Aussie Paper Alarmed with Super Bug Infections

This is an odd story that is a product of superficial journalism. This Australian journalist is worried about one bug?

Resistent bugs are part of the big picture and this report only gives the reader a peek.

http://www.businessinsider.com.au/doctors-australias-hospitals-have-been-hit-by-infections-from-overseas-and-isolation-is-no-longer-

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Clostridium difficile is old, not new, has been around for decades–studied well for at least 40 years to my knowledge–a cause of diarrheal illness, usually brought on by use of antibiotics, since it is part of the normal flora of the colon and emerges when antibiotics wipe out the other bugs in the bug filled colon.

Toxic Megacolon is the worst complication of Difficile infections, leading to blood infection causing sepsis and shock that is lethal. Toxic megacolon (evil dilated colon) is the end stage of pseudomembranous enterocolitis, the colon inflammation brought on by C. Difficile.

There are other Clostridia–Perfringes, for example, that causes gas gangrene–not a nice bunch of bugs. Difficile is resistant to treatment and recurs. Perfringes is very virulent but relatively sensitive to antibiotics.

When I was a young doctor clindamycin (Cleocin) became very popular after its release with dentists, and was implicated in a rash of clostridial/toxic megacolon cases that scared the devil out of the dental community. Imagine treating a person for an infected mouth or tooth abscess and them getting a life threatening complication?

Still clinda is a great antibiotic, just have to be aware of the problem. I use clindamycin for serious infections all the time. I keep the length of treatment as low as possible and watch for diarrhea.

In the last few years we have seen what appears to be “community acquired” or non antibiotic related C. Difficile infections, a new problem, so you have to look for Difficile in severe diarrheal illness even if the patient hasn’t been on antibiotics.

Everyone has heard by now of Methicillin Resistant Staph Aureus (MRSA), the “flesh eater” bacteria that causes skin infections and is virulent, even causes pneumonia occasionally–big problem. Seen in military, athlete, and nursing home situation, thought to be possibly carried on the skin and in the nose by kids who get antibiotics for their respiratory infections.

MRSA seems to have quieted down some in my experience, but I don’t keep counts. Reporting is not reliable because it is not required. I have treated 3 or 4 MRSA infections in the past two weeks, and I didn’t report them–didn’t even culture–we assume MRSA in spontaneous skin infections that seem virulent and spread quickly–hurt and get red, go to abscess if you don’t get after them early with Bactrim/Septra/Cleocin in our neck of the woods–all effective, along with hygiene and warm packs–usually prevents progression.

Multi drug resistant TB is around, 3rd world mostly, very troublesome. Sometimes these patients must be quarantined and may require very long periods of treatment when an appropriate combination of drugs can be found.

There is a new super resistant bug in from India
that is multi drug resistant including the guerilla cillins used for terrbile infections. The bug appears to be due to the fact that these bad boy bugs appear in patient populations treated with antibiotics so the presence of antibiotics selects out hardy, prolific and resistant bacteria.

The WSJ had a story about the Indian superbug. Metallo 1 that caught my eye. Nice name isn’t it? Probably India is the culture medium for this sort of bug because antibiotics are over the counter in India and the mutation is carried around by the general population. The mutation is on non pathologic bugs and can be transferred to other bacteria–troubling. That’s the news. In these days of international travel infectious diseases have wings.

Read on.

http://blogs.wsj.com/indiarealtime/2013/04/23/india-has-lost-superbug-war/

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2 responses to “Aussie Paper Alarmed with Super Bug Infections

  1. But what do you do when you have no spleen?

  2. The spleen is important in the defense against encapsulated bacteria like pneumococcus, as I remember the explanation.

    So Pneumococcal vaccine is important for the asplenic. As for the other species, not so important.

    However, not having a spleen is a form of immune compromise generally, so i would say–get a fever, more worrysome.

    How’s that for equivocating and not giving much specific advice.

    So I looked asplenic risks. straight forward nice explanation that expands on my meager points.

    http://www.aafp.org/afp/2001/0201/p499.html

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