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Health Specialists Launch Campaign to Prevent Anti-Microbial Resistance - 2003-07-08


Many disease-causing microbes are becoming resistant to drugs that used to kill them quickly. The situation is most serious in health care settings, where people with weakened immune systems undergo procedures that make them vulnerable to infections. American health experts are making hospitals and nursing homes a focus of efforts to prevent anti-microbial resistance.

"I never thought I'd have to be in a nursing home, not in my wildest dreams," said Karen Baker, who was in her 40s when she broke both legs in 2001 and ended up at a Denver, Colorado nursing home. She's maintained a sense of humor about living there.

"Well, they had an exercise class, and I had a cast on both legs," she recalled. I thought, well, I'll go ahead and see what this is about, and half the ladies were sleeping, they were just sound asleep in their wheelchairs. There's a lot of funny things that happen."

But there was nothing funny about the infection that followed the doctor's surgery on her legs. "One of the things he did was to put a rod through the bone, and through the incision, it got infected," she explained. "I got a staph infection, and consequently lost the whole bone, through the infection, and they had to amputate."

Doctors amputated Ms. Baker's right leg below the knee to save her life from an infection called Methicillin-Resistant Staphylococcus aureus. MRSA, as it's known, is resistant to penicillin and many other anti-bacterial drugs. In fact, over 70 percent of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs commonly used to fight them, so there's an urgent need to preserve the power of our remaining drugs.

"The key for the future is to use these drugs judiciously and not allow these drugs to be overused," said Thomas Clark, a director at the American Society of Consulting Pharmacists. He added that too many physicians prescribe anti-microbials to kill bacteria and other microbes, such as fungus, whether they're needed or not. While this kills microbes initially, it means the bugs that do survive are now resistant to the medication. And because the less resilient microbes have been killed off, the resistant ones have more room to multiply quickly, producing superbugs.

Superbugs are also more likely to appear when physicians prescribe the wrong drug. Mr. Clark recommends that whenever possible, doctors use "narrow-spectrum" anti-microbials, that is, drugs targeted to fight a specific microbe. Broad-spectrum drugs should be saved for occasions when it's crucial to fight a wide range of infectious organisms. But many of the most effective narrow-spectrum medicines are older varieties that are available in less expensive formulations, so Mr. Clark explained that drug companies promote their newer, more profitable broader-spectrum drugs. "The economic incentives are not really aligned to promote the use of the narrow spectrum drugs," he said.

While Mr. Clark would like to see anti-microbials prescribed with greater care, other health experts suggest it is just as important to prevent infections in the first place, especially in hospitals, where so many people are at risk.

"Staph is a very common germ. It exists on our skin. We're happy living with it, it's happy living with us. So most people aren't affected at all, but they carry the germ," said Scott Fridkin, a medical epidemiologist at the Centers for Disease Control in Atlanta, which is promoting a campaign to prevent anti-microbial resistance in healthcare settings.

Each year nearly two million patients in the United States get an infection while in the hospital, and about 90,000 of those patients die. Dr. Fridkin says health care workers can reduce these infection rates by vigorously washing their hands, and being prompt about washing towels and sheets as well as disposing of wound dressings. Another important step, he says, is to minimize the time that a patient remains on a ventilator or catheter, because these devices make it easier for normally harmless germs, such as staph areus, to enter the body and cause major problems.

"Pull out catheters, reevaluate their need every day. Break the chain of contagion, which is, you know, wash your hands as an infectious control precaution," he recommends.

Dr. Fridkin added that minimizing time in a health care setting reduces the chance of infections, since so many people are being treated for contagious diseases at most of these facilities.

Back at the Elmhurst Nursing Center, Karen Baker said that "The nurses are all very caring and friendly. There's just a lot of really nice staff people, really caring people."

Ms. Baker added that it will be hard to say goodbye to the friends she has made. Still, she's practicing on her crutches, so she can once again live out on her own.

"I miss cooking. I miss chopping that garlic and onion. I like doing that sort of thing, and washing dishes, too," she said.

By being out on her own again, Ms. Baker will also reduce her chances of getting another health-care setting acquired infection.