Can We Zap the Super Bugs?

Nov. 28, 2007

We keep hearing that everything is connected, and what better proof than the potentially deadly bacteria that is mutating beyond the reach of our popular antibiotics.
Consider the super bug of MRSA—a Staph infection that is resistant to the more common antibiotics. MRSA made headlines last month after a Virginia teen died from an MRSA infection that spread to the muscle around his heart, as well as his lungs, liver and kidneys. School officials immediately decided to close and clean 21 schools.
Although MRSA can be deadly, the vast majority of infections are easily treated. In fact, area students with MRSA can go to school as long as the infection can be covered with a dressing, Traverse City school officials said.
But the specter of bacterial-driven diseases that resist antibiotics should get our immediate attention on a broader level. Just 60 years after the introduction of penicillin, strains of bacteria are outrunning even our strongest antibiotics including vancomycin. Medical doctors consider antibiotic resistance one of the world’s most serious health problems.
The most dramatic example: an extremely drug-resistant strain of tuberculosis discovered last year that’s virtually incurable. It has prompted the South African government to indefinitely quarantine TB victims so they don’t spread the disease, according to a recent Associated Press report.
The question of antibiotic resistance has intrigued Stuart Levy ever since he went to medical school and spent several months in the laboratory of
Dr. Tsutomy Watanabe, a world famous research scientist in the field of drug resistance. He has continued his work at Tufts Medical School.
Levy explained that the power of nature and profit motive have combined to create the era of the super bug. He was one of the first to urge doctors to stop prescribing unnecessary antibiotics, fearing that it would hasten the bacteria’s course of mutating beyond medicine’s reach. He realized his message of “prudent” use of antibiotics had to go beyond doctors and to the public at large. In 1992 he published “The Antibiotic Paradox: How Miracle Drugs are Destroying the Miracle.” More recently, he published “The Antibiotic Paradox: How the Misuse of Antibiotics Destroys their Curative Powers.”
Levy believes his research on a mod-ified tetracycline holds at least part of the answer of heading off a bacteria-resistant calamity, but more on that later.
First, what is Staph? Can it kill you? Why are people so nervous about it? And what is its connection to our livestock and the pink stuff in the refrigerator for your toddler’s earache?
Here’s what you should know and the measures you can take.

GRAND CANYON SKIN
MRSA stands for methicillin-resistant Staphylococcus aureus.
Simply put, it describes a Staph bacteria that’s hardy enough to survive antibiotics commonly used to treat Staph, such as methicillin and amoxicillin. Some strains resist an even wider range of antibiotics.
MRSA is not new. The first case of MRSA was seen in 1968, and was confined to nursing homes and hospitals, where patients risk getting an infection while being treated for something else. Staph can ride around on the hands of staff, on the cuffs of coats, on table trays or TV remotes—especially when good hygiene is lacking.
But even if the hospital is rigorous, patients are at risk—especially surgery patients. That’s because Staph from a patient’s own skin can enter their body through an incision. Even though nurses do an antibacterial scrub prior to the surgery, there’s a chance that they may
not kill all the dangerous bacteria, said Karen Speirs, an infectious disease specialist in Traverse City, who did her fellowship on risk factors of community-acquired MRSA.
“Your skin is like the Grand Canyon, and even when you scrub it really good, you can’t get rid of all the bacteria,”
Dr. Speirs said.
To get an idea of the dramatic growth of MRSA, consider only 2 percent of all staph infections in a hospital were identified as MRSA in 1980. Now the national average is 57%. Munson Medical Center is significantly lower than that at 31%, thanks to its efforts of quarantining patients and its intensive efforts to improve hygiene, Speirs said.

MRSA UNBOUNDED
In the late 1990s, the New York Times ran a story on four otherwise healthy children—all distinct cases—in Minnesota and North Dakota who had died from what’s now called community-acquired MRSA. It was notable because the children didn’t fit the profile of people usually susceptible to MRSA. They were healthy, hadn’t been hospitalized, and hadn’t been taking antibiotics.
Community acquired MRSA is much more aggressive than hospital acquired MRSA. But here’s the question: Given this has been around for a good decade, why the sudden media attention?
“With the publicity of the four children, it was considered an oddity, a curiosity occurring in some part of the world,” Levy said. “The fact that it’s now taken over the United States relatively quickly is an indication of two things. One is that our poor hygiene measures reflect that we are underestimating the speed in which MRSA can move. And two, we now have some numbers that show how fast it’s increasing.”
Levy was referring to a recent study that said more than 90,000 life-
threatening illnesses and nearly 19,000 deaths are estimated to occur each year after an MRSA infection—the vast majority after they were medically treated. The report was issued by the U.S. Centers for Disease Control and Prevention.
“How real or unreal those statistics are, I don’t know, but my guess is they’re probably good, and the situation is probably worse than that,” Levy said.
If you get MRSA and need intraveneous therapy, doctors still have at their disposal a first-line antibiotic treatment called vancomycin. But now there is VRSA, bacteria that resists vancomycin. Essentially it’s a super bug resistant to a super-antibiotic. Eight people have been diagnosed with VRSA, six in Michigan—and one person in the last few weeks, said Dr. Speirs.
Fortunately, it doesn’t appear that VRSA moves anywhere near as quickly as MRSA, and can be treated with familiar and older drugs. But there are different kinds of vancomycin resistant bacteria that have already evolved, and can transfer their resistance to Staph, Levy said.

NOW THE GOOD NEWS
Dr. Levy is not only a researcher, he’s also an activist and an entrepreneur. In 1980, he founded the Alliance for the Prudent Use of Antibiotics, which is trying to stem the tide of bacteria mutation. His group not only badgered doctors to stop over-prescribing antibiotics, but also worked to eliminate the routine use of antibiotics in livestock.
“Ever since the 1950s, cattle have been given very low doses in their feed or water to increase an animal’s growth for the same amount of feed. Back then, when the conditions of large-scale farming were less hygienic, they felt the antibiotic was also acting like a vitamin and keeping low-grade infections in check. But what it has done and continues to do is to allow for the prominence of resistant bacteria over bacteria that is susceptible to antibiotics, and that bacteria doesn’t stay at the farm. It reaches the house on meats and vegetables. These bacteria are generally not harmful, but carry resistances from farms to people.
“The European Union banned any antibiotics for this use. Banned it! And they haven’t had any problems in the production of their livestock. We have not gotten there yet, but we’re headed there and we’re going to get there.”
Specifically, there’s are two bills that would prohibit the use of eight antibiotics used for disease prevention and growth promotion. But the bills have languished in Congress since 2002, opposed by the powerful pharmaceutical industry and The Coalition for Animal Health, whose members include the National Cattlemen’s Beef Association and the National Turkey Federation.

A THIN PIPELINE OF DRUGS
Dr. Levy said that there’s another problem: pharmaceutical companies are not financially motivated to research new antibiotics.
The last major new class of antibiotics was introduced 27 years ago—the quinolones. Since then, research has focused on modifying existing antibiotics. Only one new class of antibiotics has been introduced in the last 20 years, although numerous new generations have been approved, Levy said.
Most drug companies have invested their research dollars into medicines treating chronic diseases. Those offer steady revenue, as opposed to antibiotics that are used more as a one-two punch.
The major drug companies have left antibiotic resistant research to small bioceutical firms. Dr. Levy said he formed one of his own, Paratech Inc., to fill the void. He is developing a tetracycline derivative that he believes will outwit the resistant bacteria.
The drug is in Phase 2 of an FDA study and looks promising. Paratech will likely sell it to a large pharmaceutical company for an expensive and large-scale, Phase 3 study.
“I’ve spent most of my life looking at this and dreamed of finding a drug,” he said. “The data is not all in yet, but it looks as if it will fight a lot of the e-coli and the MRSA as well.”
Dr. Norm Licht, a Traverse City orthopedic physician, is less enthusiastic about the power of drugs.
“The fact is, bacteria has been here for 100,000 years. It multiplies faster, finds resistance faster than we can find the drugs to beat it. Sooner or later the bacteria will win, and we’ll lose,” he said.
Understanding our immune system is key to staving off serious diseases, said Dr. Licht, adding that people unknowingly fight off disease every day. Cancer cells, for example, can be with us as infants and only take deadly control when we’re much older.
“So why does your immune system fail? If science can address that issue—why the immune system fails and how to turn it on when necessary—then we might have a chance of beating this.”
The vast majority of patients who walk through the door are unaware of the simple things they can do to build a better resistance to sickness and disease. Others have simply lost motivation, said Dr. Greg Chapell, a Traverse area chiropractor.
“The bugs are getting stronger and we are getting weaker. We need to be more proactive. We need to eat well, get enough sleep, get out and exercise and have a good mental attitude. That way, we are less susceptible to these germs,” Chapell said.