The Spread of Superbugs

[Guest guest]

*/The Spread of Superbugs/*

By NICHOLAS D. KRISTOF

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

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. "

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