An article in yesterday’s New York Times by Andrew Pollack - Doctors Struggle to Treat Gram-Negative Bacterial Infections – NYTimes.com – brings to the public’s awareness that Gram-negative organisms such as Klebsiella pneumoniae and Acinetobacter are becoming almost as common but have very few treatment options in the form of effective antibiotic coverage.
The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.
Mr. Pollack reports that “[a]ccording to researchers at SUNY Downstate Medical Center, more than 20 percent of the Klebsiella infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide.”
The number of infections occurring annually in hospitals is simply staggering – roughly 1.7 million hospital-associated infections, according to the Centers for Disease Control and Prevention. More horrifying is the CDCP’s estimate that when taking into account all types of bacteria combined, these organisms cause or contribute to 99,000 deaths each year.
“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, Calif., and the author of “Rising Plague,” a book about drug-resistant pathogens.
Mr. Pollack’s article also sheds light on yet another little-known but equally tragic fact – a physician’s choices in treating some of these deadly Gram-negative bacteria are not without significant risks to the patient – neuro and nephrotoxicity.
Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. These drugs were largely abandoned decades ago because they can cause kidney and nerve damage, but because they have not been used much, bacteria have not had much chance to evolve resistance to them yet.
“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”
As many are aware or becoming increasingly aware, the drug-resistant bacteria are believed to be the by-product of overuse of antibiotics by healthcare providers over the past many decades. Specialists in infectious disease have been vocal advocates for the judicious use of antibiotic therapy and avoidance of the ‘take a pill’ first approach by many front line providers such as internists.
In his article, Mr. Pollack provides a link to a campaign started by the parents of a 27 year old young man, who survived his post-operative, hospital-acquired MRSA infection twice only to die a victim of a Gram-negative organism, Enterobacter aerogenes. These advocates for prevention of hospital-acquired infections, Armando and Victoria Nahum, started the Safe Care Campaign. A visit to this site is most instructive and we invite you to do so.