Over the past 60 years, most serious infections have been treated with some type of penicillin-related antibiotic. Today, penicillin is not as effective as it once was. That is because some bacteria have developed ways to survive or weaken them.
Each year 100,000 people in the United States are hospitalized with Methicillin-resistant Staphylococcus Aureus, (MRSA). MSRA scares doctors and patients alike. It can spread rapidly, and it's difficult to treat, because it is resistant to most easily used antibiotics.
Bobbi McKeon is a nurse practitioner, whose problems began one day at work. "It all started with a paper cut," she said. "A paper cut! I was sending lab reports out to my patients, and I got a paper cut. I didn't think much of it. You know, you just wash it off, throw a Band-Aid on it and keep going."
Her finger got worse. She took an antibiotic. It didn't work. She took a second stronger antibiotic. That didn't work either. Her nail was removed and pus was drained. After a third antibiotic failed, a culture of her finger identified MRSA. Vancomysin was the last in the line of drugs left to treat the infection, and it had to be administered intravenously.
Vancomysin resolved the infection, but the introduction of the intravenous line set off a series of serious health problems, including a blood clot in the largest blood vessels in her body and further complications which affected her lungs and heart. Only recently has she returned to work, having spent nearly three years recuperating.
"Three years ago, I think I used antibiotics maybe five times in my life," said Ms. McKeon. "I was very healthy. I ran four-five miles (up to eight kilometers) every day. It was just different than it is now. I didn't get short of breath. I could go hiking. I could do anything I wanted. I could get on a plane and fly.
"Now they are telling me that [flying] is not a smart thing to do, because they don't pressurize the planes until you get to be about 3,000 feet [900 meters] and that can affect my lungs," she continued. "So, I am kind of stuck."
She has to sleep sitting up, is dependent on blood thinners and exercises cautiously. Her attitude toward antibiotics and how she prescribes them has radically changed.
"My colleagues tease me. They say it is easier to get a narcotic from me than it is an antibiotic," she said. "I am absolutely very intense about teaching people about antibiotic resistance. When someone comes in and they have got a sinusitis that five years ago would have been treated with an antibiotic, and they want it now, and you have to explain that it is viral and it is not going help - they don't really want to hear that. They just want that little magic pill. And, so I spend a lot of time educating my patients."
David Witt chairs the Infectious Disease Group for the 3.5 million members of the Kaiser Permanente health insurance plan in Northern California. Bobbi McKeon was his student and co-worker.
"I think what is unique about her is just how simply compelling the case is," he said. "This kind of problem is ubiquitous, but so seldom do we have such a perfect demonstration of how a trivial, trivial infection can become so catastrophic."
Dr. Witt said Bobbi McKeon's case represents the real threat of antibiotic resistance. "It is not in those who have taken the antibiotics necessarily. It is a community public health issue," he explained. "It represents the dangers of not having effective drugs or safe drugs to treat serious infections, and it is a very early glimpse of the future, if we don't do everything that we can to prevent this."
Kaiser Permanente actively promotes the appropriate use of antibiotics through mailings, posters and flyers. Clinic guidelines address the issue of antibiotic resistance and doctors are encouraged to prescribe antibiotics only when absolutely needed.
David Witt said this strategy among Kaiser patients has produced a 40 percent reduction in the use of antibiotics for diagnoses where antibiotics are of questionable value.
"The appropriate use is not zero," he said. "The appropriate use for colds is zero. The appropriate use for upper respiratory infections is zero. The appropriate use for sinusitis is probably 20 percent of what we use. The appropriate use for otitis media or ear infections is probably 20 or 40 percent of what we use. So, our goal is not 100 percent reduction. We don't know exactly what the low is. I think we [at Kaiser] are approaching what is called the nadir. I think we are approaching the low."
David Witt walks down the corridor of a Kaiser hospital in South San Francisco where patients are recuperating from serious illness or surgery. Precautions are enforced here, because drug-resistant bacteria take hold and can spread infection among patients who are the weakest.
Dr. Witt points out an isolation cart equipped with gloves and gowns and masks, and to the alcohol gel dispensers mounted on the wall between every two rooms.
"When we look in hospitals, what puts people for instance with leukemia or bone marrow transplants at risk is staff not washing their hands," he said. "It is actually a much [more simple] issue than we would think."
Can just hand washing solve the problem? "My patients, who have chemotherapy or get very low white counts, I actually will have them ask everyone coming in, 'Did you wash your hands?" said Dr. Witt. "I think that it is very effective. I think that it is necessary, but it is a very effective educational tool."
David Witt said incremental changes have real benefits. While we can not stop bacteria from mutating, he said, we can slow their spread by simple hand washing and the appropriate use of antibiotics.