Don’t bug me! Surviving in an era of the muscular microbes

Despite current efforts being made in some parts of the Great Republic to the south to abolish Charles Darwin, evolutionary adaptation carries on, and nowhere is that fact more marked than in the microscopic world of the microbe.

The age of antibiotics ushered in new miracles of disease control and we’ve all benefited hugely from these wonder drugs. But we’ve also overused them, not only in medical prescriptions, but also in our ever more promiscuous employment of antibiotic drugs throughout our industrialised food production systems.

The microbes are fighting back—they’re getting tougher and ever more resistant to our drugs. And because they reproduce in huge numbers over short time spans, thereby passing on their genetic adaptations with great rapidity, they are now outrunning our ability to come up with new drugs with which to combat them.

You’ve probably been reading scary, apocalyptic stories about “Bird Flu”.

And you’ve doubtless seen the headlines about “Necrotizing Fasciitis”, “C Difficile”, and “MRSA”----nasty infectious microbes that have surfaced in some of our hospitals in Canada and in other developed countries.

Of the above police line-up of nasty bugs, MRSA (Methicillin Resistant Staphylococcus Aureus) is the most common and widespread. It is the one that has “bugged” me several times and that, in consequence, I know the most about.

So let’s look at MRSA.

Like many people with arthritis, I have had joint replacement surgery and this renders me vulnerable to opportunistic infections (metal and dacron joint implants are not nourished by a blood supply and consequently exist at a remove from the body’s immune defences). As well, since many types of arthritis are really auto–immune disorders, treatment may involve ingestion or infusion of immuno-suppressive drugs and susceptibility to infections can thereby be enhanced. And finally, frequency of exposure to the hospital environment and to multiple surgeries---elements in many of our lives--- raises the possibility of contact with super bugs like MRSA and related risks of infection.

In my case, my first MRSA infection began in my surgically reconstructed left foot and developed some six months after I had had some supplementary work done on the foot--- following the primary operation done a year before that. I suddenly developed a high fever, which I did not immediately connect to my foot. After two days, my foot became red and swollen and soon my whole leg ballooned up and became violently red and angry. I was admitted to Emergency and put on an intravenous line while a culture of the offending microbe was attempted.

The first two days of antibiotic infusions were ineffective and my leg grew angrier. My fever did not abate. Meanwhile my culture did not “take” and I was counselled just to be patient and “give the antibiotics a chance”. As the infection spread relentlessly up my leg and began lapping at the edges of my titanium knee, I became more and more agitated. Finally, in response to my insistence that another antibiotic be administered, I was put on intravenously administered Vancomyacin---the primary weapon against MRSA. I could feel that this antibiotic was working pretty immediately, but the subsequent treatment was lengthy! Indeed, I stayed on my intravenous line and a daily infusion of Vancomyacin for the next 4 months, and my foot, which had ruptured under the force of the infection, took another two months to close over and heal.

I have since had three more MRSA infections but none has been as serious as the first---in part because I know now what I am dealing with and immediately that I suspect that I have an MRSA infection, I move against it with lightning speed.

But if you’ve never had a close encounter with MRSA ---and I sincerely hope you haven’t --- I’d like to pass on a few tips to help safeguard you against this very nasty superbug.

If you have prosthetic joints, take a preventative antibiotic before doing things like having your teeth cleaned by the dentist.

Exercise special awareness if you are immuno-compromised. Use particular caution in places where MRSA now likes to hang out –places like public swimming pools and sports facilities, as well as hospitals. Be careful with any cuts or scrapes that can open your skin to bacteria. I promptly disinfect any cut or flesh abrasion and now carry a bottle of plastic bandage with me to apply to places like feet, where bandages won’t stick and a barrier against bacteria is strongly advisable.

If you have noticeable entry points for bacteria on your body ----like toenail fungus and your feet are exposed to swimming pool tiles---consider treating the fungus with a systemic medication. Always use flip-flops rather than your bare feet when at a public pool.

Wash your hands frequently during the day and after touching surfaces or other persons. Make sure you scrub your hands thoroughly and leave a germicidal soap on them for several minutes before rinsing it off.

In the hospital setting, don’t be shy about saying you’re immuno-compromised--- if this applies to you--- and ask health care providers or attendants to wash their hands before they touch you (many MRSA infections in hospitals are spread by patient-to-patient contact by doctors and nurses who sometimes neglect hand washing, when rushing from patient to patient).

If you are immuno-compromised, take every fever seriously. Don’t tell yourself “It’s probably just a bad cold”. It may not be and speed is important in combating an MRSA infection.

If you do develop an infection, insist that a lab culture of the offending microbe be done but don’t await the results if the infection moves rapidly—remember the microbe’s identity can also be hypothesised by what medications it responds to. If you get what may be an MRSA infection near a surgical site, it also may be important to have CT scan done quickly to determine how deep the infection may be and how lengthy and intensive anti-biotic therapy may need to be.

And finally be alert to the hygiene status of your local hospitals. Put pressure on officials to openly disclose infection rates and to devise effective hygiene strategies to contain superbug outbreaks. Be alert to the risks of infection but try not to be paranoid. After my first superbug experience, I tried living inside a Zip-Lock bag but found breathing too difficult and I’m now again out in the world! But I’m now bug-wise and I strongly advocate that you, too, become so! *

• If you would like to learn more about MRSA, you can visit a comprehensive UK web site that tracks the ongoing super bug wars in Great Britain - http://tahilla.typepad.com/mrsawatch/ . Much of the discussion there is also relevant to the superbug situation and attendant debate in Canada.