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INVISIBLE ENEMY: THE SUPERBUG THREAT

Introduction
Medicine faces some major problems at ria are slightly different from the rest. If
Focus the beginning of the 21st century. In the the mutation is one that makes the
This News in Re-
last 25 years, 30 previously unknown bacterium resistant to the way in which
view module
examines the rise human diseases have been identified for it is targeted by an antibiotic, the mu-
of antibiotic- which no cure exists (among these are tated bacterium is given a huge com-
resistant bacteria. two of major concern to Canadians, petitive advantage over other bacteria,
We look at how SARS and West Nile virus). And at and thrives. The antibiotic has actually
and why they have least 20 major maladies, including made the bacterium stronger, and
developed, their
impact in both
tuberculosis and malaria, have re- contributed to resistance to itself.
hospital and com- emerged in more deadly or drug-resis- Some bacteria can and have devel-
munity settings, tant forms. oped resistance to most, if not all, the
and the variety of Most alarmingly, we are on the verge antibiotics that are used against them.
attempts being of losing a battle long considered to The biggest current menaces in hospi-
made to bring
have been won: the fight against bacte- tals, especially to surgery patients, are
them under con-
trol. rial infection. In 1928, when Alexander strains of none other than S. aureus that
Fleming first discovered penicillin, a have become resistant to methicillin and
fungal spore capable of killing bacteria, many other antibiotics (MRSA methi-
Definition a new age of medicine began. This was cillin resistant Staphylococcus aureus).
Antibiotic refers to the beginning of the age of antibiotics. Recently, some strains of MRSA have
substances that are
Its significance was confirmed in 1945 even developed a resistance to vanco-
used to destroy
disease-producing when Fleming received the Nobel Prize mycin, a powerful antibiotic with
bacteria. Bacteria for medicine, along with Howard frequent unpleasant side effects. Vanco-
are micro-organ- Florey and Ernst Chain, who had mycin was used for over 30 years as an
isms that can cause proven penicillins potential as a thera- antibiotic of last resort before resistance
disease. peutic drug. to it emerged.
By screening soil samples for sub- One major reason for the develop-
stances that kill bacteriathe way in ment of antibiotic-resistant bacteria is
YV Sections
marked with this
which most of these drugs were first the over-prescription of antibiotics,
symbol indicate developedscientists created an arse- often for ailments they are powerless to
content suitable for nal of antibiotics to use in the fight fight. Patients see them as miracle
younger viewers. against infection. By 1960, because of drugs and demand them from physi-
the wide variety of antibiotics available, cians. Under pressure, physicians
many thought the war against bacteria prescribe them, knowing full well that
had been won. From the beginning, they will have no beneficial effect.
however, bacteria were already fighting A second major reason is that patients
back. A strain of Staphylococcus aureus fail to take the full dose prescribed,
(S. aureus) became resistant to penicil- which is necessary to totally clear up
lin shortly after it began to be widely the infection. Instead, they stop as soon
used in the 1940s. as they begin to feel better.
Random genetic mutation is the When improperly used, antibiotics
reason that bacteria become resistant. can have three major negative effects.
Some bacteria double in numbers every They can:
20 minutes, and some of the new bacte- Lower the bodys immunity

CBC News in Review May 2005 Page 35


Destroy good bacteria in the body hospitals. Meanwhile, the direct hospi-
Quote that help with digestion tal costs of hospital-acquired infections
The bottom line is
Lead to the development of antibiotic- in Canada are estimated to be $1.5-
that an antibiotic is
doomed as soon as resistant bacterial strains billion annually.
it rolls off the Antibiotic-resistant bacteria have The fight against antibiotic-resistant
production lines. become a major problem in hospitals in bacteria continues on many fronts.
Alison George, Canada and around the world. In Despite its problems, Canada is consid-
New Scientist, July ered to be a leader in the fight against
19, 2003 Canada alone about 200 000 hospital
patients each year develop a hospital- antibiotic resistance. The number of
acquired infection. Increasingly often Canadians prescribed oral antibiotics
the bacteria responsible are proving to has dropped and continues to do so. The
be antibiotic-resistant. The reasons, in U.S., with its higher percentage of
addition to the misuse of antibiotics, are resistant bacterial strains, is also begin-
many. Canadas population is aging, ning to cut back on routine antibiotic
and hospitals deal with more and more use. New prescriptions of antibiotics for
patients weakened by chronic disease. children fell 25 per cent between 1995
Surgical treatments are more aggres- and 2000. But, as Ronald Grossman of
sive, and surgical patients are the ones the University of Toronto School of
most susceptible to infection. Cost- Medicine said in 2002 (The Globe and
cutting has reduced the number of Mail, January 20, 2002), Theres still a
available hospital beds, which means core of individuals that have miscon-
hospital are more crowded; crowding ceptions about antibiotics and are using
people together facilitates the spread of them inappropriately.
infection. In addition to public education about
It has been estimated by experts in antibiotic use, there is a new emphasis
infection control that, for every dollar on hygiene in many institutions. New
spent on infection control, five dollars therapies, drugs, and vaccines are under
are saved in future treatment costs. development. There is a real awareness
Unfortunately, it is impossible to tell, among medical professionals that this is
after the fact, if disaster was actually a critical war. No one wants to go back
averted by prudent expenditure. As a to the times before antibiotics, when
result, infection control is rarely a almost all seriously ill hospital patients
priority expense with governments or died from bacterial infection.

For Reflection
What would your world be like without effective antibiotics? Have you, your
friends or members of your family been prescribed antibiotics for infections?
Which ones? Why? Have any of these people experienced any form of resis-
tance while taking one of these drugs?

CBC News in Review May 2005 Page 36


INVISIBLE ENEMY: THE SUPERBUG THREAT
YV Video Review
1. How many Canadians die every year as a result of hospital infections? ____
Answer the ques-
tions as you watch 2. How many become ill? _______________________________________________
the video. Make
sure you have 3. Where does hospital infection rank among the leading causes of death in
adequate answers Canada? _______
for all questions.
4. According to Dick Zoutman, how is MRSA spread?

Further Research
5. What does industrial hygienist Ugis Bickus say hospitals need to do to rid
To stay informed
about current
themselves of infections or germs?
health issues facing
Canadians, consider
a visit to Health 6. How much extra time does an infected patient spend in hospital? ________
Canada at www.hc-
sc.gc.ca. 7. What is the total cost to Canadian hospitals of extra care for infected
patients?

8. According to reporter Susan Ormiston, what is the number-one defence


against the spread of superbug infections?

9. Guidelines require one infection control professional per 100 beds. What
percentage of Canadian hospitals do not meet this guideline? ________ %
10. How many cases of community-acquired MRSA had appeared in Calgary
by October 2004?

11. In Chicago, what percentage of children admitted to hospital with Staphy-


lococcus infections have MRSA? ___________________%
12. The presenter finishes this video presentation by giving two tips that
doctors say are the best ways to protect ourselves. What are they?

13. How does this information affect your view or possible use of hospitals?
Explain.

CBC News in Review May 2005 Page 37


INVISIBLE ENEMY: THE SUPERBUG THREAT
Bacteria Fight Back
By the mid-1940s, penicillin, the first Britain
Quote antibiotic, was regularly being used to In Britain the most severe problem is
The world defi-
control infections, and by the mid- MRSA, or methicillin-resistant Staphy-
nitely favours the
bugs; microbes 1950s some bacteria were already lococcus aureus (see Five Deadly
have the advan- showing resistance to the drug. Pharma- Profiles, on page 40). In 1994, only
tage. There are a ceutical companies rapidly began two per cent of staph infections in
lot more of them developing new and stronger antibiot- hospital patients were MRSA; that
than us. Their ics, and doctors used them with enthusi- figure has now risen to 40 per cent.
generation of time
is minutes instead
asm. But bigger problems soon began to Every year 300 000 British patients
of years. They appear. pick up a potentially life-threatening
evolve rapidly. And, As recently as the 1980s, doctors infection in hospital; 5 000 of these will
of course, we aid thought they had bacteria licked, wrote die. In 2002, 800 patients died from
and abet them in Anna Kuchment in Newsweek, Decem- MRSA alone.
many waysby
ber 6, 2004. But the microbes have
travel, commerce in
foodstuffs, trans- bounced back with a vengeance, devel- Canada
portation of ani- oping resistance to the strongest of Canada has a better record with some
mals, and our antibiotics. A study released over the hospital infections than both the U.S.
abuse and overuse summer reports that 70 per cent of and Britain, but the trend is worrisome.
of antibiotics. infections acquired in hospitalsthe In 1995, for example, the percentage of
Were playing right
into their hands.
hot zone for disease transmissioncan staph infections that were MRSA was
Jim Hughes, defy at least one drug. one per cent; this figure had risen to
Director, National The problem is an international one, eight per cent by 2000. Each year, about
Center for Infec- and the statistics we have are truly 200 000 Canadians suffer from a hospi-
tious Diseases, alarming. Complicating our understand- tal-acquired infection; somewhere
Centers for Disease
ing of the problem of hospital-acquired between 8 500 and 12 000 die.
Control, in National
Geographic, Febru- infection is the fact that, at least in Canadas most notorious problem
ary 2002 Canada and the United States, hospitals with hospital-acquired infections in-
are not required to report all cases of volves Clostridium difficile (C.
infection by drug-resistant bacteria. difficile), which has been especially
Further Research However, what we do know is scary prevalent in Quebec hospitals. In the
An excellent refer- enough. Here are some examples: year between April 1, 2003, and March
ence article on the 31, 2004, there were 7 004 cases of C.
various antibiotics United States difficile in Quebec hospitals. After
and their uses is
In the U.S., between 5 and 10 per cent being infected, 1 270 patients died. Not
available from
Kimballs Biology of all patients admitted to acute-care only has the infection rate risen dra-
Pages at hospitals (that is, those hospitals that matically in recent years, so has the
users.rcn.com/ deal with non-chronic conditions) death rateby almost 60 per cent. In
jkimball.ma.ultranet/ acquire one or more infections while 2000-01, 12 per cent of infected pa-
BiologyPages/A/ they are there. This means that approxi- tients died. By 2003-04, 18 per cent of
Antibiotics.html.
mately two million U.S. patients are those who acquired the infection died.
infected every year. Of these, 90 000 It is important to note that some
die as a result of their infection. countries have even higher rates of

CBC News in Review May 2005 Page 38


hospital-acquired antibiotic-resistant been especially evident in segments of
Further Research bacterial infections than do these three the population where large numbers of
Learn more about countries. Hong Kong and South Af- people (just as in hospitals) are concen-
necrotizing fasciitis
at the Public Health
rica, for example, have rates as high as trated together: prisons, the military,
Agency of Canada 80 per cent of infected patients. But one and athletic teams.
Web site: country, The Netherlands, has been able The superbugs are causing an entire
www.phac- to hold the line remarkably well. In the range of problems, from skin boils in
aspc.gc.ca/publicat/ case of staph infections, only one per children to necrotizing fasciitis, or
info/necro_e.html.
cent of Dutch cases are drug resistant flesh-eating disease. In one Texas
(see Fighting Back, page 43). hospital alone, cases of boils in children
caused by MRSA shot up from nine in
Community-based Infection 1999 to 459 in 2003, says New Scien-
The October 9, 2004, issue of New tist. There were 14 cases of flesh-
Scientist, reporting on a meeting of the eating MRSA in Los Angeles last year,
Infectious Diseases Society of America, with several patients needing recon-
described an alarming new develop- structive surgery.
ment: the rapid increase of antibiotic- Doctors, however, are especially
resistant superbug infections outside concerned that MRSA is now causing
hospitals. The culprit: methicillin- fatal pneumonia in otherwise healthy
resistant Staphylococcus aureus, or young people. In one group of 17
MRSA (see Five Deadly Profiles, people who developed MRSA pneumo-
page 40). The rise in infections has nia, five diedand their average age
was 28.

Discussion
Many medical authorities are predicting significant outbreaks of antibiotic-
resistant, community-based infections in many parts of Canada. How might
public health departments prepare for them? Are there any recent experiences,
Canadian or international, that might serve as templates for how an outbreak
might behave, and how to respond? Has your community suffered any of these
outbreaks recently?

CBC News in Review May 2005 Page 39


INVISIBLE ENEMY: THE SUPERBUG THREAT
Five Deadly Profiles
Many different types of bacteria have Also emerging is a new strain of
developed resistance to at least one MRSA that spreads through skin con-
commonly prescribed antibiotic. Some tact and even affects healthy people. It
strains have gone on to develop resis- first appears as small sores that look
tance to a whole variety of antibiotics. like insect bites. These later turn into
Here are profiles of some that are most boils and major abscesses.
worrisome for scientists and medical
workers, and are common sources of 2. Enterococcus
hospital-acquired infections. Enterococcus is a bacterium that lives
in the human digestive tract. Normally
1. Staphylococcus aureus benign, it does not cause problems for
(S. aureus, Staph) healthy individuals. It can, however,
Staphylococcus aureus is a bacterium cause infections in those with compro-
that is found on the skin and on mucous mised immune systems if it enters the
membranes, especially in the nose. If it bloodstream or urinary tract through a
has an opportunity to enter the body it wound. It is a common hospital prob-
can cause a variety of infectionsskin, lem.
wound, urinary tract, and blood stream Especially dangerous is VRE, or
infections, and pneumonia. It can also vancomycin-resistant Enterococcus. It
cause food poisoning. A serious staph causes life-threatening illnesses in the
infection causes a high fever, attacks very young, the very old, and the seri-
vital organs, and lowers blood pressure, ously ill. It also readily transfers its
ultimately causing the patients death. resistance gene to both Staphylococcus
Before antibiotics, infections killed the and Streptococcus bacteria.
majority of seriously ill hospital pa-
tients; the usual cause of these infec- 3. Streptococcus pneumoniae (Strep)
tions was staph. Streptococcus pneumoniae is the lead-
Methicillin is the most commonly ing cause of inner ear infections, sinusi-
used antibiotic to treat staph infections. tis, pneumonia, and meningitis. Strep
However, S. aureus has rapidly devel- was once easily treated with penicillin,
oped a strain that is resistant to methi- but many strains have developed a
cillin. It is known as methicillin-resis- resistance to it and other antibiotics. In
tant Staphylococcus aureus (MRSA). In fact, the resistance rate continues to
1990, only two per cent of S. aureus climb rapidly. The routine dosage of
infections showed such resistance; by antibiotics required to treat childhood
2002 over 30 per cent of hospital staph ear infections from strep doubled
infections in North America were between 1996 and 2001.
caused by MRSA. Hospital-acquired
MRSA can often only be treated with 4. Campylobacter
vancomycin, the drug that doctors often Campylobacter bacteria cause diarrhea,
call the antibiotic of last resort. Cases cramping, abdominal pain, and fever
of MRSA resistant to vancomycin are within two to five days after exposure
beginning to appear. to the organism. The diarrhea may be

CBC News in Review May 2005 Page 40


bloody and can be accompanied by common causes of hospital infections,
nausea and vomiting. The illness typi- and has become a major problem in
cally lasts one week. In persons with hospitals in Quebec, especially in the
compromised immune systems, Montreal area. There were 1 406 cases
Campylobacter occasionally spreads to in 88 Quebec hospitals between August
the bloodstream and causes a serious and November 2004 alone. Over 1 200
life-threatening infection. This is the patients with C. difficile died in 2003
disease that is most commonly a result 18 per cent of those who developed an
of handling uncooked or improperly infection.
prepared chicken. C. difficile is notorious because the
The antibiotics most commonly used use of antibiotics actually increases
to treat severe cases of Campylobacter chances that patients might develop it.
are erythromycin and quinolones like When antibiotics are used to treat
fluoroquinolone. Campylobacter in infections, they lower the number of
North America is beginning to show good bacteria in the intestines and
resistance to quinolones, which are a colon. C. difficile can then thrive and
class of antibiotic given to both humans flood the digestive tract with infection-
and animals. causing toxins. The number of hospital
patients receiving antibiotic therapy
5. Clostridium difficile (C. difficile) makes them especially vulnerable. A
Clostridium difficile causes intestinal recent study has indicated that the strain
difficulties ranging from diarrhea to currently active in Quebec may be one
colitis. C. difficile is one of the most especially resistant to treatment.

Analysis
Complete the following chart based on the information in this reading. Rank
the superbugs from 1 (most dangerous) to 5 (least dangerous).

Name of Superbug Why it is Harmful Your Ranking


from 1-5
and why

CBC News in Review May 2005 Page 41


INVISIBLE ENEMY: THE SUPERBUG THREAT
Down on the Farm
In the European Union, the use of most Committee recommendations in-
Few people give
antibiotics to promote growth in ani- cluded:
much thought to
the use of antibiot- mals has been banned since 1999. Four Antibiotics for treatment and control
ics in the context of remaining antibiotics will be phased out of disease in farm animals should only
farming. It is now in 2006. Agricultural use of antibiotics be available by prescription.
accepted that their is still widespread in the U.S. and Antibiotics not approved by Health
overuse and misuse Canada, and evidence is piling up that,
have contributed Canada should be prohibited from
significantly to the
as a result, bacterial resistance is in- importation, sale, or use.
development of creasing. Studies have also shown that Any antibiotics that are important in
antibiotic resistance the use of antibiotics to promote growth human medicine or that impair the
in bacteria. Antibi- in farm animals accelerates the end of
otics used in farm-
effectiveness of human drugs should
their medical effectiveness. In 2002, a be rapidly phased out of animal use.
ing have also
special committeethe Advisory
become an environ- A permanent national surveillance
mental concern. Committee on Animal Uses on Antimi-
crobials and Impact on Resistance and system should be created to monitor
They are found in
soil, bodies of Human Healthpresented Health antibiotic resistance in farm-animal
water, and even in Canada with a 150-page report investi- production.
the air in animal gating the uses of antibiotics by Cana- Resistance risk should be included in
barns. any review of new or existing antibi-
dian farmers. The committee observed
(reported by Gail Powell in Food in otics for agricultural use.
Canada, October 2002): After an in-depth investigation of the
Farmers have over-the-counter or feed U.S. poultry industry conducted by
mill access to many antibiotics with- Consumer Reports (January 2003), the
out prescription. editors made similar recommendations:
The food-borne infections that people The U.S. government should require
get generally come from animals; companies to monitor data on the use
antibiotic resistance in the bacteria of antibiotics in food animals.
that cause these infections also comes The use of medically important drugs
from animals. for anything other than the treatment
Animal-source bacteria can pass their and control of disease should be
resistance genes to human bacteria. prohibited.
Antibiotic resistance can be passed
from animals to humans either
through the food chain or through the
environment (water, soil, or air).

To Do
In a well-written paragraph indicate whether you support or reject the recommen-
dations outlined above.

CBC News in Review May 2005 Page 42


INVISIBLE ENEMY: THE SUPERBUG THREAT
Fighting Back
As early as 1996 a group of Canadian oped a Guideline for Hand Hygiene in
Quote health professionals, recognizing the Health Care Settings to assist health-
No matter what
threat from antibiotic-resistant bacteria, care professionals in preventing hospi-
we do, bacteria will
find a way around began a campaign against over-pre- tal-acquired infections. Unfortunately,
it. But there are scription and misuse of the drugs. The as one study demonstrated, the new
some things that message they have tried to get across is guidelines are not always followed: 50
always work. simple: per cent of the doctors in Chicago
Resistant bacteria Antibiotics should only be prescribed hospitals failed to adhere to the guide-
are not resistant to
hand washing.
for conditions for which they are lines.
Dan Jernigan of the effective. Viruses such as colds and William Bowie, a professor of infec-
U.S. Centers for flu do not respond to antibiotics; the tious diseases at the University of
Disease Control, drugs are useless. British Columbia, wrote the following
quoted in New for The Globe and Mail (May 28, 2003)
Scientist, October
If one is prescribed an antibiotic, it is
important to take the full dose pre- during the SARS crisis in Toronto:
16, 2004
scribed and to not stop as soon as one Most hospital-transmitted infections
is feeling better. go from hospital staff or equipment to
Further Research The campaign has been successful, patients. We must pay more attention to
The Centers for and prescriptions for antibiotics in the staffs hand hygiene, to the equip-
Disease Control and ment used to deliver medicines or
Prevention (CDC) in
Canada are continuing to decline.
Meanwhile, the rate of hospital-ac- oxygen, and to proper surgical tech-
Atlanta, Georgia, is
quired infections has remained the same nique. Such attention will not happen
the U.S. govern-
ments leading or increased. The bacteria causing these without monitoring and even harangu-
agency for protect- infections have become harder and ing. For that, well need staff with the
ing the health and
harder to treat. skills, the time, and the mandate to
safety of individu- teach, evaluate, track trends, and inter-
als (www.cdc.gov/ vene. And for that, well need more
aboutcdc.htm). The Prevention: Hygiene and
infection-control practitioners.
closest Canadian Infection Control
equivalent is the According to many health-care
The most effective way to fight hospi-
National Microbiol- professionals and critics, Quebecs
tal-acquired infections is to prevent
ogy Laboratory recent problems with Clostridium
(NML) in Winnipeg them in the first place. The major
difficile are partly a result of a shortage
(www.hc-sc.gc.ca/ weapons used in Canadian hospitals are
of infection-control supervisors. The
english/media/ to increase infection control methods
releases/2001/ Quebec governments response has
and to improve environmental hygiene.
2001_110ebk1.htm). been aimed at funding more nurses
Bacteria can be spread in several
The World Health dedicated to infection control. A ratio of
Organization
ways, but health-care workers them-
one nurse per 130-150 acute-care beds
(WHO) is the selves are one of the major transmitters.
is the aim; this is still below the na-
United Nations Bacteria can be spread to a patient by
Agency with inter-
tional standard of one infection-control
doctor or nurse hand contact, on a
national responsi- specialist per 100 beds.
stethoscope, or left on a patients bed
bility for health The Quebec government announced
rail. Cleanliness, especially clean hands,
and safety other basic measures to bring the prob-
(www.who.int/en/). is a key to preventing this transmission.
lem under control. According to the
In 2002, the Centers for Disease
CMAJ: Canadian Medical Association
Control and Prevention (CDC) devel-

CBC News in Review May 2005 Page 43


Journal (September 28, 2004), these with antibiotics until completely rid of
The CDCs guideline
included increased handwashing, the infections. Wards and critical-care
for hand hygiene is
available at disinfection of rooms, isolation of facilities where infections have been
www.cdc.gov/ infected patients and a rigorous ap- found are closed to new admissions,
handhygiene. praisal of the use of antibiotics. and thoroughly cleaned before they are
reopened.
The Dutch Response: Search and The success of the Dutch approach is
Destroy unparalleled. While the rate of methicil-
One of the lowest rates of antibiotic- lin-resistant Staphylococcus aureus
resistant hospital-acquired infections (MRSA) infections in England rose
belongs to the Netherlands. The tech- from two per cent in 1994 to 40 per cent
nique they use can best be described as in 2004 (and from one per cent in
search and destroy. The Dutch screen Canada in 1995 to eight per cent in
all patients for such infections, and 2000), the Dutch held their rate to one
isolate any cases they find. They also per cent. Dutch doctors insist that it is
screen all hospital staff, and treat any their extensive screening of patients and
who are found to be carriers. Both health-care workers alike that is respon-
patients and staff are decolonized sible for this success.

To Consider
1. Do you think that the Dutch approach could be adapted to Canadian
hospitals? Could most hospitals afford to close an entire ward for a period
of time if an infection were discovered?

2. What other measures do you think hospitals might take to reduce infec-
tions?

3. What personal measures of hygiene could you take to lessen your risk of
bacterial infection?

CBC News in Review May 2005 Page 44


INVISIBLE ENEMY: THE SUPERBUG THREAT
New Weapons Against Superbugs
While bacteria are fighting back against The biggest potential problem with
Further Research some of our strongest weapons, doctors phage therapy is that some phages do
A useful history
and scientists are not about to give up not kill their host bacteria, but have a
and description of
phage therapy by the fight against them. In addition to symbiotic relationship with them. Some
Elizabeth Kutter of controlling and refining the use of of these phages can carry genes that
Evergreen State currently available antibiotics, they are may increase the bacterias toxicity.
College in Olympia, developing new weapons to assist in the This is a potentially serious problem,
Washington, is fight. Most of the major pharmaceutical should the wrong phages enter the
available at
www.evergreen.edu/
giants have given up on antibiotic body. Nonetheless, several firms are
phage/ research to concentrate on more profit- working on phage therapy, and trials are
phagetherapy/ able chronic disease treatments. Smaller due to begin soon.
phagetherapy.htm. biotechnology companies, however, are
An excellent, trying old, new, and sometimes radical Preventing Infection
accessible discus-
solutions to the antibiotic-resistance Developing anti-bacterial vaccines is
sion of recent
Western develop- problem. Here are some of the more another approach. One promising line
ments in phage promising directions their research is of research recognizes that most bacte-
research is John taking. ria begin invading their hosts by cling-
MacGregors Set a ing to the cells of mucous membranes
Bug To Catch a Phage Therapy in the respiratory, gastrointestinal, or
Bug in New
Scientist, April 5,
Phage therapy has been around for over urinary tracts. It has been known for
2003. a century, but was largely abandoned by some time that there are compounds
Western medicine because of the initial that prevent this. Some of these anti-
overwhelming effectiveness of antibiot- adhesives occur naturally. For example,
Did you know . . . ics. The technique survived in Eastern cranberry juice, an old folk remedy, has
Canadian micro- Europe, where it is still used in a num- been used to prevent urinary tract
biologist Felix ber of countries. infections for many years. Other com-
dHerelle first gave Bacteriophages are viruses that attach pounds are being designed from
these viruses the
themselves to the outer surfaces of scratch.
name bacteri-
ophage? He suc- bacteria and inject their own DNA, Cytovax, now merged with
cessfully used the hijacking the cellular machinery of the Millenium Biologix Inc., is an
virus to save the bacterium and forcing it to make phage Edmonton-based biotechnology com-
lives of Parisian proteins and more phage DNA. New pany recognized as a leader in this
children hospital- phages are formed, which explode out research. It has developed and clinically
ized with dysen-
tery. DHerelle of the bacterium and destroy it in the tested a vaccine against Pseudomonas
continued to process. aeruginosa, an antibiotic-resistant
explore phage Phage therapy advantages are many. bacterium that causes 10 per cent of
therapies, but by Phages are specific to individual bacte- hospital-acquired infections in the U.S.
the mid-1940s, ria species, and do little harm to the It is believed that bacteria are less likely
thanks to penicillin,
phage therapy was
good human bacteria. Phages breed to develop a resistance to this type of
no longer used in rapidly in the body, increasing in therapy, which relies on thwarting
the West. strength as needed; but they also die rather than destroying the invader.
away as the harmful bacteria are de-
stroyed.

CBC News in Review May 2005 Page 45


Human Antibodies to the penetrating the cell walls of bacteria
Further Research Rescue and then preventing them from repro-
Although Cytovax
Rather than relying on chemistry, some ducing. Resistant bacteria have devel-
is now part of
Millenium Biologix, companies are developing vaccines that oped mechanisms to expel the tetracy-
it still provides use human antibodies to trigger the cline or prevent it from disabling their
information about bodys immune system to destroy the reproductive system. Paratek has devel-
its research and invading bacteria. Inhibitex, a U.S. oped over 1 000 new molecules that are
Cytovaxine at biopharmaceutical company, has devel- much harder for bacteria, including
www.cytovax.com/
index.cfm. Read
oped such a vaccine to prevent hospital- MRSA, to defeat. The company hopes
about Veronate at associated infections in very-low-birth- that the drug will be approved for use
www.inhibitex.com/ weight (VLBW) infants. Because by 2008.
product/ VLBW infants spend an average of two These are only a few of the attempts
veronate.asp. months in hospital neo-natal units, they being made to defeat bacteria in what
Paratek Pharma-
are particularly susceptible to such Alison George (New Scientist, July 19,
ceuticals has a very
informative Web infections. Inhibitexs vaccine, 2003) calls an antibiotic arms race.
site at Veronate, targets specific proteins on Without these drugs we would be very
www.paratek the surface of MRSA. It is now in its vulnerable indeed. We go about our
pharm.com/ Phase III clinical study. lives surrounded by billions of harmless
index_fla.html. bacteria on our skin, in our intestines,
Improving Older Drugs and in the environment. But if some of
Some companies are re-engineering these same organisms manage to invade
older antibiotics to work in new ways. the body and multiply in the blood, the
One such company, Paratek Pharma- endotoxins that they produce can cause
ceuticals of Boston, is working to blood poisoning. For most of human
combine resistance-reversing drugs history this would have been fatal.
with tetracycline to create a new form Without the new therapies, it could be
of the drug. Tetracycline works by fatal again.

Inquiry
Which of the above strategies aimed at fighting superbugs, do you think is
likely to be most effective? Why?

CBC News in Review May 2005 Page 46


INVISIBLE ENEMY: THE SUPERBUG THREAT
Protecting Family and Friends
All of us have family and friends who, from time to time, have to be hospital-
ized. While we tend to think of hospitals as places to go to be cured, for many
individuals they have become places that make them more ill than when they
went in.

More and more, patients are being asked to assume responsibility for guaran-
teeing the success of their treatmentby providing full information on their
symptoms, by monitoring their reactions to treatments, by faithfully taking all
required medications, and by asking questions to ensure they fully understand
any procedure they will undergo.

For this exercise, prepare a list of at least five important things a member of
your family or a friend should know or do before, during, and after a hospital
stay. They should be things that would help that person to avoid the dangers of
hospital-acquired infections. The list might include questions to ask, procedures
to follow, or dangers to be aware of. When you have completed your list,
compare it with those of other members of your class.

As a final step, compare your list with the Tips for Adult Patients to Prevent
Antimicrobial Resistance from the Centers for Disease Control and Prevention
at www.cdc.gov/drugresistance/healthcare/ha/tipsforadults.PDF; and to the
Tips for Surgery Patients to Prevent Antibiotic Resistance at www.cdc.gov/
drugresistance/healthcare/surgery/Tips_for_Surgery_Patients.pdf.

My List for Avoiding Hospital Infections

Knowing or Doing Why This Might Help


1.

2.

3.

4.

5.

CBC News in Review May 2005 Page 47