Antibiotic-resistant “bad bugs” are getting worse

• The Gist: Those involved in medical cases and their record reviews must keep abreast of the newest enemies in patient health.

© 2007 The Medical-Legal News

The Journal of the American Medical Association reported in mid-October that the methicillin-resistant staphylococcus aureus (MRSA) bacterium kills 31 out of every 100,000 Americans, or 94,300 cases per year — more deaths than from the AIDS virus.

Science News reported in its Oct. 13 issue that the Infectious Diseases Society of America has elevated Acinetobacter baumanii to its list of “bad bugs” and puts the germ on the same par as MRSA and vancomycin-resistant Enterococcus faecium (VRE). The article quoted doctors who said that known A. baumanii cases probably are just a tip of the iceberg and that physicians have had to rely on colistin, an antibiotic from the 1970s, to combat A. baumanii. Resistance to colistin is thought to be inevitable, and the mortality rates for patients who contract A. baumanii are anywhere from 10 to 60 percent. Intensive-care patients are most susceptible to such infections.

Newsday reported from separate analyses that New York doctors have identified a “superbug” linked to pediatric ear infections that repels all 18 government-approved antibiotics. This superstrain is an emergent form of Streptococcus pneunomiae. Even though a vaccine exists to protect against seven related strains, there is no vaccine against this one.

The bacterium often causes ear infections in children, and pneumonia in the elderly. The strain is of such concern that physicians may have to relearn the lost art of fine-needle eardrum puncture to drain fluid from the ears of infected children.

“This is a superbug that we’re reporting for the first time — and this is frightening,” said Michael Pichichero, a professor at the University of Rochester. He is also a partner in a private Rochester, N.Y., pediatric practice called Legacy, for which he has named the strain. Pichichero has identified 11 Legacy cases. Data on nine were reported in October in JAMA, but Pichichero said he has since diagnosed the superstrain in two other children.

The first child with the infection developed a hearing loss in both ears because Pichichero and his colleagues were uncertain of the cause. Subsequent children, he said, were treated with oral levofloxacin, a highly potent antibiotic that is not approved for children.

Pichichero said physicians in Alaska and Massachusetts also have identified the strain.

In Sweden, doctors are worried about the extended spectrum Betalaktamases bacterium that is found in the intestine. Several hundred infections have been reported and the superbug is resistant to common antbiotics.

Antibiotic misuse destroys weak bugs and leaves hardy survivors behind that learn new and sometimes deadly tricks. “Any long-term antibiotic use will lead to the natural selection of resistant organisms,” said Dr. Roy T. Steigbigel, a Stony Brook University Medical Center professor. •

— Newscom