The Spread of Superbugs (NY Times)

[Guest guest]

The Spread of Superbugs By NICHOLAS D. KRISTOF

Until three months ago, M. Dukes was a vigorous, healthy executive at a

California plastics company. Then, over the course of a few days in December as

he was planning his Christmas shopping, E. coli bacteria ravaged his body and

tore his life apart.

Mr. Dukes is a reminder that as long as we're examining our health care system,

we need to scrutinize more than insurance companies. We also need to curb the

way modern agribusiness madly overuses antibiotics, leaving them ineffective for

sick humans.

Antibacterial drugs were revolutionary when they were introduced in the United

States in 1936, virtually eliminating diseases like tuberculosis here and making

surgery and childbirth far safer. But now we're seeing increasing numbers of

superbugs that survive antibiotics. One of the best-known — MRSA, a kind of

staph infection — kills about 18,000 Americans annually. That's more than die of

AIDS.

Mr. Dukes, 52, picked up a kind of bacteria called ESBL-producing E. coli. While

it's conceivable that he touched a contaminated surface, a likely scenario is

that he ate tainted meat, said Dr. Brad Spellberg, an infectious-diseases

specialist and the author of " Rising Plague, " a book about antibiotic

resistance.

Vegetarians are also vulnerable to antibiotic resistance nurtured in hog barns.

Microbes swap genes, so antibiotic resistance developed in pigs can jump to

microbes that infect humans in hospitals, locker rooms, schools or homes.

Routine use of antibiotics to raise livestock is widely seen as a major reason

for the rise of superbugs. But Congress and the Obama administration have

refused to curb agriculture's addiction to antibiotics, apparently because of

the power of the agribusiness lobby.

The ESBL E. coli initially remained in Mr. Dukes's colon, causing no particular

damage. But then he suffered an inflammation that perforated his colon — and the

bacteria escaped.

Mr. Dukes began suffering stomach pains and saw his doctor, who gave him Cipro,

a strong antibiotic that had previously worked against the infection. This time,

the pain grew worse. The next evening, he was in surgery to remove eight inches

of his colon.

A culture attributed the infection partly to ESBL E. coli. Doctors inserted a

tube to administer an intravenous antibiotic in an effort to save his life.

If ESBL E. coli is frightening, there are even more potent superbugs emerging,

like Acinetobacter.

" We are seeing infections caused by Acinetobacter and special bacteria called

KPC Klebsiella that are literally resistant to every antibiotic that is F.D.A.

approved, " Dr. Spellberg said. " These are untreatable infections. This is the

first time since 1936, the year that sulfa hit the market in the U.S., that we

have had this problem. "

The Infectious Diseases Society of America, an organization of doctors and

scientists, has been bellowing alarms. It fears that we could slip back to a

world in which we're defenseless against bacterial diseases.

There's broad agreement that doctors themselves overprescribe antibiotics — but

also that a big part of the problem is factory farms. They feed low doses of

antibiotics to hogs, cattle and poultry to make them grow faster.

A study by the Union of Concerned Scientists found that in the United States, 70

percent of antibiotics are used to feed healthy livestock, with 14 percent more

used to treat sick livestock. Only about 16 percent are used to treat humans and

their pets, the study found.

More antibiotics are fed to livestock in North Carolina alone than are given to

humans in the entire United States, according to the peer-reviewed Medical

Clinics of North America. It concluded that antibiotics in livestock feed were

" a major component " in the rise of antibiotic resistance.

Legislation introduced by Louise Slaughter, a New Yorker who is the only

microbiologist in the House of Representatives, would curb the routine use of

antibiotics in farming. The bill has 104 co-sponsors, but agribusiness interests

have blocked it in committee — and the Obama administration and the Senate have

dodged the issue.

After weeks of receiving intravenous antibiotics, Mr. Dukes is now recovering at

home in Lomita, Calif. He must use a colostomy bag, but he hopes to be patched

up and ready to return to work next month. Still, he knows that the ESBL E. coli

remains in his gut.

" As long as it's contained in my colon, I'm a happy camper, " he said. " But if it

gets out again, I'm in trouble. "

Dr. J. Blaser, chairman of the department of medicine at New York

University Langone Medical Center, and a former president of the Infectious

Diseases Society of America, agrees that agricultural use of antibiotics

produces cheaper meat. But he says the price may be an enormous toll in human

health.

" You could have very lethal pandemics, " he said. " We're brewing some perfect

storms. "

http://www.nytimes.com/2010/03/07/opinion/07kristof.html