Maryn McKenna

Journalist and Author

Mothers, Farmers and Chefs Against Antibiotic Misuse

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If you’ve been reading me for a while, you may remember Everly Macario and her son Simon Sparrow: I told their story in my 2010 book Superbug and blogged about them in 2011. Everly is a public health researcher in Chicago and the sister and daughter of physicians. Yet despite all her own knowledge, and all the knowledge resident in her family, she was unable to protect 17-month-old Simon from the MRSA infection that killed him in 24 hours in 2004.

Simon, as I wrote about him last year, was:

[A] big, sturdy child with no health problems except a touch of asthma. The day before he died, he woke up feverish and disoriented, startling his parents with a cry unlike anything they had heard from him before. It was a busy morning — his older sister had a stomach virus — but they got him to the pediatric ER, got him checked, and brought him home when doctors found nothing unusual going on.

A few hours later, Everly was working at home, watching both kids, and Simon’s breathing changed. Her husband James, a history professor, had driven a few hours away to give a speech. She called a friend who is a pediatrician, held the phone up to Simon’s nose and mouth so she could hear, and then got back on the line.

“Hang up,” her friend said. “Call 911.”

She did, and then she called her husband, who reversed course and began tearing back to the city. At the hospital, Simon failed rapidly: His heart raced, his blood pressure crashed, his lungs filled with fluid. His skin darkened with pinpoint hemorrhages. He died the following morning.

Simon Sparrow. Photo: Courtesy Everly Macario

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Staph In Pigs And Pig Farmers: The Latest Reports (ICEID 1)

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Photo: AndJohan/Flickr

I’m spending the first part of this week at the International Conference for Emerging Infectious Diseases, a biennial scary-disease nerdgasm that is sponsored by the Centers for Disease Control and Prevention, the American Society for Microbiology and other worthy organizations, and in this iteration has drawn about 1,600 participants from more than 50 countries. (You can see the program here. I had planned to live-blog it, but the hotel was just renovated and apparently they built a Faraday cage into it, since connectivity is a painful trickle.)

On Monday’s agenda, among other intriguing talks: Two updates on MRSA, methicillin-resistant S. aureus, among farmers in two states.

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Flu Infections and MRSA Deaths in Maryland

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Sad news out of Maryland, and a reminder of how devastating MRSA, methicillin-resistant Staphylococcus aureus, can be when it combines with flu infection. According to the Maryland Department of Health and Mental Hygiene, the Washington Post and ProMED, five members of a family have fallen ill and three have died from MRSA pneumonia that took hold in lungs inflamed by flu infection.

The dead are Ruth Blake, 81, and her children Lowell, 58, and Vanessa, 56. Another child, Elaine, also fell ill and was hospitalized, and Ruth Blake’s sister has been hospitalized also. They had all contracted one of the seasonal flu strains circulating this year: H3N2. According to the Post, Ruth Blake was vaccinated against flu this season; her children were not. The assumption is that both flu and MRSA spread from the mother to the children.

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'Pig MRSA' Came From Humans, Evolved Via Farm Drugs

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In the summer of 2004, a 6-month-old girl who lived in the southeastern part of the Netherlands — prime, intensive hog-farming country — went in for surgery for a birth defect of her heart. As is routine in the Netherlands, which has excellent hospital infection control, she was checked before surgery for MRSA, the drug-resistant bacterium that can live on the skin without causing infections and can be unwittingly transmitted from one patient to another. The girl was carrying MRSA, which was a surprise — but the bigger surprise was that her MRSA strain did not render any results on the standard identification test, PFGE.

Looking for a source for the mysterious strain, the hospital epidemiologists where the girl was being treated asked to check her family: father, mother, school-age sibling. They were carrying it. They asked to check the family’s social circle; some of them were carrying it too. Then, flailing about for an answer — the Netherlands has such low rates of MRSA that these persistent findings were really rather odd — the epidemiologists asked what the family and their friends all did for a living, and received the answer that they were all pig farmers. So they checked the pigs, and the pigs were carrying the MRSA strain as well. And if a new MRSA strain in humans was odd, then a MRSA strain in pigs was very odd — because swine have their own varieties of staph, and are not supposed to get S. aureus, the usually human strain that accounts for the “SA” in MRSA.

That summer of detective work (which is told in full in my book Superbug) provided the first sighting of what would come to be called MRSA ST398, or in Europe CC398: a strain which was not quite like hospital MRSA, and not quite like community MRSA, and which carried a distinctive signature of resistance to tetracycline, a drug that is not much used for human MRSA but is routinely used in confinement-style farming. From its first identification, ST398 spread rapidly through Europe, and then into Canada, and then to the United States, being found first in pigs and pig-farm workers, and then in retail meat, and then in people with no connection to farming at all.

The only mystery was where it had come from.

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Drug Resistance in Pork: More Going On Than Appears

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A paper released recently, by the University of Iowa team that is the lone US research group tracking “pig MRSA” ST398, caused a ripple. (It came out while I was at ScienceOnline and it’s taken me a while to catch up.) The paper compares the occurrence of MRSA, drug-resistant staph, on various cuts of retail pork from pigs that were raised either conventionally in confinement, with routine use of antibiotics, or in an alternative rearing scheme with no antibiotics. (NB: Not “organic,” despite what some headlines said; that’s a separate issue of USDA licensure.) The team found that both conventionally raised and antibiotic-free meat carried MRSA, both the human-associated kind and the pig-adapted kind.

The TL;DR over the past week has been: There’s just as much resistant bacteria on drug-free meat as there is on conventional meat, so why spend the money — or raise the alarm over farm antibiotic use?

My interpretation is a little more nuanced. But my takeaway is that, in its underlying data, the study proves what campaigners against ag antibiotic use keep saying: that once you use antibiotics indiscriminately and drive the emergence of resistant organisms, you have no way of predicting where that resistance DNA will end up.

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Sleeping With The Enemy: What You Get From Your Pet

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The most numerous and passionate comments I’ve ever gotten here were responses — OK, vituperation and denunciations — to a post describing how a Pacific Northwest family caught plague from their dogs’ fleas.

So I’ll be over in the corner donning a flame-resistant bio-suit — because  it turns out that, when it comes to pets on the bed, plague is not the only health risk. It’s one of many, along with hookworm, roundworm, MRSA, rabies, Chagas disease, Pasteurella, cat scratch fever, Capnocytophaga, Cryptosporidium and Cheyletiella. Oh, and bites.

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More MRSA Found In U.S. Retail Meat (Turkey, Too)

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There are two new studies out that confirm, once again, that drug-resistant staph or MRSA — normally thought of as a problem in hospitals and out in everyday life, in schoolkids, sports teams, jails and gyms — is showing up in animals and in the meat those animals become.

The strain of staph that shows up in farm animals, known as “livestock-associated” MRSA or MRSA ST398, first emerged in pigs in the Netherlands, and has been widely identified in retail meat in Europe. (You can find a long archive of posts on ST398 here, and more here.) But that same strain has been difficult to identify in the United States. That may be due in part to the U.S. having a uniquely massive epidemic of community-associated MRSA, far larger than in any other country, which likely both obscures any animal epidemic from detection, and possibly also fills the ecological niche that livestock-associated staph might otherwise occupy. But, it must be said, there’s also remarkably little political will to look for livestock-associated MRSA (though the U.S. Department of Agriculture has now funded a study).

Nevertheless, individual investigators keep trying, and when they look for the pathogen, they find it, such as in these studies from May and this one from April. Now, two other teams have as well.

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Warm Weather Increases Hospital Infections, And What That Might Mean For Climate Change

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What makes hospital-acquired infections so intractable? There’s no question that some of the organisms that cause them are tricky: MRSA hangs out on the skin and and in the nostrils, and E. coli resides in the gut, making it easy for them to be carried into hospitals undetected. Hospital workers’ poor performance on hand-washing is well-documented. And recently, researchers have begun to wonder whether hospitals have missed an opportunity by not emphasizing environmental cleaning —- of rooms, computers and equipment, for instance -— given how persistently some bacteria can linger.

A new paper in PLoS One, though, says there’s another factor contributing to the problem, one that has missed consideration until now: weather. An 8-year study of infection data from 132 hospitals finds that as outside temperatures rise, in-hospital infections with some of the most problematic pathogens rise also.

The analysis is a warning to healthcare institutions to be additionally on guard when it is warm outside. But the authors say it’s also a warning to the rest of us: If global climate change raises ambient temperatures, it could increase the likelihood of deadly hospital infections as well.

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How Much Is a Drug-Resistance Death Worth? Less Than $600

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So, antibiotic resistance: We care about it, right? The World Health Organization does: It made antimicrobial resistance the theme of this year’s World Health Day. The Centers for Disease Control and Prevention does. The journal Lancet Infectious Diseases says it’s a “global health concern.” The major association for infectious disease physicians has pleaded for attention. Two separate sets of legislators have introduced two bills in Congress.

You’d think, with all those calls for attention, that combating antibiotic resistance would be a priority in the United States. But if we can take how much we spend to research a problem as a gauge of how much we care about it, then antibiotic resistance is no priority at all.

As in: For every death from AIDS, the US federal research establishment awards approximately $69,000 in grant funds. And for every death from MRSA, it awards $570.

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More MRSA, in milk: A new strain in cows and humans

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Despite the massive AIDS anniversary this week, I was expecting to write about the EU E. coli outbreak next. But there’s striking new news on MRSA that makes it worth putting off E. coli one more day. I’m traveling many time zones away from home, though, so this will be quick.

Researchers in England and Denmark have announced they have found a never-before recorded variant of MRSA in cow’s milk in England that has already caused human infections in England, Scotland and Denmark, and researchers in Ireland have simultaneously announced that they have found the same strain in hospitalized patients there as well.

Here’s how this unfolded:

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