E-DRUG: Drug resistant bacteria cause fresh concerns
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[Copied from BMJ 2000;320:1228 ( 6 May ) as fair use. WB]
Drug resistant bacteria cause fresh concerns
Scott Gottlieb New York
Infections caused by so-called "superbugs," resistant to most
available antibiotics, are causing renewed concerns worldwide.
Four recent outbreaks of new and more virulent strains of disease
caused by contact with animals or contaminated food have
been reported in the New England Journal of Medicine..
"The underlying cause of why these things happen is the changing
food supply, growing world population, international travel,
and overuse of antibiotics," said Dr Michael Osterholm, the chief
executive officer of Ican, a medical information company and
author of an accompanying editorial on the topic (2000;342:1280-
1).
In one of the four studies a 12 year old boy was infected with a
drug resistant strain of salmonella bacteria, most likely from
infected cattle (2000;342:1236-1241). Although most cases of
salmonella do not require antibiotic treatment, the finding
worries specialists because the salmonella strain that infected the
boy was resistant to the antibiotic ceftriaxone, the drug of
choice for serious cases of the illness. Although researchers are
unsure exactly how the boy became ill, they found that a
bacterial sample taken from him exactly matched one from a
salmonella outbreak in cattle near his home.
In a second study reported in the same issue (2000;342:1250-3), a
12 year old boy with poorly controlled diabetes became
seriously ill and was admitted to a US hospital with enteritis
necroticans, a potentially life threatening intestinal infection that is
rare in the United States and causes severe stomach pain,
vomiting of blood, and low blood pressure. The boy eventually had
to have surgery to restore his intestinal function, according to Dr
Toni Petrillo of Children's Healthcare of Atlanta in Egleston
and colleagues. The culprit turned out to be a bacterium that
contaminates chitterlings, known as Clostridium perfringens type
C, which is typically more common in developing countries.
In a third study (2000;342:1229-35), researchers reported on an
outbreak of 94 cases of viral encephalitis due to Nipah virus
in Malaysia, a newly discovered paramyxovirus that was
associated with recent contact with pigs. The new virus caused
severe and rapidly progressive encephalitis with high mortality and
features that suggested involvement of the brain stem..
Finally, in a fourth study (2000;342:1236-41), contaminated
sweetcorn salad served in Italy caused more than 1500
people�mostly schoolchildren�to develop high fevers and
diarrhoea. The outbreak was unusual because it was caused by
Listeria moncytogenes, a bacterium that is not thought to
commonly cause disease in healthy people. The bacteria, which
usually contaminate meat products, can cause miscarriage and
stillbirth, and serious, sometime fatal, infections in infants, elderly
people, and those whose systems are immunocompromised.
Researchers said that economic factors such as poverty,
overcrowding, poor sanitation, and lack of access to clean drinking
water or adequate health care, play a key part in the spread of
contagious diseases. Overuse or misuse of antibiotics to prevent
disease and encourage growth in animals raised for food also
fosters the growth of drug resistant strains of bacteria.
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