National Nurses United

MRSA is only one of several varieties of bacteria that have become resistant to medicine's magic bullet: antibiotics. Formerly easily treatable germs like E. coli, Salmonella, and Campylobacter have morphed into organisms that can be virtually immune to treatment. "The bad bugs are getting stronger and they're getter stronger faster," says Smithsonian Institution ethnobiologist Mark Plotkin in the National Post of Canada. "We feel like we're looking at an almost hyper-evolutionary period." The statistics are sobering. According to a major 2002 nationwide investigation by the Chicago Tribune of hospital infections, 103,000 people in the U.S. die each year from these infections, making them the fourth-leading cause of death after heart attacks, stroke, and can- cer. The Centers for Disease Control (CDC)—which puts the fatali- ties at 90,000—found that hospital infections were up 36 percent over the past 20 years and that, out of 35 million admissions a year, some 2.1 million will acquire one. Solving the problem will not be easy, because antibiotic-resistant pathogens are generated by a constellation of conditions and prac- tices, from poor hygiene in hospitals to the widespread use of antibi- otics in animal agriculture. And to make matters worse, at the very time these super germs are on the rise, many pharmaceutical companies are abandoning the search for new antibiotics in favor of more lucrative drugs aimed at long-term, chronic conditions. According to Dr. John Bartlett of Johns Hopkins University School of Medicine and chair of a legislative taskforce for the Infec- tious Diseases Society of America, there are virtually no new antibi- otics in the pipeline, which means, "We're in a bit of trouble now, and maybe a great deal of trouble in five years." Hospitals and healthcare workers are at war with an ancient and recently invigorated enemy. Given the nature of bacteria, it is a war in which all victories are incremental. The daily mutation rate for E. coli in human beings is 10 to the 12th power, a figure that is hard to grasp even using a computer. The phenomenal reproductive rate, coupled with bacteria's ability to share genetic material, means that almost as fast as human beings invent something to kill them, bacteria become resistant. The history of anti-bacterials is a history of stroke and counter- stroke. Penicillin was isolated in 1939. By 1941, there were penicillin- resistant streptococci. Human practices add to the problem. Sometimes patients don't finish their prescribed course of antibiotics, which means it is easier for resistant germs to emerge since what doesn't kill bacteria makes them stronger. Sometimes the problem is misuse of the drug through over pre- scription or the wrong prescription. A U.S. Office of Technological Assessment found that up to 50 percent of antibiotics are prescribed inappropriately. While the American Medical Association is deeply concerned about the global increase in resistance to antibiotics—a 1995 state- ment by the organization warns of a "public health problem of poten- tially crisis proportions"—it jealously guards the right of doctors to prescribe what they wish, and fiercely resists setting any national standards for the use of antibiotics. But you don't have to go to a doctor to get a dose of antibiotics, just chow down on some barbeque. In a study for the CDC, L. Clifford McDonald found that super- market chicken was riddled with vancomycin-resistant Salmonella. "The widespread resistance to this drug now seen in meat-borne bac- teria appears to stem from farm use since 1974 of a related antibiot- ic—virginiamycin—as a growth promoter," reported Science News of McDonald's research. An estimated 13.5 million pounds of antibiotics are used in animal agriculture for non-therapeutic purposes—the same kinds of antibi- otics used in human medicine—says Susan Prolman, the Washington representative of the Food and Environment Program of the Union of Concerned Scientists (UCS). And about three million pounds of antibiotics in the U.S. are used to treat human beings annually. The UCS says that 70 percent of all the antibiotics are used on healthy animals because they save farmers money by allowing them to pack thousands of animals into sheds and pens that are rarely cleaned. "Chickens raised for meat live about 45 days, but their cages are only cleaned out every one or two years," says Prolman. "They not only live in their own filth, but the filth of generations." Cows, pigs, and fish are raised under similar conditions. Such CAFOs (Communal Animal Feeding Operations) act as giant petri dishes in which antibiotic-resistant bacteria evolve and get passed on to workers, as well as to consumers. CAFOs also produce two trillion tons of antibiotic laden-waste 12 R E G I S T E R E D N U R S E W W W . C A L N U R S E S . O R G A U G U S T 2 0 0 6 "If you spend five minutes in a room with someone with MRSA, you are going to

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