Don’t be afraid — What you don’t know can’t hurt you. Or maybe it can ...
This is from the New York Times, 4/8/19: “In January, the Centers for Disease Control and Prevention sent out an urgent public alert about a deadly bacteria, resistant to virtually every known antibiotic, that sickened more than a dozen Americans who had elective surgery at Grand View Hospital in Tijuana, Mexico. But when similar outbreaks take place at hospitals on American soil, the CDC makes no such public announcement. That is because, under its agreement with states, the CDC is barred from publicly identifying hospitals that are battling to contain the spread of dangerous pathogens.”
Drug resistant pathogens, a.k.a. superbugs, have been around for a while. Methicillin-resistant Staphylococcus aureus (MRSA) was first reported in 1960, just one year after methicillin was approved for use in the UK, and methicillin resistance was reported in the US eight years later. Vancomycin was introduced into clinical practice in 1972 and resistance reported in 1979. This November, the CDC has issued its “Antibiotic Resistance Threats in the United States 2019”, which is “dedicated to the 48,700 families who lose a loved one each year to antibiotic resistance or Clostridioides difficile, and the countless healthcare providers, public health experts, innovators, and others who are fighting back with everything they have.”
The bacteria and fungi listed in the report are divided into three classes, urgent threats (there are five of them), serious threats (11 resistant pathogens) and concerning threats (2). In addition, there are three bacteria on the watch list, inluding whooping cough. This disease can be prevented with a vaccine, but is very contagious and can be fatal to infants.
The existence of antibiotic resistant bacteria, including Candida auris ,the most recent and most resistant of the drug resistant pathogens, has been well documented for anybody who knew where to look, or knew to look at all. A report on PLOS Pathogens was titled “Candida auris: An emerging pathogen ‘incognito’?” and the entire abstract reads “The initial description of C. auris arose following the isolation of a novel species from the ear canal of a patient in a Japanese hospital ... Since this report in 2009, cases have subsequently appeared in hospitals in South Korea, India, the Middle East, South Africa, and South America ... First hospital outbreak of the globally emerging Candida auris in a European hospital. First report of Candida auris in America: Clinical and microbiological aspects of 18 episodes of candidemia. First three reported cases of nosocomial fungemia caused by Candida auris.”
PLOS stands for Public Library of Science, an open access, high quality group of scientific journals not hidden away in academic libraries or behind a pay wall. But while the existence and spread of C. Auris was reported throughout the world, there were no mentions of the infections in the United States.
As the New York Times reported the problem, a culture of secrecy has kept the American press from reporting the spread of drug resistant pathogens in the United States. On Nov. 13, New York State became the first state to release a list of hospitals and nursing homes where cases of C. Auris had been treated. The fungus had been reported in 64 hospitals and 103 nursing homes. The list for New York City includes every major hospital – nationally and even world-renowned hospitals, but these hospitals are afraid that if people are aware that a superbug has been reported there, prospective patients will choose not to be admitted.
The CDC report states that the problem of antibiotic resistance is greater than had been previously realized. According to the report, nearly 2.8 million people suffer infections from these “superbugs” every year. Of those, 35,000 people die from these infections. At the same time, the Food and Drug Administration (FDA) has approved some new antibiotics that show activity against resistant bacteria, but it’s critical that these drugs be used carefully since the bacteria can develop resistance more rapidly than researchers can develop antibiotics.
We’ve suffered from overconfidence and casual use of antibiotics. Physicians have prescribed antibiotics to treat viral conditions, where antibiotics are useless. The FDA is trying to reduce use of antibiotics in feed and water for food animals, but it’s a voluntary program and unlikely to gain full compliance.
An article in the journal P&T begins “The rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics, which have transformed medicine and saved millions of lives... Many decades after the first patients were treated with antibiotics, bacterial infections have again become a threat.” It will take a great deal of dedication and luck to find new treatments for resistant organisms, and a whole new philosophy of how these treatments should be used. And, we will have to be aware of the threat of bacterial resistance. It’s been estimated that there are between 10 million and a billion species of bacteria working to develop antibiotic resistance, and only one species of humans trying to fight back.
Sam Uretsky is a writer and pharmacist living in Louisville, Ky. Email sdu01@outlook.com.
From The Progressive Populist, December 15, 2019
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