the human body. It’s especially plentiful in the nose and the skin. The methicillin resistant part is relatively new, and it’s the consequence of using antibiotics indiscriminately for the past fifty years. Having been in contact repeatedly with antibiotic molecules, the bacteria have genetically altered themselves to be resistant to them. These resistant strains first showed up in hospitals, not surprisingly, because people with chronic illnesses are most likely to end up in the hospital and also more likely to have been treated repeatedly with antibiotics for infections. Now, however, community bacteria have been so overexposed to antibiotics that they, too, have altered their genes. It isn’t so much that the bacteria are escaping from the hospital to the community, it’s that we have overused antibiotics in both the hospital and the community, and now we are paying the price. The article acknowledges that this is the true crux of the problem, but only after suggesting several times that hospitals are the chief culprit. The Real Story: The New York Times has a better account of this same phenomenon. They put the blame squarely where it belongs: with all of us -doctors and patients. It truly is a challenge sometimes to prescribe antibiotics appropriately. There is a large segment of the population who have been taught over the past fifty years that antibiotics are necessary for every cold, every sinus headache, every cough, every fever. It’s no easy task to undo such extensive and long-standing indoctrination. Then, too, there are pressures from daycare centers and babysitters who do not want sick children attending, understandably. Parents, however, see antibiotics as a quick cure that will get the child back to the daycare center or the babysitter within twenty-four hours. The antibiotic may not be doing any good, and in fact, may be doing more harm, but the daycare centers and babysitters think the children aren't contagious if they’re on antibiotics. In fact, when placed needlessly on antibiotics, they are more likely to be spreading antibiotic-resistant strains of bacteria to all the other little kids. The demand for antibiotics isn’t just limited to children, however. Adults demand them for themselves for the very same reason. Their co-workers feel safer from their contagion if they can tell them they are on antibiotics. Doctors are to blame as well, of course, for all the reasons the Times lists. Most of the time, though, the fight to avoid unneccessary antibiotics is such an endless Sisyphian task, that we sometimes succumb to fatigue. Despite all of our best efforts to educate; despite posters, patient handouts, and ready explanations; sometimes, many times, we are just too tired to fight. It’s so much easier to whip out that prescription pad and write a prescription for the antibiotic du jour. No long explanations, no arguments, no unpleasantness when the illness lingers or when the throat culture comes back positive after all. We all succumb at some time or another, and so do our bit to further the spread of antibiotic resistance. The sister article to the Times piece has good suggestions for approaching common infections. Although the article is geared toward pediatrics, the same rules of thumb apply for adults as well: -Eighty percent of ear infections will go away without antibiotics within a week. -For a bad sore throat, the agency advises doctors always to test for strep with a throat culture and to wait for the results before prescribing an antibiotic. The test is easy, but pediatricians do not always perform it. (Nor do family physicians and internists) -For bronchitis, which is almost always viral, the C.D.C. recommends withholding antibiotics unless pneumonia is suspected or the cough lasts longer than 10 to 14 days without improvement. And remember this pearl of wisdom: Medical experts say using antibiotics judiciously can be the best thing a parent can do for a child. Children who have recently taken antibiotics and then contract other infections are three to nine times as likely to have a drug-resistant infection as they would have been if they had not taken the antibiotic. Ditto for adults. CORRECTION: Charles Murtaugh (permalinks not working, scroll down to the plasmid post) correctly takes me to task on the biology behind antibiotic resistance in bacteria. It’s a matter of survival of the fittest in the presence of antibiotics more than it is spontaneous mutation. posted by Sydney on 7/24/2002 06:08:00 AM 0 comments 0 Comments: |
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