A doctor's warning

Deadly superbug gains foothold in Florida
 

By John L. Guerra



(AP) — A deadly germ untreatable by most antibiotics has killed a seventh person at the National Institutes of Health Clinic in Maryland.

The Washington Post reported the death Friday. NIH officials told the paper that the boy from Minnesota died Sept. 7. NIH says the boy arrived at the research hospital in Bethesda in April and was being treated for complications from a bone marrow transplant when he contracted the bug.

He was the 19th patient at the hospital to contract an antibiotic-resistant strain of KPC, or Klebsiella pneumonia (KPC). The outbreak stemmed from a single patient carrying the superbug that arrived at the hospital last summer.

The paper reported the Minnesota boy's case marked the first new infection of this superbug since January.

This recent article reminded me of the stern doctor at Lower Keys Medical Center a few Sundays ago who made me promise to finish the antibiotics he prescribed me to kill a skin condition on my forearm.
As he wrote the prescription, however, I confessed out loud that I'd taken the last of some left-over ampilicin before deciding to see him.

The white lab coat froze, turned slowly and the doctor wearing it looked me in the eye (this is how doctors scare the living s--- out of you) and said, "What were you doing with ampicilin? Where did you get it?"

I never try to B.S. doctors, so I told him. "I had some left from a prescription  ..."
"Don't ... Ever ... Not take all of your antibiotics as prescribed," he stammered. He showed me silent scorn until he finished writing the antibiotic prescription.
"You promise to take all of this as directed?" he asked, holding the prescription close to his chest, awaiting an answer. I promised to follow his directions and now my arm is fine.

The doctor's warning to finish my antibiotics, however, was but a small reminder that doctors and hospitals in the Keys and elsewhere in Florida are very worried about superbugs such as KPC and other infectious microbial agents/pathogens that do not respond to antibiotics.

Key West Man died of infection

A local construction worker taken off life support last week serves as a stronger symbol of what is possible when someone in the Keys gets an infection that can't be defeated with antibiotics and other strategies. He did not have KPC, but hearing his story convinced me to have my arm checked out at Lower Keys.
The man's name shall remain anonymous, but he was well-known at Don's Place bar and in the construction community. According to people who knew him, the middle-aged man cut his leg during concrete work and may have waited too long to seek medical attention. When he was taken to Lower Keys Medical Center about three weeks ago, he was feverish, in and out of consciousness, and his leg had swollen -- symptoms of sepsis, or blood infection. He was airlifted to a Miami hospital, but apparently went into a coma during the flight. For the next weeks, doctors had him on a ventilator and tried the strongest antibiotics at hand. They amputated his leg and tried other drugs to halt the infection but he never recovered. His organs shut down and his life ended last week.

Florida doctors: MRSA was just a preview

According to an online site called "The Florida Infectious Disease Forum", as deadly as KPC is, the public has not been educated on prevention strategies. Experts say the victory is in prevention, as it was with Methicillin-resistant Staphylococcus aureus (MRSA), a skin infection that has been fatal for some people around the country. The Keys had a  nice little outbreak of it a few years ago, spurring schools and county officials to launch a MRSA-prevention education campaign.

Time to pay attention to KPC

There has been no such push to prevent KPC in the Keys and in the rest of the nation, according to the online forum.
KPC causes pneumonia, urinary tract infections, and sepsis; the mortality rate from these infections is extremely high. What makes it scary is that it latches to other infections and rides right on to the lungs like a nasty hitchhiker. The pandemic flu of 1917 was so fatal to young and healthy people because it caused the body to fling so many antibodies to the lungs that victims drowned in their own sputum. KPC creates an antibody reaction akin to that.

I found this tidbit from the Florida Infectious Disease online forum:

"If KPC becomes prevalent to even a fraction of the extent that MRSA is, we are really in trouble. KPC is a lot more difficult to treat," a physician wrote.

"And if we can’t treat these patients due to antibiotic resistance, the number of deaths which are kick-started by influenza will be higher than anyone is currently thinking about."

The Miami KPC outbreak

A Miami teaching hospital in 2010 released the results of what happened when KPC broke out in one of its Surgical Intensive Care Units. Nine patients came down with it; six of them died; four others lived but caught KPC with accompanying sepsis.
When the hospital tested 15 surfaces in three rooms that held the patients, 10 of the surfaces showed KPC baccili: on door knobs, bedding, bed rails, and even on the keyboard of a PC-on-wheels in the hall outside the hospital rooms. Nurses and front office staff roll those PCs from bed to bed to key in patient and billing data, which turned out to be a great way to spread KPC from room to room.

Staff swabbed down everything in the rooms, including bedside tables, television monitors, bed railings, door handles, such medical equipment as heartbeat monitors, ventilator tubing--everything where KPC had colonized.
The warning about KPC's danger did not reach all staff members, however.
"Compliance with hand hygiene and with the use of gowns and gloves was not systematically monitored before or after the intervention started," a compliance review at the same hospital revealed.
The report said the outbreak ended without any transmission outside the hospital. It should be noted, however, that MRSA also was once constrained to hospitals.

-- John Guerra