Saturday, November 03, 2007
Dangerous bacterial infections are on the rise
What you can do to counter the trend and stay safe.
When conducting hospital rounds a few months ago, Neil Fishman, M.D., saw five patients whose infections didn’t respond to any available antibiotic. “I was shocked,” says Fishman, an expert in antibiotic resistance with the Infectious Diseases Society of America in Arlington, Va. “I fear we’re at a tipping point--on the verge of returning to a pre-antibiotic era, when none of our antibiotics may work at all.”
Most bacterial infections can still be treated with at least one antibiotic. But there are emerging problems. For example:
Nearly 1 of every 3 pneumococci--the bacteria responsible for many pneumonias--has become resistant to penicillin, and 1 in 10 is resistant to most other antibiotics.
An antibiotic-resistant strain of staphylococcus that triggers potentially deadly lung and bloodstream infections is spreading through hospitals in this country and, increasingly, into communities.
Few if any antibiotics work against a bacterium called Acinetobacter baumannii, which has infected the wounds of many soldiers returning home from Iraq and Afghanistan, in some cases forcing doctors to amputate infected limbs.
Gonorrhea and tuberculosis are making a comeback, in part because the bugs responsible for them have developed defenses against previously used antibiotics.
Consumers have contributed to the growing crisis by not taking antibiotics properly and, in many cases, insisting that their doctor prescribe antibiotics for viral infections, such as the flu, ear infections, and the common cold, even though antibiotics work only against bacterial infections.
Doctors have made the situation worse by acquiescing to those ill-informed requests and, when antibiotics are required, sometimes prescribing the wrong dose, the wrong schedule, or the wrong medication. For example, recent research suggests that doctors often turn to newer, more powerful antibiotics when older ones would suffice. And some doctors use antibiotics for even more controversial purposes, such as the long-term treatment of Lyme disease or rheumatoid arthritis.
In hospitals, the combination of drug misuse and poor hygiene has brought the problem of antibiotic resistance to a crisis. Almost 5 percent of all hospitalized patients now acquire an infection during their stay; nearly 100,000 of them die each year as a result.
Here are some steps you can take in your home, your doctor’s office, and in the hospital to protect yourself from antibiotic-resistant bacteria.
SAFE AT HOME
The more an antibiotic is used as a drug and, to a lesser extent, in animal feed and possibly even household cleaners and other consumer products, the more opportunity bacteria have to adapt to it. Using the wrong drug dose or the wrong medication to treat infection can also breed resistance by allowing some bugs to survive, develop resistance, and multiply. So the key to combating antibiotic resistance is preventing unnecessary and inappropriate antibiotic use--tasks that start at home.
Don’t self-treat. Don’t use your own or other people’s leftover antibiotics to treat a self-diagnosed infection, since the drug may not be right for your current infection--if you have one. And don’t order antibiotics online without a prescription, since you might get the wrong drug, the wrong dose, or even a counterfeit product.
Use antibiotic creams sparingly. These over-the-counter products, such as neomycin (Mycitracin, Neosporin, and generic), are needed only for cuts that leave visible dirt or grit behind. In most other cases, washing the wound thoroughly with regular soap and water will provide all the protection you need.
Avoid “antibacterial” products. Soaps with the germ-killing ingredient triclosan don’t prevent infections when used at home, research suggests. Other antibacterial products, including deodorants, wipes, and cleaning products, probably don’t either. But their widespread use may make antibacterial soaps less effective for people who really need them, such as hospital and nursing-home staff. Prevent infection at home by washing hands with plain soap and water or an alcohol-based product like Purell.
Dispose of old antibiotics properly. Researchers have now detected antibiotics in the water supply, possibly from agricultural runoff, excretion from bodies, or old antibiotics dumped into toilets or thrown into landfills, where they may leach into rivers or the groundwater. So if you have old antibiotics in your medicine cabinet, take them to your pharmacist, who can give you advice on the best way to get rid of the drugs and may even participate in a medication-disposal program.
Consider purchasing certified-organic meat. Organic chicken, beef, and other meat don’t necessarily harbor fewer bacteria-resistant germs than regular meat, recent Consumer Reports tests have shown. And organic meat typically costs more. But at least animals raised organically haven’t been fed antibiotic-laced feed, and organic meat hasn’t been treated with antibiotics. So purchasing organic meat can help reduce the spread of antibiotics in the environment.
WORK WITH YOUR DOCTOR
Doctors know that antibiotics work only against bacteria, not viruses. But they often prescribe the drugs for likely viral infections “just to be safe” or to satisfy an insistent patient. So don’t expect or accept antibiotics for common respiratory-tract infections.
Even when you do require antibiotics, your doctor might not prescribe them appropriately. Here’s how to prevent those mistakes.
Get tested. Expect your doctor to check a blood count or take a culture of the infected tissue or fluid. That will help confirm the diagnosis of a bacterial infection before your doctor prescribes an antibiotic, and will help in matching the drug to the bug.
Fight it off. If you have only a mild infection, ask if you can delay treatment for a few days to see if your body can fight it off.
Consider short courses. Ask whether a brief course of antibiotics--such as the three-day plan advised for simple urinary tract infections--can clear the infection. (That approach should be tried only when studies have proved that short courses eliminate the infection.)
Ask about targeted drugs. “Narrow-spectrum” antibiotics that target the likely bacteria are usually better choices than broad-spectrum ones, which can trigger multiple resistances simultaneously. Those medications are often cheaper, too.
Take as directed.Many people stop taking antibiotics once they start feeling better. But unless you finish the course, some of the responsible bacteria will probably survive and perhaps adapt to the medication. So take all the antibiotic pills your doctor prescribes.
Be leery of preventive and long-term use. Doctors sometimes prescribe antibiotics to ward off recurrent urinary tract infections or before dental surgery. But such preventive use is appropriate only if self-help measures and short courses of antibiotics don’t work, or if you’re at high risk of a dental infection spreading to your heart because, for example, you have an artificial heart valve or certain congenital defects.
Some doctors prescribe antibiotics for months or even years to treat Lyme disease or rheumatoid arthritis. But recent guidelines for Lyme disease emphasize that two to four weeks of treatment usually provides maximum benefits. And though some evidence suggests that tetracycline antibiotics may help certain people with rheumatoid arthritis, researchers say that’s not because the disease is caused by an infection but because the drugs may interfere with certain cartilage-destroying enzymes. More important, that benefit appears small, especially compared with the success of other arthritis drugs now available.
BUG-FREE IN THE HOSPITAL
Surgical procedures, needles, and catheters can carry bugs into the body. And hospital staff may fail to take the necessary steps to stop the spread of infection. To cut your risk of contracting or inadvertently spreading an infection while in a hospital or nursing home:
Insist on clean hands. Expect everyone who touches you to first wash their hands with soap or an alcohol-based solution. If you don’t see them do that, politely ask them to. And ask doctors and nurses to clean their stethoscopes, too, since studies show that they seldom clean those instruments between patients.
Don’t swallow bacteria.Keep your hands away from your eyes, nose, and mouth, and don’t set food or utensils directly on tables or beds.
Monitor antibiotic use. Hospital patients are too often given antibiotics plus an acid-suppressing heartburn drug. That combination of drugs can allow invading bacteria to colonize in the gut and sometimes triggers hard-to-treat infections. Before some kinds of surgery, on the other hand, antibiotics may be underused. Ask your doctor if your operation poses a significant threat of infection and if you should receive a single dose of an appropriate antibiotic in the hour beforehand.
Ask about your catheter. The risk of catheter-associated urinary-tract infections increases the longer the catheter remains in place. So if you’re still using a catheter 48 hours after surgery, find out whether your nurse or your doctor has forgotten to remove it.
Choose your hospital. Ask your doctor or surgeon if he or she knows the infection rates for hospitals in your area and, if possible, ask to be admitted to the one with the lowest rate. The hospital-infection initiative Stop Hospital Infections of Consumers Union, the publisher of this newsletter, offers information on the roughly 20 states that now require hospitals to make infection rates public, and what you can do to help make other states take the same step.
PROTECT YOURSELF FROM STAPH INFECTIONS AT THE GYM
A strain of the bacterium methicillin-resistant Staphylococcus aureus (MRSA) has spread from hospitals into communities, mostly in gyms and health clubs, where people unknowingly share contaminated towels or athletic equipment. While the strain is less deadly than the version found in hospitals, it's now a leading cause of skin-related visits to the emergency room. To protect yourself, don't share towels, put a clean towel over workout mats, and wipe down equipment with the alcohol spray that most gyms provide. And see your doctor if you have signs of skin infection: boils or a localized, painful rash that doesn't heal.