Antibiotic Resistance Causes Hospital Deaths

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Part I

Recent evidence suggests that antibiotic resistant bacteria are behind a significant portion of the death and injury associated with hospital stays. Unfortunately, the record-keeping methods that hospitals use tends to mask this: the damage done by antibiotic-resistant bacteria and officially attribute deaths due to antibiotic resistance to other causes. I personally doubt that hospitals are trying to hide antibiotic resistance. Even so, problems which are not well recorded and documented tend to be slow in attracting solutions.

Dangerous antibiotic resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus) are becoming more prevalent in healthcare settings. According to CDC data;

In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was some 63%.

It is difficult to determine the exact number of people killed by antibiotic resistant infections, since such deaths post-surgery are often listed as due to “complications of surgery” or similar. But some recent research suggests that a significant portion of hospital related death and disability is associated with resistant bacteria.

Patients with MRSA (Methicillin-Resistant Staphylococcus aureus) bacteremia had more acute renal failure and hemodynamic instability than patients with MSSA (Methicillin-susceptible Staphylococcus aureus) bacteremia. They had a longer intensive care unit stay and ventilator dependency. Patients with MRSA bacteremia had a higher 30-day mortality rate (53.2% vs 18.4%) and in-hospital mortality rate (63.8% vs 23.7%).

S. aureus is a highly flexible and potentially dangerous pathogen capable of causing skin abscesses, wound infections, endocarditis, osteomyelitis, pneumonia and toxic shock syndrome.

In other words, a lot of people who get sick from hospitals do so because they have resistant bacteria and the antibiotics that they’re given either don’t work or don’t work well enough to get rid of the infection.

There are a variety of ways that bacteria become resistant to antibiotics. Some bacteria produce an enzyme which destroys penicillin class antibiotics. Quercitin (a natural antibiotic in apples and garlic) and various fluoroquinolone antibiotics (like Ciprofloxicin) function by binding to an enzyme called DNA gyrase, which is found in bacteria but not people. Scientists exploit differences like these between bacteria and people to make drugs that kill bacteria but not people. Mutations in the bacterial enzyme can cause antibiotics that target the enzyme to quit working. And almost all bacteria can adapt to pump out antibiotics, though this takes up the bacteria’s energy and slows the growth of the bacteria.

Use of antibiotics began less than a century ago. Why have bacteria adapted so quickly?

There are a number of factors.

The first is that people prescribed antibiotics take just part of their medicine, feel better, and then quit. The most resistant bacteria return in full force.

Even taking antibiotics properly can cause the benign bacteria in a person’s stomach to become resistant. If these harmless but antibiotic resistant bacteria interact with disease causing bacteria, the antibiotic resistance can easily spread to the dangerous bacteria.

Also, farmers regularly give their livestock antibiotics of the same class as those that have been approved for human use in order to speed up the animal’s growth. It is normal for farmers to do this even when their animals are not sick.

If we wanted to deliberately produce and distribute antibiotic resistant bacteria as effectively as possible, modern factory farming methods come pretty close to the system we might design.

When I lived in China, the situation was far worse than in the US. Antibiotics could be purchased over the counter without a prescription. Doses too small to cure disease yet large enough to encourage resistance were frequently recommended. Likewise, antibiotics were frequently recommended uselessly for viral infections (some antibiotics, such as those in the tetracycline class, can reduce inflammation and feel like they’re having an effect even in viral infections). Food products (of all things), including organic food (fertilized with animal wastes) are increasingly being imported from China where antibiotic resistance is rampant.

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