“Getting Cultured!”- Further Adventures in Living with Superbugs

Previously, I wrote about the challenges which people who are immuno-compromised may face in combating the risk of infection and I cited my own early experiences with MRSA (Methicillin Resistant Staphylococcus Aureus). MRSA is also known as “The Superbug”, a strain of staph which is taking up residence in many hospitals and which has also moved out into the broader community.

Now, I hasten to add that it has been a very long time since I took my biology courses at university and even then, by way of instruction, I had very little in the way of microbiology lessons. But wrestling with Superbugs is taking me ever deeper into the world of microbiology, and by degrees, I am slowly learning the necessary vocabulary along with treatment protocols. I thought I might invite you to take this learning journey with me --- in the hope that when discovering more about these villainous bugs and when mastering the very specialised vocabulary attached to their petri dish world, some important (maybe even vital) future information may emerge for all of us who are immuno-compromised.

I am calling this learning process “getting cultured” because what is more cultured than bacteria, after all? And because there is a great deal of informational ground to cover, I thought it could be done as a series, like “Lord of the Rings” or “Star Wars” and, in each episode, some specialised medical terminology could be de-mystified.

So if you’re still with me, this is Chapter Two of “Superbugs.”

I recently had occasion to be hospitalised briefly for sinus surgery. On admission, I was startled to discover that my file now contained references to my previous MRSA infections and that I am now regarded as a “potential carrier” or as someone who may have been “colonised” by MRSA. “Of course, you’ll have to go into isolation in a private room following surgery,” the lady in Admissions said. “Oh”, I said, trying not to appear startled, “You mean I’ve finally found the formula for getting a private room?” The Admissions Lady didn’t smile and I beat a hasty retreat into the waiting room, feeling rather like the legendary “Typhoid Mary”.

Actually, I didn’t enjoy my post-surgical isolation. I was lonely in my private room, my post-op misery not relieved by the fact that with three feet of packing material in each nostril, I looked like Miss Piggy on a bad day. As well, because visits to my room required nurses to go through a complex procedure involving hand washing and gown changing, the nurses on duty weren’t too eager to see me very frequently. But what I was very pleased about was observing the seriousness which a major hospital in Vancouver was treating MRSA. Personal feelings aside, I salute the hospital authorities for their vigilance, their foresight, and their prudence. It is a sad fact that most cases of MRSA infections in hospitals are spread by care-givers going from one patient to the next, without proper care of garments or vigilant observation of hand washing procedures. So here we had a major metropolitan hospital facing up to the issue head-on and doing something effective about it.

While recuperating from my surgery, I had the good fortune to attend the annual Scientific Meeting of the American College of Rheumatology in San Diego from November 12 to 17. On the opening day of the meeting, I found myself at a hugely informative talk by Dr. George Karam, a Professor of Medicine at Louisiana State University School of Medicine in Baton Rouge. Dr. Karam’s lecture was titled: “Bad Bugs; No Drugs" and it was all about the nasty antibiotic resistant microbes we are now contending with, and the ever-diminishing pharmaceutical arsenal with which to combat them. In short, Dr. Karam’s talk contained a great deal of information which we immune-compromised members of the arthritis community need to be aware of and vigilant about.

In his opening comments, Dr. Karam said that the “unintended consequences of antibiotic use were not taught in medical schools” and that “we’re selecting out resistant pathogens.” He added, sounding a clear note of alarm, “We have nothing in the pipeline of any significance to deal with this problem”.

Dr. Karam went on to carefully lay out, in great detail, the latest guidelines and standards of care for treating a wide variety of infections in pharmacologically immunosuppressed patients. He began with the scariest infection---sepsis---a particularly dangerous condition marked by hypothermia (low body temperature); hypoglycaemia; (glucose deficiency); unexplained metabolic acidosis (excessive acidity of body fluids), and other evidence of “end-organ” effects in the brain, heart, lungs, and other organs. He emphasised that speed in treatment (“You must get it right on day one”) was of the essence in dealing with sepsis and that effective treatment involved low-tidal volume ventilation (assisted respiration under lower pressures); tight glycemic control, steroids to address septic shock and early intravenous antibiotic therapy. Dr. Karam said that it was imperative that intravenous antibiotic therapy be started within one hour of severe sepsis.

I carefully took notes through the whole of Dr. Karam’s lecture and I will continue on in the next issue with his comments on treatment of other conditions associated with immuno-suppressed patients.

As an aside, Dr. Karam used the phrase “Gram Positive Bacteria” many times but I didn’t know what it was until I looked it up after returning home. Well, it’s all about colour. The “Gram stain” is the most widely used staining procedure in bacteriology. It is called a differential stain because it differentiates between bacteria that stain purple (Gram positive) and those that stain pink (Gram negative). Several varieties of step and staph bacteria stain purple, including MRSA and are therefore placed in the Gram Positive group.

My little MRSA friend also happens to stain a deep yellow colour when it is cultured in sheep blood agar, thereby earning itself the Latin word “Aureus” for its golden property.

Now how’s that for getting “cultured”?