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It's difficult to imagine a world without antibiotics and yet, before the twentieth century there weren't any. The discovery of the very first antibiotic, penicillin, and the subsequent development of more "wonder drugs" changed all that. But over the past 60 years, a war has been raging between man's ability to produce effective antibiotics to fight infection and nature's ability to fight back. We have the advantage of intelligence, but the bacteria and viruses outnumber us. This issue is about a new "superbug" that is being seen more and more often. Read on to learn how you can protect yourself.

USATODAY: September 21, 2005 Study: Three Chicago-area children have died of a toxic shock syndrome-like illness caused by a superbug they caught in the community and not in the hospital, where the germ is usually found. The cases show that this already worrisome staph germ has become even more dangerous by acquiring the ability to cause this shock-like condition. "There's a new kid on the block," said Dr. John Bartlett of Johns Hopkins University School of Medicine, referring to the added strength of the superbug known as methicillin-resistant Staphylococcus aureus, or MRSA. NBC NEWS: September 25, 2005: The CDC (Centers for Disease Control) reports 30 new cases of antibiotic resistant bacteria in a center for victims of the Katrina storm. Lab tests indicate the resistance is caused by MRSA(methicillin-resistant Staphylococcus aureus) otherwise known as the "superbug." Authorities say that among the infected patients, many are children. NEW YORK, October 06, 2005 /PRNewswire: In response to the increasing clinical and economic burdens of the potentially deadly bacteria called methicillin-resistant Staphylococcus aureus (MRSA), an interdisciplinary group of public health, industry and infectious disease experts has united to form the MRSA Leadership Initiative. The initiative will focus on global prevention and management of MRSA.

A daily battle for survival
Ever since life began on this planet, there has been an ongoing battle - the battle of survival. The weak and vulnerable succumb to the strong and fit who then have more opportunity to reproduce others like themselves. This so-called "survival of the fittest" affects all species from the simplest one-celled organisms to the complexity of mankind. To survive, we must defend ourselves daily from many potential threats.

Our first line of defense - our skin
One such threat is bodily invasion. As humans, we are attacked every day by millions of microscopic bacteria (germs), viruses, and parasites who would like nothing better than to invade our bodies and use us as food for growth and reproduction. Our first line of defense is our skin and the inner linings of our lungs and digestive system, which together make up the main interface between us and the bacteria in our environment. When a bacteria lands on our skin, it usually does no harm unless it is allowed to penetrate the surface. In fact, all of us are covered with millions of colonies of bacteria every day. On average, there are over 500,000 bacteria on each square inch of our skin. We don't bother them, and fortunately, they usually don't bother us. This is called bacterial colonization.

However, if there is a break in the skin such as a small scratch or cut on our hand, bacteria immediately try to take advantage of this injury and invade the moist tissues beneath the skin. There, if allowed, they grow and multiply rapidly producing a toxin that damages the tissues further. This is called a bacterial infection.

The second line of defense - our immune system
Fortunately, inside our bodies there is an amazing protective mechanism called the immune system. It is designed to defend us against these foreign invaders. When we cut ourselves and bacteria invade the wound, our immune system mobilizes special white blood cells to battle the invaders. Thankfully, a healthy immune system is usually able to kill the invading organisms faster than they can reproduce - and the immune system usually wins.

The third line of defense - antibiotics
Our immune system can only do so much, however. When bacterial invasion is massive, as in a major injury, or if the bacteria is especially deadly, our immune system is sometimes unable to overcome the invasion. The infection may then spread to the bloodstream where it is carried to all parts of the body. This is a serious infection called septicemia. Most cases of septicemia are found in already ill hospitalized patients.

Prior to the 1940's, medical science had little to offer patients with bacterial infections and many died from minor wounds that became infected or from diseases such as strep throat. In 1928, in London, Dr. Alexander Fleming was examining a culture of bacteria when he noticed that it had become contaminated with a mold called penicillium. Rather than simply throw it away, he noticed that there was a clear halo around the mold where the bacteria did not grow. Seeing that halo was Fleming's "eureka" moment. He correctly deduced that the mold must have released a substance that prevented bacterial growth. As a result, the first antibiotic, penicillin, was born just in time to treat the war wounds of WWII.

By the middle of the century, Fleming's discovery had spawned a huge pharmaceutical industry, turning out synthetic penicillins that would conquer some of mankind's most serious infectious diseases Today every physician has a vast array of antibiotics at his disposal. In fact, each year in the United States over 110 million antibiotic prescriptions are written, saving countless numbers of lives.

How antibiotics work
When you take an antibiotic tablet, it is absorbed through the intestinal wall and enters your bloodstream. Your blood carries the antibiotic throughout the body where, hopefully, it reaches the site of infection in sufficient concentrations to kill the offending bacteria. Antibiotics take advantage of the fact that bacterial cells don't work the same way as our cells. This is why they are able to kill the bacteria and not kill us.

Most antibiotics work in one of three ways. Bacteria produce proteins and DNA within their cells so they can grow and multiply. Some antibiotics block the production of bacterial proteins which prevents them from growing. Other antibiotics stop the bacteria from making DNA, so the bacteria can no longer divide. Other antibiotics weaken the bacterial cell's wall and the bacteria simply burst.

Too much of a good thing
Unfortunately, as the use of antibiotics expanded, the bacteria took notice and began a counter attack of their own. Unlike humans, who usually average decades between generations, bacteria divide very rapidly producing a new generation as fast as every 20 minutes.

Every once in a while, whenever a large population of bacteria is exposed to an antibiotic, a few bacteria mutate and develop a sort of biological armor that protects them from that antibiotic. As the sensitive bacteria are killed, the fittest bacteria - the ones that survive the antibiotic attack - began to flourish and then transfer their resistance to the next generation. This ability to fight back usually strengthens with each mutation allowing them to thwart even the most intelligently designed drugs. Over the past 63 years, deadly so-called "superbugs" have evolved to withstand medicines like penicillin, tetracycline, and Cipro.

Staph - a common "bug"
Staphylococcus aureus (commonly referred to as "Staph") is one of the most common infections seen in normal healthy people. We all come into contact with Staph bacteria every day. They are very small single-celled organisms - about 10 times smaller than the cells in your body - and live everywhere from soil to air. In fact, about a third of us have Staph on our bodies (usually up our noses) all the time and never know it. Staph bacteria are transferred from our nose to our skin fairly regularly as we scratch or blow our nose. On the surface of our skin, Staph usually causes no problems. However, if the bacteria gets into an injury like a cut, it multiplies in the wound and releases a toxin which further damages the tissues causing a skin infection with redness, pain, swelling, and pus.

MRSA- a new "superbug"
When a Staph infection requires treatment, doctors usually turn to an antibiotic derived from penicillin called methicillin. Methicillin was specifically designed in 1959 to kill the Staph bacteria. However, within two years, a few strains of Staph developed resistance to this new antibiotic. This strain was termed "methicillin-resistant Staphylococcus aureus" and the acronym MRSA was born.

For many years, MRSA infections were found only occasionally, often in small clusters in a hospital ward. Hospitalized patients often have compromised immune systems due to illness or surgery which makes them more vulnerable to MRSA. However, recently outbreaks have been identified in the community setting among athletes, military recruits, and children. It is showing up among the people least likely to expect it - young men who are often in perfect health. MRSA infections are also now commonly found in long-term care facilities such as nursing homes. As the bacteria becomes "smarter" that number grows larger. In 1974, 2 percent of Staph infections were from MRSA. By 1995, that number had soared to 22 percent. Today, more than 60 percent of Staph infections are MRSA! Recent estimates by the CDC place the number of people hospitalized with MRSA annually at approximately 100,000. Over the past two years, it has become so common that even paramedics know it by its phonetic nickname: "Mersa."

Fighting back
Modern medicine is fighting back. Evanston Northwestern Healthcare (ENH), a Chicago hospital system, has launched an ambitious screening program to reduce the rate of MRSA within the hospital. A nasal swab is collected on every new inpatient. The swab is tested for MRSA using a new rapid response DNA test which can determine within two hours, whether a patient is a carrier of MRSA. (Results of current tests are not known for two to five days.) It is hoped that the quicker results will improve patient management and reduce the risk of MRSA transmission in the hospitals. Patients with positive swabs are treated with a nasal antibiotic ointment for 5 days and must shower with a special antibiotic soap.

Recent studies have shown that this simple treatment can eliminate nasal MRSA over 95% of the time. When a similar pilot program was applied to surgical patients, the rate MRSA wound infections was reduced nearly four-fold. Mandatory screening is expensive, but the average cost to treat a complicated MRSA case is around $30,000 to $40,000. ENH hopes to reduce the overall rate of MRSA infections in Chicago Hospitals by 50% within two years saving lives and money in the process.

Locally, hospitals in Pennsylvania are working together to prevent and eliminate MRSA infections. This commitment was demonstrated by a standing-room-only crowd on June 29, 2005 when more than 200 physicians, nurses and infection control practitioners from the Pittsburgh area and around the state attended a workshop on eliminating MRSA. "There is a strong commitment by hospitals to eliminate one of the most rapidly growing and virulent infections that patients can acquire," said Marilyn Rudolph, R.N. and Vice President of Performance Improvement for VHA Inc. VHA, a national alliance that helps member hospitals improve clinical and operational performance, has a regional office, VHA Pennsylvania, in Green Tree. Rudolph and VHA Pennsylvania were instrumental in planning and supporting the MRSA workshop. VHA will continue to support all of the region's hospitals in future efforts.

How is MRSA treated?
When Staph methicillin resistance was found, a new antibiotic called vancomycin was developed. But since 1996, some strains of Staph have also become resistant to vancomycin. These strains are known as VRSA. In response, the first new class of antibiotic in 35 years, linezolid, was developed in 2000, but lost its firepower against MRSA/VRSA within a year. These infections are more difficult to treat, requiring high doses of newer antibiotics. Some patients do not recover. Patients who do survive MRSA often spend months in the hospital and endure several operations to cut out infected tissue. The battle continues.

How to prevent spread of MRSA

• Handwashing is the single most important factor in preventing the spread of infection. For example, MRSA is spread from person-to-person by direct contact. This means that if a person has MRSA on the skin (especially on the hands) and touches another individual, MRSA may be spread. If you have an infection, clean your hands frequently with an antibacterial soap and water or an alcohol-based hand rub, especially after changing your bandages or touching the drainage.
  
• An open wound is the main entry for MRSA. If your skin is injured, clean the wound with an antiseptic wash like Johnson & Johnson's Hurt Free Antiseptic. Keep any infected area covered with clean, dry waterproof bandages. Pus or drainage from wounds is very infectious. Throw used dressings away promptly.
  
• Don't share towels and razors with others, especially in the gym. Use the supplied antiseptic spray before using gym machines. No matter how little you sweat or how great you think you smell, take a shower immediately following a workout.
  
• Take antibiotics when you should and always take the full course of prescribed antibiotics. Many patients do not finish all the pills in their prescriptions, which enables bacteria populations in their bodies to become fully resistant following this sub-lethal dose.
  
• Don't use antibiotics when you shouldn't. Overuse of antibiotics encourages bacterial resistance. Over 50% of antibiotics prescribed last year were given for viral infections, which are not affected by antibiotics. Exposing the bacteria in our bodies to these drugs unnecessarily can enable resistant ones to survive and thrive because other bacteria have been killed.
  

Summary
If you or your family are active and do anything that could traumatize the skin, you are potentially at risk for MRSA. Any skin cuts should be treated promptly. Any injury or skin abscess that does not heal quickly should be seen by a doctor. We can all help wage this war by practicing good hygiene, taking antibiotics as prescribed - and only when necessary.

The search for new antibiotics active against "superbugs" such as MRSA is of paramount importance. The US pharmaceutical industry spends millions of dollars each year in antibiotic research trying to invent new antibiotics that can destroy the latest strains of resistant bacteria. So far, medical science has been able to keep up, but the bacteria have the advantage with their rapid turnover time and brute force of numbers. Are our strongest medicines becoming obsolete, and can we develop new drugs in time to replace them? Only time will tell, but in the meantime we must be careful or the superbugs might win...