Antibiotic-resistant
germs are showing up in hospitals, playrooms, and gyms around the country.
Here's how to keep you and your family safe
By Jessica
Snyder Sachs, as first appeared in PREVENTION
magazine
One summer
morning in 2004, Susanne Petrosky, 37, of Perkasie, PA, woke up feeling
feverish. It was a month after she'd given birth to her third child, and one
touch of her left breast--hot, swollen, tender--told her it was infected. She
knew the drill, having been through it with her second baby. She called her
doctor, picked up a prescription for the antibiotic clindamycin, and took it faithfully for the full 7 days. No
more breast infection.
Then the
diarrhea started, with cramping so bad it made her recent labor pains seem
mild. She made an appointment to see her doctor and got on the Internet.
"I typed in clindamycin and side effects and it came
right up--severe, sometimes fatal, diarrhea," she says. On the phone, her
doctor was reassuring. That was on a Thursday. She spent much of the weekend
lying on the bathroom floor; on Monday morning her sister drove her to the
doctor. "He took one look at me," Petrosky says, "and told us to
go straight to the emergency room."
Petrosky had
picked up a dangerous new strain of an old bug: Clostridium difficile. The
bacteria, which produces toxins in the intestine, is common--when people on antibiotics end up with diarrhea, C.
difficile is often to blame. Generally, once they've finished taking the drugs,
the diarrhea clears up on its own. But the new strain is much nastier than
normal. It churns out 20 times the colon-damaging toxins as the older version,
causing severe intestinal inflammation, or colitis, and is resistant to several
important antibiotics. When Petrosky got sick,
Canadian hospitals had already reported more than 200 deaths from C.
difficile--toxins had eaten right through the walls of patients' colons. Many
American hospitals were experiencing similar outbreaks, and the hypervirulent
strain had begun to infect people in the general community. Since then, the
situation has only gotten worse.
Experts have
long warned against the overuse of antibiotics because of the possibility
that bacteria would develop resistance to the drugs we use to kill them. Now,
researchers say, some of their fears have come to pass. The CDC estimates that
of the approximately 2 million bacterial infections Americans acquire in
hospitals each year, 70% are resistant to at least one of the drugs commonly
used against them. Why that's scaring the experts: If standard drugs don't
work, doctors sometimes have to turn to more potent--and more
toxic--alternatives. In some cases, those last-resort antibiotics have caused irreversible liver
or kidney problems or lasting pain from nerve damage. In others, people
have died for lack of an effective treatment. The CDC says that drug resistance
kills 70,000 Americans each year--more than car accidents and homicides
combined.
"The
superbugs are here," says Martin J. Blaser, MD, president of the
Infectious Diseases Society of America and the chair of New York University
Medical School's department of medicine. "And it doesn't take a crystal
ball to see that even more problems are coming."
Scientists
are trying to develop new bacteria-fighting drugs, but that process takes
decades. In the meantime, we have to defend ourselves. It's crucial to be able
to recognize the warning signs of a superbug infection, or, even better,
prevent one. Here are four of the most dangerous of these germs and how leading
experts say you can protect yourself.
Superbug C.
difficile: A Toxic Intestinal Bug
When Petrosky
got to the hospital, doctors immediately put her on extrapowerful antibiotics. She improved, but her right
arm went numb from medicine-induced nerve damage; when her physicians switched
drugs, she relapsed. It took more than 9 weeks to get her out of danger. After
her recovery, her 4-year-old son and a neighbor went through similar bouts of
illness. The neighbor had to be hospitalized.
The number of
new cases of C. difficile-associated colitis among US hospital patients has
doubled over the past 5 to 10 years, to as many as 500,000 a year, reports CDC
medical epidemiologist L. Clifford McDonald, MD. The infection rate outside
hospitals appears to have increased many times over, as well. And the death
rate has skyrocketed: from less than 2% to as high as 17%.
Prevent It
Don't badger
your doctor for unnecessary antibiotics. Remember: Antibiotics don't work against viral
infections such as colds or flus.
Ask about
alternatives if your doctor suggests long-term antibiotics for a chronic bacterial
infection such as acne. (Try remedies like benzoyl peroxide cream instead.)
Avoid
broad-spectrum antibiotics, if possible, when an illness
requires an antibiotic. (Broad spectrum means they kill off good bacteria along
with the bad.) The broad-spectrum antibiotics most associated with C. difficile
infection are clindamycin (Cleocin), and the
fluoroquinolones (Cipro, Floxin, and Levaquin).
Consider
upping your intake of "friendly" bacteria, such as Lactobacillus and
Bifidobacterium. They can be found in many brands of live-culture yogurt. Such
a step can't hurt; research continues on whether it can help deny bad bugs a
foothold in your system.
Treat It
Contact your
doctor if you have diarrhea or cramping and gas that lasts longer than a few
days, and avoid antidiarrheal remedies, which can prevent your body from
expelling C. difficile's tissue-damaging toxins. Instead, drink lots of fluids
to stay hydrated and try the BRAT diet: bananas, rice, applesauce, and toast.
Superbug
MRSA: Out of the Hospital and in your Community
On Christmas
night, 2005, 14-month-old Bryce Smith had a stuffy nose and slight fever--his
first cold, say his parents, Katie and Scott Smith of Santee, CA. Around
midnight on New Year's Eve, Bryce began to struggle frighteningly for breath.
The Smiths rushed him to the hospital, where a nurse checked his oxygen level.
Within seconds, Katie recalls, at least 10 doctors and nurses had crowded
around her baby, looking very scared.
X-rays and CT
scans showed that Bryce's lungs were riddled with holes, and a team of surgeons
hurried him into the operating room. Doctors told the Smiths that Bryce had the
worst kind of lung infection, one caused by a particularly virulent variety of
staph bacteria. Dubbed CA-MRSA, for community-acquired methicillin-resistant Staphylococcus aureus,
the bacteria is resistant to penicillin, amoxicillin, and the other
"cillins." And it produces poisons--which were chewing up Bryce's
lungs.
Bryce lay in
a medically induced coma for a month as doctors infused his body with a
cocktail of antibiotics, sedatives, and other drugs.
The medicines worked: After 40 days, the doctors brought him out of sedation
and removed his tubes. But his parents have to be supervigilant now, because
the treatment weakened his immune system, at least temporarily. "What
would be an ordinary cold for us could prove deadly for him," his dad
says.
Staph causes
problems only when it slips past the body's defenses, through a cut or scratch
or into lungs weakened by a viral infection. Close contact--on playing fields,
in locker rooms and showers, and between children in day care and
preschool--has been the key to many outbreaks. (Young children appear to be
particularly at risk.)
MRSA made
headlines in 2005 when Miami Dolphins Junior Seau and Charles Rodgers were
hospitalized with limb-threatening skin infections and college football player
Ricky Lannetti of Philadelphia died suddenly of MRSA pneumonia on the heels of
the flu. And a study in the New England Journal of Medicine startled physicians
by revealing that the bug now causes more than half of all skin infections
treated in US emergency rooms. It's crucial, say researchers, for doctors to
keep the possibility of MRSA in mind--the study found that most cases of
MRSA were treated with drugs that don't work against the superbug.
How To Avoid
MRSA
Prevent It
* Wash cuts and scrapes thoroughly with soap
and water.
* Don't share personal items such as towels and
razors, and just in case you have a scratch that would offer entry to MRSA,
always keep your clothing or a towel between your skin and any shared surfaces
such as workout equipment or locker-room benches. *
* Get vaccinated against the flu--the disease
clearly raises the risk of the most severe kind of staph infections.
Treat It
* Don't ignore an infected wound or a
pus-filled boil--not even a scratch, if it seems to worsen over the course of a
few days. MRSA skin infections tend to be very red, swollen, and painful,
sometimes with a raised bump resembling a spider bite. Getting the right
antibiotic is critical, so ask your doctor to consider the possibility of MRSA.
* Be particularly vigilant about any chest cold
or flu that takes a sudden turn for the worse, or a fever that spikes over 102
degrees F. "Every major medical center is now on the alert for MRSA,"
says John Bradley, MD, chief of infectious disease at Rady Children's
Hospital--San Diego, where Bryce was treated. "But there's still a problem
with general practitioners and small community hospitals, where doctors may
never have seen a case."
Superbug E.
Coli: Food's Dangerous Hitchhiker
Frightening
news stories recently about the damage done by tainted spinach made it horrifyingly clear:
Produce, like meat, can harbor lethal germs. The culprit in spinach, E. coli 0157:H7, is not antibiotic resistant (in fact, antibiotics are not used to treat this
infection), but is indisputably extratoxic; the poisons it produces can cause
fatal kidney failure. Strains of other foodborne bugs, Salmonella and Campylobacter, turn out vicious toxins, as
well--and these bugs shrug off many drugs that once could vanquish them. All
told, these pathogens sicken 3 to 4 million Americans each year and kill
several hundred.
Prevent It
Be scrupulous
about washing hands after touching raw meat or eggs, and cook these foods
thoroughly. (More than half of all cuts of raw supermarket chicken carry Salmonella and
Campylobacter, studies show.)
Use hot,
soapy water to wash cutting boards and other kitchen surfaces that come in
contact with raw meat or eggs.
Rinse
produce--even veggies and fruits with a thick rind, such as cantaloupe--with a
strong spray of water. If produce is contaminated by irrigation water, as was
the case with spinach, only thorough cooking will
destroy the germs.
Wash your
(and your kids') hands after handling pet rodents and reptiles or farm animals,
which can spread Salmonella and Campylobacter.
Throw your
kitchen sponges into the dishwasher daily and dishrags into the washing machine
often; use hot water.
Treat It
Superbug UTI:
Bladder Infections That Won't Quit
The first
time Dena Kelley got a urinary tract infection, she ended up in the emergency room.
It was the winter of 1999, and Kelley, now a 33-year-old store manager in
Anchorage, was seeing what looked like tissue in the toilet bowl--the lining of
her infected bladder. "It was unbelievably painful," she says,
"and it scared the heck out of me."
The ER doc
gave Kelley a powerful antibiotic--Cipro--to stop the infection fast, but 6
weeks later, Kelley got another UTI. Over the next year, she averaged an infection every 2
months. Finally, her doctors reluctantly turned to a drug to which she'd been
allergic in childhood--amoxicillin, at four times the usual dose. Fortunately,
Kelley had outgrown her sensitivity to the drug, which ended the agonizing
bouts of UTIs. But she can no longer make it through the night without a trip
to the bathroom. And her doctors have told her that permanent bladder damage
may predispose her to chronic infections throughout her life.
Roughly half
of all women get at least one UTI at some point in their lives. Until the late
1990s, doctors were able to treat the problem with trimethoprim-sulfamethoxazole (Bactrim), a narrowly
targeted antibiotic with minimal side effects. But many UTIs have become
resistant to Bactrim and other drugs. So doctors must use stronger antibiotics that can cause problems of
their own.
"It's
frustrating," says Gazala Siddiqui, MD, a urogynecologist at the
University of Texas Medical School at Austin. "These powerful antibiotics increase the chances of a yeast infection, and also the chances that
a woman's next bacterial infection--whether it's another UTI or pneumonia--will
be drug resistant."
If a
resistant UTI lingers, it can cause scarring--which predisposes a woman to even
more UTIs. Some doctors try to stop the vicious cycle by keeping women on antibiotics for months at a time. But that
virtually guarantees that any break-through infections will be impervious to antibiotics, says Siddiqui, who's
sometimes had to admit patients to the hospital for intravenous treatment.
Prevent
Antibiotic-Resistant Bladder Infections
Prevent It
Begin with
good vaginal hygiene: Wipe from front to back after using the toilet and pee
before and after sexual intercourse. Don't douche, and consider alternatives to
spermicides; both can irritate the delicate tissue around the urethra, raising
the odds of infection.
Discourage
UTI-causing bacteria by making the urinary tract and vagina more acidic. "Cranberry juice is good at this. Cranberry capsules are better," says
Siddiqui, who recommends two or three glasses or capsules a day for women who
are prone to recurrent infection. Also helpful: acidifying vaginal jelly
available by prescription (Acigel) or over the counter (RepHresh).
Try a low-estrogen vaginal cream if you're peri- or
postmenopausal and getting lots of UTIs. It will keep the tissue of the urethra
from thinning and becoming more vulnerable to infection.
Treat It
If you
suspect a UTI, ask your doc to send a urine sample for analysis. Start antibiotics, but call back for results. If
it turns out not to be a bacterial infection, stop the drugs and work with your
doc to find the true cause. If a bacteria is at fault, check to make sure the
drug you're on is effective against the bug you have.
3 Stay-Healthy
Moves To Make Right Now
1. Scrubbing
with old-fashioned soap and hot water is the best way to keep germs at
bay. Do it before eating, after using the toilet or handling animals, and
before and after preparing food. Wash vigorously for 20 seconds, experts
say--about the time it takes to sing "Yankee Doodle Dandy."
2. If a sink
isn't handy, clean up with an alcohol hand sanitizer. Studies show that
when someone is sick in a household, classroom, or workplace, using a gel
(between hand washings) reduces the spread of disease-causing bacteria and
viruses. Be sure to choose a product containing 60 to 95% alcohol--some contain less and can
actually help spread germs. Use a generous gob--enough so that hands still feel
damp after rubbing them together for 20 seconds.
3. Skip
antibacterial soap. Household
soaps and other products with antibacterial chemicals, such as triclosan and
triclocarban, don't prevent infection any better than products without them,
studies show. Worse, some experts worry that they may promote drug resistance.
There's no proof yet that they do, admits resistance crusader Stuart B. Levy,
MD, of Tufts University. "But why take the risk when they haven't been
shown to be any more effective?"
Have A
Healthy Hospital Stay
Ironically,
"A hospital is not a good place to be when you're sick," says Curtis
Donskey, MD, chief of infection control at the Cleveland VA Medical Center.
Filled with the sickest patients on the strongest antibiotics, they're breeding grounds for
superbugs. Unfortunately, many doctors neglect the steps that can reduce
patients' risk of picking up nasty germs during their stay, says Donskey, who
has spent a decade raising awareness among his colleagues. Enlist a friend or
family member to help ensure that doctors and other medical personnel follow
these guidelines.
* Ask your
doctor to remove invasive devices such as catheters and IV lines as soon as
it's safe--they provide a pathway into your body for dangerous bacteria.
* Request the
most highly targeted antibiotic if you require one. Remind your doctor to take
you off the drug as soon as possible.
* Demand to
know more about infection rates. Few states now require hospitals to release
this information, so it's next to impossible to "shop around" to
avoid particularly risky facilities. That may be changing: New York recently
passed a law requiring hospitals to make public their rates of
hospital-acquired infection, and a number of other states are considering
similar legislation.
Writer Jessica Snyder Sachs is the author of Good
Germs, Bad Germs: Health & Survival in a Bacterial World
(Hill&Wang/FSG) and Corpse: Nature, Forensics, and the Struggle to Pinpoint
Time of Death (Perseus/Basic Books).
