INNOVATION

Attack of the Superbugs

Gene detectives tracking a outbreak at the National Institutes of Health reminded of how much we don’t know about how infections spread through a hospital

Randy Rieland

August 31, 2012

The superbug behind a deadly outbreak Courtesy of the Centers for Disease Control

Everybody, it seems, has a story of a friend or family member who became sicker after they went to the hospital. It’s become a dark slice of conventional wisdom: If a disease doesn’t kill you, the hospital just might.

At heart, though, I think most of us don’t want to believe that. We want to hold on to the notion that hospitals are a safe haven, a place where smart and experienced people are dedicated to keeping us safe. How could we not get better?.

But the ugly truth is that hospitals are a bacterial war zone and the recent story about an outbreak at the National Institutes of Health (NIH) Clinical Center last year is a sobering reminder of how much we don’t know about the enemy.

Desperate measures

According to a paper published in the journal Science Translational Medicine, the staff at NIH realized, just before a lung transplant patient from New York was admitted in June, 2011, that she was carrying in her body a bacteria that resists antibiotics, what’s come to be known as a superbug. They went to unusual lengths to make sure the infection didn’t spread, isolating her and requiring that any staff member entering her room wear a gown and gloves. When she left a month later and there were no signs of the bacteria in other patients, they thought they had dodged a bullet.

They were wrong. Over the next six months, the bacteria infected 17 other people. Eleven died, six of them from superbug infections in their bloodstreams.

This was despite desperately aggressive measures by the NIH staff to control the outbreak. They built walls to isolate the infected patients.They threw away blood pressure cuffs and other reusable equipment after one use. They hired monitors to watch doctors and nurses and make sure they were wearing gowns, gloves and masks and scrubbing their hands. They sprayed rooms with a powerful disinfectant and began checking every patient with throat and rectal swabs.

Still, for the last half of 2011, another patient became infected almost every week. To keep this in perspective, almost all the patients in NIH’s Clinical Center were seriously ill and were there as part of clinical trials. So, many had weakened immune systems and were more vulnerable to infections.

That said, very few hospitals would have the resources to take the steps NIH took. And as Maryn McKenna, author of Superbug: The Fatal Menace of MRSA, wrote recently on Wired.com:

“There was nothing unusual about this outbreak, other than the resources that the NIH infection preventionists were able to marshal to attack it by means of their unique funding. Outbreaks…are happening in health care across the United States — at NIH, at academic medical centers, at community hospitals, in nursing homes — all the time.”

Tracking a superbug

Pretty grim. But there is an element to this story that’s more positive–the detective work done by Julie Segre, a genome researcher at NIH and Evan Snitkin, from the National Human Genome Research Institute. Together with a team of scientists, they began mapping the genome of the bacteria found in the first patient, the woman from New York. A procedure that took three years back in the 1990s now can be done in a matter of days.

By comparing that genome sequence with what they found in the bacteria from the other patients, the scientists hoped to track how the superbug spread through the hospital. They were surprised by what they found. Patients had not become infected in the order in which it appeared they had. For instance, one patient with lymphoma didn’t test positive for the infection until six weeks after the source of the superbug had left the hospital. He died soon thereafter, but given his weakened immmune system, he should have become ill within days of exposure.

Which meant the lethal bacteria had managed to stay alive somewhere in the hospital. Eventually, it was found in a respirator that had been used by a patient who had the bacteria in his body, but had not gotten ill. The equipment had been cleaned several times, with both bleach and a disinfectant, but obviously without success. The superbug was also found in a sink drain. The hospital tore up and replaced the plumbing.

One nasty lurker

By the end of the year, no trace of the superbug could be found. The genome sequencing clearly helped scientists better understand how a strain of bacteria can move through a hospital unit and how, disturbingly, it can lurk there. It’s only a matter of time before this kind of tracking could be done in close to real time.

Which is good news, because superbugs are not going away. In anything, we’re experiencing what might be called Germ Gap–drug-resistant bacteria are developing faster than new antibiotics can be created to fight them. In fact, very few new categories of antibiotics are now being invented–only two since 1968.

There are several reasons. First, they’re technically very difficult to create. And they’re not nearly as profitable for drug companies as meds, say for high cholesterol or depression, that people take every day for years. On top of that, the Food and Drug Administration, for safety reasons, has made it challenging for new antibiotics to be approved.

And so, if the superbugs aren’t winning yet, the odds are tipping their way. A final word from science writer Maryn McKenna:

“Unless we start paying more attention to systems — for research funding, for disease surveillance, for drug development; for addressing, in an organized way, the accelerating loss of the antibiotic miracle — the result will be deeply dramatic: more outbreaks, and more deaths.”

Now, for some good news

Let’s give it up for vitamins: According to Oregon State researchers, a very high dose of vitamin B3 has been found to boost the ability of immune cells to fight superbug bacteria.
Down go the mean old germs A group of Canadian researchers has invented a disinfectant called Akwaton which they say is harmless to humans but can wipe out dangerous bacteria, such as MRSA, that can survive on flat surfaces in hospitals for a long time.
Fatal attraction: Scientists in Singapore say they’ve created a “magnetic-like” coating that traps and destroys 99 percent of the bacteria and fungi it encounters.
The Force be with them: Meanwhile, at the University of Montreal, researchers say they’ve found a treatment that can weaken resistant bacteria enough to allow the body’s immune system to effectively fight it.The lead researcher compared the effect to taking away Darth Vader’s armor and lightsaber. As biologist Christian Baron pointed out, “A naked Darth Vader would be an easy target.” Indeed.

Video bonus: A little video tutorial on MRSA, the nasty superbug that can hang out in hospitals.