Recent headlines about bacteria that are not treatable with many antibiotics can certainly be terrifying, especially when hearing the stories of morbidity popularized on TV.  These 1-one-celled 'superbugs' are capable of inducing serious damage on humans, which are a billion times larger than themselves.  It has long been know that people spending prolonged times in hospitals are more likely to come in contact with these bacteria, simply because of the exposure to a greater number of sick people in a space.  The increasing number of cases of community acquired infections with resistant organisms, however, merits that attention be paid to your daily practices so that your risk of acquiring an infection like this decreases.

An article from the New England Journal of Medicine (NEJM) last month coined bacteria as the "champions of evolution" for their ability to survive via natural selection in the presence of antibiotics.  Some of the ways that a resistant organism can wreak havoc on the human body include abscesses, cellulitis or skin infections, airway infections, and gastrointestinal infections. 

Skin infections are most concerning for Staphylococcus Aureus, which is named from the Greek root 'Staphylo' meaning grape for its preference to form clusters with its infectious coworkers and relatives. This bug has become famous for its ability to resist Methicillin, a penicillin derivative, in the form of Methicillin-Resistant Staphylococcus Aureus (MRSA).   Since the year 2003, over 30% of Staphylococcus Aureus strains found in hospitals have been found to be resistant.  A new strain named VRSA currently emerging in hospitals is highly resistant to Vancomycin, one of our strongest antibiotic weapons. The community acquired strain of MRSA is usually less dangerous and remains vulnerable to a variety of drugs. 
An abscess is like an infected capsule that is walled off from the body's immune system and generally will not disappear unless surgically drained.  Any skin changes that cause redness, drainage of blood or pus, rashes or painful itching may be concerning for cellulitis and should be examined by a health professional. The evidence has shown that the most important aspect of treating is drainage of the abscess, and that antibiotics such as Bactrim or Clindamycin taken by mouth for 7-10 days are helpful in clearing the body of residual bacteria.  After the drainage, the bacteria will be cultured (grown) and tested for response to several antibiotics, thus learning to which drugs the bug is resistant.  There are a few spots that MRSA spends its free time, and thus there are ways to avoid getting infected.  Some suggestions to avoid abscesses include always using new towels to dry off, bathing at night, and washing your hands before touching other parts of your skin.  A good recommendation is to avoid touching your face and neck, areas where the porous nature of the skin is ripe for infections that can cause pimples and abscesses.  Washing all skin wounds with germicidal soap or iodine and keeping them free of foreign bodies (ie dirt, splinters, etc) will help to prevent any bacteria on your skin from getting into your body.  Also don't forget where the sun don't shine, because bacteria like to vacation in warm, moist environments that you often forget about like between the butt cheeks, in the armpits, under breast tissue, and in between folds of skin. 

The NEJM article also identifies vancomycin-resitant Enterococcus faecium (VRE) and Pseudomonas as other bacteria of worry for clinicians.  Enterococci are mostly found in the hospital, and are the leading cause of infections in hospitalized patients. VRE is the 3rd leading cause of endocarditis, or heart valve infections, and also causes abdominal infections after surgery and urinary tract infections.   Currently about 90% these bugs are resistant to vancomycin and 100% to ampicillin.  Hospital measures to prevent the spread of this bacteria include careful antibiotic prescriptions and requiring all healthcare workers to wear gowns and gloves when in contact with patients to prevent their spread. Pneumonia, or respiratory infection, can cause fevers and cough with sputum and is caused is usually caused by Streptococcus Pneumonia, Haemophilus Influenza, and Serratia species which are all easily treatable.  The most concerning for doctors is when a pneumonia arises in a patient that has been recently hospitalized because, these bacteria are often the survivors of many attempts at their lives with various antibiotics. Particularly Pseudomonas Aeruginosa can present as a resistant form that has been the cause a devastating pneumonia in military veterans returning from Iraq, and the resistance can even be transferred to family members. 

While pharmaceutical companies have been gradually spending less and less money on research and development of new antibiotics, the good news is that our arsenal still contains some big guns that these bugs aren't expecting.  The importance of completing your prescriptions of antibiotics cannot be underestimated because surviving bacteria in your blood are more likely to be the survivors of the previous therapy and make you more likely to get a resistant infection in the future.  Maintaining a healthy immune system and using the methods provided above can be a good way to reduce your risk of coming in contact with these crippling critters. 









 

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