Maryn McKenna

Journalist and Author

SUPERBUG on Capitol Hill

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Constant readers, I’ve been shamefully absent from the blog, but with reason, since I’ve been traveling promoting the book. There was a pretty interesting opportunity this week that I wanted to tell you about: I was asked to be part of two Congressional briefings in Washington, DC Wednesday, addressing the overuse of antibiotics in agriculture and the contribution that makes to the emergence of resistant organisms such as MRSA. I went specifically to tell the story of the emergence of MRSA ST398, which we’ve been talking about for years here.

The briefings (FYI, “hearings” are for Congresspersons, “briefings” are for their staff) were cosponsored by the Pew Charitable Trusts, Union of Concerned Scientists, American Public Health Association, Infectious Diseases Society of America, and the nonprofit Keep Antibiotics Working.

Here’s Pew’s announcement, here’s the UCS version, here’s a write-up from the Washington Examiner, and here’s a longer one from the site Spectrum Science.

Surfacing. (Whew.) And some great reaction.

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Well, constant readers, it’s been an amazing two weeks. SUPERBUG was published, and ate my life. I’ve been on NPR’s Fresh Air, and on 21 (22?) other radio stations so far, with more radio, and TV, to come.

I’m starting to plan the next phase of the book campaign. If you work at a hospital or medical school, or are a student, contact me: Wherever you are, I’ll come talk.

This week I’m headed out for some tour appearances in Atlanta: at Georgia Gwinnett College on Wednesday, and on Thursday, at the offices of Danya International in the afternoon, and then at Eagle Eye Book Shop in Decatur Thursday night. If you need more details, email or tweet me!

The book has gotten some wonderful reviews and, what matters more to me at this point, blog reactions, because the blogs signal to me that real people are really engaging with the story. I’ve put excerpts and links up on the book’s site on this page.

Here’s one that just came in over the transom that just floored me. It’s from Rep. Louise Slaughter, Congress’s only microbiologist, author of PAMTA, the legislation intended to bring some direction and control to agricultural use of antibiotics:

Maryn McKenna’s Superbug provides a heart-rending and enlightening portrait of the spread of Methicillin-Resistant Staphylococcus Aureus (MRSA). Commonly imagined to be a disease that only affects elderly hospital patients, McKenna’s book shows that no area of the United States is untouched. Thirty percent of high school athletic programs in one survey reported MRSA. In another study, 80 percent of farms and 40 percent of pigs had MRSA. The consequences are horrific. In 2005, 94,360 invasive MRSA infections occurred in the United States, with almost 19,000 deaths.

In the United States, the response to MRSA has been largely uncoordinated, and left to individual institutions, schools, and health care centers. American hospitals have tried a range of responses. Some hospitals have tied executive pay to staff hand-washing rates; others isolate patients with MRSA. Nationwide educational campaigns reduced antibiotic prescription rates temporarily, only to see them rise again. The pipeline for new antibiotics dried up due to economic disincentives for drug companies to invest in short-course medications like antibiotics. The medical system has not yet been able to contain antibiotic resistant pathogens like MRSA.

The problem is just as dire on American farms. Limited action has been taken to reduce misuse of antibiotics in agriculture. While the FDA did ban agricultural usage of the powerful antibiotic fluoroquinalone, farms still regularly use powerful antibiotics as ‘growth promoters’ in daily feed for animals.  This year, I introduced legislation, HR 1549, the Preservation of Antibiotics for Medical Treatment Act, which would take additional steps to protect seven medically-critical classes of antibiotics for human usage against MRSA and other antibiotic resistant pathogens. Maryn McKenna’s book is a powerful call to action. 

– Louise M. Slaughter, MEMBER OF CONGRESS

PUBLICATION DAY and so many people to thank. The short list:

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Sara Austin, Susan Raihofer, Emily Loose, Maura O’Brien, Ali Pisano, Dominick Anfuso, Martha Levin, Elizabeth Stein.
Andrew Dodds, David Ratner, Shirley Sandler, Chuck Monroe, Elise Bogdan.
Penny Duckham, Deirdre Graham, Matt James, Drew Altman;  Bruce Shapiro, Frank Ochberg, MD, Dorie Griggs.
Barth Anderson, Frances Katz, Quinton and Jean Gregor, Anne Edwards, MD, Joanne Kenen, Howard Gleckman. 
Michael Coston, Crawford Kilian, Scott McPherson, “Revere.”
Michael T. Osterholm, PhD; Kristine Moore, MD; Jim Wappes, Robert Roos, Lisa Schnirring; Kathleen Kimball-Baker; Nicholas Kelley,  Paul Mamula, PhD.
Coilin Nunan; Ramanan Laxminarayan; Donald Berwick, MD, Donald Goldmann, MD Frances Griffin, Joseph McCannon, Madge Kaplan; Lisa McGiffert.
James Sliwa, Steven Baragona.
Robert S. Daum, MD, Susan Boyle-Vavra, PhD, Everly Macario, SciD, Michael Z. David, MD, PhD, Susan Crawford, MD, Christopher Montgomery, MD, Ben Yoon, Lakesha Lloyd; Robert Bielski, MD, Stephen Weber, MD, John Easton.
Henry “Chip” Chambers, MD, Francoise Perdreau-Remington, PhD, Adam Hersh, MD, Binh An Diep, PhD, Kristen Bole; Rick Loftus, MD, Steve Gray.  Elizabeth Bancroft, MD, Nolan Lee, MD, Gregory J. Moran, MD, John Edwards, Jr., MD, Loren G. Miller MD.
John Bradley, MD, Bradley Peterson, MD. Don Janssen, DVM, Nadine Lamberski, DVM, Jeff Andrews.
Nicole Coffin, David Daigle, Rachel Gorwitz, MD, Jeffrey Hageman, Fred Tenover, PhD, Timothy Naimi, MD, Denise Cardo, MD,  Joan Brunkard, PhD, David Sugerman, MD, Roberta Carey PhD, Brandi Limbago PhD, Lonnie King DVM, Jennifer Wright DVM; Susan Sanchez, PhD; Arthur Kellermann, MD, Katherine Heilpern, MD, Henry Blumberg, MD, Leon Haley, MD, Michael Huey, MD, Andre Nahmias, MD; Tom Keating, PhD.
David Edell, Cathy Supak, Mike Carroll, Marilyn Felkner, MD.  Heinz Eichenwald, MD, Mari Nicholson-Preuss.
Gregory Belzley, Martha Sperling, Anita Alberts, Nate Wenstrup, Natalie Leonard, Carrie Takahata, Eric Balaban; John Clarke, MD, Luis Rivera, MD, Timothy Faloon, Rhonda Moore; Charles Alexander, Jr., Gary Benson, David White, Chris Pearson; Pierre Tattevin, MD, Jason Farley, PhD; Elizabeth Cumming, Katie Schwartzmann, Samuel Gore, MD.
Tara Smith, PhD, Michael Male, DVM, Abby Harper; J. Scott Weese, DVM; Andreas Voss, Md, PhD,  Jan Kluytmans, Md, PhD; Pat Gardiner.
Barry Farr, MD, William Jarvis, MD, William Schaffner, MD. Jeff Bender, DVM, BJ Anderson, MD, John Odom, MD, Marjorie Hogan, MD, Kirk Smith, DVM,  Patrick Schlievert, PhD.
Paul M. Wiles, Thomas N. Zweng, MD, Stephen L. Wallenhaupt, MD, James W. Lederer, Jr., MD, Suzie Rakyta, RN, Sandy Cox, RN, Patti Deltry, RN, Kati Everett. Keith M. Ramsey, MD, Kathy Cochran, RN, Delores Nobles.
Barry Eisenstein, MD, Richard Baltz, PhD, Grace Thorne, PhD Jared Silverman, PhD,  Kevin Tally, MD. Joann Lindenmayer, DVM, Robert Moellering, MD, Jeffrey Linder, MD. John Powers, MD,  Ron Najafi, PhD, Mary Beth Minyard,  Henry Shinefield, MD,  Lisa Bayne.
Allison Agwu, MD; Steven J. Barenkamp, MD; Gonzalo Bearman, MD; Benjamin Estrada, MD; Eugene L. Green; Brenda Hollier; Christoph U. Lehmann, MD; Nkuchia Mikinatha, DrPH; Michael Nagy, MD; Louis Rice, MD; Lisa Saiman, MD; Torrance Williams.
Rose Aliberti; Kepa Askenasy; James Bell; Michael Bennett; Laura Chen Davies, Robin Cook; Stephanie Crowell; Amber Don; Eva Ferguson and Beverly and Ernie Dieringer; Nick and Janet Johnson; Kevin Keller; Mollie and Brian Logan; Diane Lore and Richard Ross; Clarissa and Tony Love; Christina Marzullo; Jane McGuinn, Molly Donohue, Charlotte McGuinn Freeman; Steve, Sue and Pat McNees; Karen Moser; Carole and Ty Moss; Victoria Nahum; Melissa Quintana; Debbie Russ; Danielle Sheffler; Scott and Katie Smith; Andrea and Jay Sorensen; Jeanine Thomas; Suzanne Turpin Upton; Tom Wolff, Christine Fusco, Lourraine Stamets.
Samara Cummins, Krista Reese, Rich Eldredge. Lt. Col. Robert J. McKenna, Cerise McKenna Vablais, PhD, Zach McKenna. Rev. Robert E. Lauder, John J. McKenna. Matthew McKenna, Darla Albrigh, Davd Tuller, Randy Dotinga, Elizabeth McKenna.
Loren D. Bolstridge III.

From my heart, thank you all.

More from Fresh Air: a playlist

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In advance of the Fresh Air interview today, their tweeter(s) asked for suggestions for a MRSA playlist! Here’s some of the suggestions:
Fever, Peggy Lee
Countin’ On A Miracle, Bruce Springsteen
Ready or Not, the Delfonics (or as sampled by the Fugees)
Time to Get Ill, Beastie Boys
Hurts So Good, John Mellencamp (was he John Cougar Mellencamp then?)
Infected, Bad Religion
and of course:
I’ve Got You Under My Skin.

SUPERBUG the book: First excerpt, first interview, and news!

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Constant readers: It’s two weeks to publication, and I’m starting to lose my grip on everything there is to do. (As you might be able to tell by my radio silence…) I’m very backed up on great research to tell you about.

First, though, let me share some book news:

EXCERPT: The first excerpt of SUPERBUG has been published on Simon and Schuster’s website! It looks like the entire Chapter One.


INTERVIEW: I was invited to Chicago the past few days to do a speech for International Women’s Day, and ended up doing some sneak-preview media appearances. Here’s the sound file of an interview with the fabulous Alison Cuddy of WBEZ-FM.

MORE INTERVIEWS: I’ll be listing forthcoming interviews and appearances on my page at BookTour.com. You’ll notice there isn’t much up there yet: We’re still working on publicity. So help me fill this page, OK? Here’s how:


TOUR, A PLEA: My publisher, Free Press, doesn’t really believe in sending authors around. They have some justification: As I can testify from my last tour, sometimes a book tour mean spending two hours making painful chit-chat in an empty bookstore whose entire population is the staff, the friend who drove you, and a street person who wandered in and is conversing quietly with her demons. (Twenty-Third Street Books, Portland, OR, thanks for asking. I hear they closed.) But that bad experience notwithstanding, I believe there’s value in getting out and talking to readers, victims, disease geeks and anyone else interested in this bug, and I’m willing to do it, if you’ll help.

So: If you’re a clinician, a professor, or a teacher, and you’re willing to host SUPERBUG and me at a class, a department brown-bag or a Grand Rounds, please get in touch. Ditto if you run a Cafe Scientifique, have a book club that wants to talk about science or medicine, have a church group, a kid’s group, a med-student society… you get the idea. If I can get there, I’ll come. I know already that I’ll be in and out of Minneapolis and Atlanta, my two home bases, and also in North Carolina, Iowa, Chicago, and I hope San Francisco, Portland and Boston as well. Help me add to the list!

Right, back to research tomorrow.

"Pig MRSA" causing human infections

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Hi, everyone. Apologies for dropping out of sight! As SUPERBUG’s publication draws closer (and it’s very close now), I keep finding new tasks that I have do to. Last week’s was to go to New York to shoot a video for the Simon & Schuster website — and while there, I got caught in Snowpocalypse, got delayed coming home, and picked up a nasty cold. So I’m a bit behind.

But there’s exciting news tonight to start us up again: “pig MRSA,” ST398, causing human infections in Canada and Denmark.

“Infections” is important, because up til now, most evidence for  the spread of MRSA ST398 in humans has been through detection of colonization, the symptomless carriage of MRSA on the skin and in the nostrils. The first finding of ST398 in the Netherlands was via colonization; so was its first identification in humans in Canada, and also in the United States just about a year ago.

[Read more…]

Antibiotics and farming — how superbugs happen

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Constant readers: There’s an important new paper that’s been out for a week that I haven’t gotten to you. I apologize; it’s been busy. (Let’s not even talk about the important paper that’s been out for two weeks. Maybe over the weekend…)

We’ve talked for ages now about the potential dangers of unrestricted antibiotic use in agriculture, and how it’s analogous to the inappropriate antibiotic use that human health authorities disapprove of in humans. The main culprits, in farming, are subtherapeutic dosing, also known as growth promotion — that’s giving routine smaller-than-treatment doses to animals to increase their weight — and prophylactic dosing, which is giving a treatment dose to an entire herd or flock either routinely, if there is thought to be a disease threat, or when there is known to be disease in some members of the herd/flock. In either case, animals are getting antibiotics when they do not need them — when they are not sick. And just as in humans who take antibiotics when they are not sick, or take too-low doses when they are sick (such as not finishing a prescription), these practices in animals encourage the development of resistant bacteria.

(Necessary comment here: No one, to my knowledge, objects to giving the appropriate doses of antibiotics to animals that are sick. Why would you?)

[Read more…]

New film on organic farming (for European readers and Francophones)

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This is a little outside our usual subject matter, but:

What looks like a marvelous new documentary exploring environmental damage and human illness from pesticides and other farming chemicals is coming out in France, but needs assistance to get onto the international festival circuit. It’s called Nos enfants nous accuseront (Our Children Will Hold Us Responsible), and among other things, looks at the efforts of a French village to make all the food served in its schools organic — which, even in food-centric France, is much harder than it sounds.

You can view the trailer here. The more clicks, the more the film will be taken to have support, and the higher its rankings will go for festival consideration.

It comes well-recommended by friends of mine in Paris, so I hope you’ll take a look.

Farming and antibiotics – and voices from the ag side

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The whole issue of how antibiotics get used in agriculture — as growth promoters, as prophylatic treatment to prevent spread of infection within a farm, or as true treatment — is intensely controversial. For a sense of how farmers feel embattled, read the comments to this entry at FairFoodFight on whether there is a distinction between “Big Ag” and “small ag.” and consider that the PAMTA legislation I posted about in December, which would require veterinarian oversight of farm use of antibiotics,  has been strongly opposed by agricultural interests every time it has been introduced. (Large-farm use of antibiotics, let me remind you, has been concluded to be the driver behind the emergence of “pig MRSA” ST398.)

But I recently ran across two pieces online that I want to draw your attention to, because they demonstrate that thinking in agriculture about antibiotic use is not monolithic, and may be changing. Both were posted on the same site, the Illinois-based Agri-News Online.

[Read more…]

Bad news in the President's budget request

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It’s been a few days since the rollout of the White House’s proposed 2011 budget request, time enough for people to dig deep into the minutiae and figure out what that massive document really says. The Infectious Diseases Society of America has done the drilling for the health and infectious disease line items, and I’m sorry to say the news is not good.

Worst first: The proposed budget would cut funding for the CDC’s antimicrobial resistance programs by 50%, $8.6 million. That means that only 20 state or local health departments, or health care institutions, will get money from CDC for surveillance and control of resistant bugs. That’s only 40% of what was funded this year, when 48 health departments and health systems were funded. Which is very disturbing: If there’s one thing almost everyone agrees on with regard to MRSA, it’s that we need more surveillance, not less.

In addition, all state grants in the Get Smart About Antibiotics program, which runs campaigns to reduce inappropriate use, get zeroed out.

There are other cuts as well to infectious-disease program at CDC and elsewhere in HHS, including to to a major childhood immunization program and to pandemic defenses. And funding for HIV/AIDS, TB and other NIH research programs barely tiptoe upward.But these frank cuts in programs to combat antimicrobial resistance, at a time when MRSA is burgeoning, Gram negative organisms such as Acinetobacter are gaining ground, and drug development is stalling, surely cannot be smart.

The IDSA analyis is here.

Back again to MRSA in animals, and spreading to humans

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There are two new reports out regarding new findings of “pig MRSA” ST398 (about which we have talked a lot; archive of posts here.)

First, researchers from the Complejo Hospitalario Universitario de Vigo and Complejo Hospitalario de Pontevedra, both in Pontevedra in northwest Spain, report that they have identified that country’s first human cases of infection with ST398. (It was only last fall that Spain reported the first identification of the strain in animals.)

The age of the three patients was 59, 82, and 83 years, respectively. Two patients owned pigs and the other a calf. Two patients were diabetic and were hospitalized because they developed skin and soft-tissue infections by MRSA ST398. The third patient had bronchitis and the strain was isolated from a respiratory secretion submitted to the laboratory from an outpatient clinic. The three patients had had multiple hospital admissions in the last 12 months.

Tellingly, the researchers spotted these particular isolates (out of 44 analyzed at the two hospitals in 2006) because they were resistant to tetracycline. Tetracycline resistance is not common among community strains of MRSA, because the drug isn’t the first-line choice for skin and soft-tissue infections; and when it is given, it’s usually for a short course, so the drug does not exert much selection pressure on the bug. But tetracycline is a very common animal antibiotic, and tetracycline resistance is a hallmark of ST398; it is one of the factors that led the Dutch researchers who first identified the strain to take a second look at the bug.

Second, researchers from several institutions in Italy report a very troubling case of ST398 infection that produced necrotizing fasciitis — better known as flesh-eating disease. [Read more…]

Once again, flu and bacterial co-infection

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With the H1N1 pandemic trending down, it may seem that the question of how much bacterial co-infection affects the outcome of flu is less important than it was. But though the pandemic is subsiding — for ever, for this season, or just until a third wave, who can say — researchers are just now getting enough good data to be able to make solid observations about what happened during the past 10 months.

Case in point: Writing in the journal Public Library of Science (PLoS) ONE, a team of researchers from Australia has pinpointed the incidence of MRSA co-infection during flu in two hospitals in Perth last summer, which was the Australian winter and the height of their flu season. Of 252 patients admitted for H1N1 infection, 3 were identified during treatment as having MRSA pneumonia. They survived, but two other patients who died were found to have MRSA pneumonia during post-mortem exams. [Read more…]

MRSA in the journal Science – spread, outbreaks and an argument for active surveillance

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I have a story tonight at CIDRAP about a paper published this evening in the journal Science. To respect fair use and make sure my colleagues get clicks, I just quote the story here — but then I want to talk about why I think it’s such an important study.

   A multi-national team of researchers has applied a new genomic tool to a 50-year-old bacterial foe, using minute mutations to track the spread of drug-resistant staph both across continents and within a single hospital.
On a global scale, their sleuthing tracked the movement of one clone of methicillin-resistant Staphylococcus aureus (MRSA) back and forth across the planet, pinpointing when individual cases transported infections across national borders to spark new outbreaks. Separately, their method demonstrated that what appeared to be a hospital epidemic of MRSA was not a single outbreak, but rather a mixed event of patient-to-patient transmission of one strain that was accompanied by multiple importations from outside the hospital of similar but unrelated strains. …
In a briefing yesterday for the press, the authors emphasized the latter finding, pointing out that the traditional infection control measures usually applied to hospital outbreaks would not curb the spread of infections that were carried in undetected from outside. Their method, they said, provides a proof of concept for using cutting-edge genomics to uncover the precise pathways by which MRSA spreads within hospitals—not only tracing its path from patient to patient, but also identifying the bug in patients whose undetected bacterial carriage could spark outbreaks but have not yet.

If you’d like more, here’s a very good story at Scientific American, one at BBC Health and one by the Associated Press; and Science Daily‘s version.

[Read more…]

News round-up!

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As promised, lots to catch up on — so here’s a quick round-up of some great reading that I have been stashing and that you may have missed in the past few weeks.

BBC News: Disinfectants may train bacteria to resist antibiotics
The BBC Health page (bookmark it!) translates a paper from the journal Microbiology on Pseudomonas aeruginosa’s newly recognized ability to pump the active ingredient in disinfectants out of its cells — and then to apply that same ability to the antibiotic Ciprofloxacin, even when it has never been exposed to Cipro before. Money quote: “... Residue from incorrectly diluted disinfectants left on hospital surfaces could promote the growth of antibiotic-resistant bacteria.”

Associated Press:  Solution to killer superbug found in Norway
In the latest installment in a 6-month series, AP writers Martha Mendoza and Margie Mason examine Norway’s success in forcing down rates of hospital MRSA. chiefly by extremely strict control of antibiotics dispensed in hospitals. I have some disagreements with this story; I don’t think they account for how much easier it is to do antibiotic stewardship, as it’s called, in a single-payer health system such as Norway or their second example, England, compared to the extremely complex US system. But I’m very glad to see the AP (and the Nieman Foundation at Harvard, where Mason was a fellow) support public exploration of antibiotic resistance, which I obviously feel gets insufficient attention. (Stay tuned for SUPERBUG’s discussion of one US stewardship program that has worked and may be replicable.)

Time: Should weight factor into antibiotic dosage?
Time.com looks at a provocative new paper in the Lancet that questions whether standard prescribed dosing of antibiotics isn’t really a form of inappropriate use. Money quote: “Dosage according to body mass is standard in anesthetics, pediatrics, oncology and other fields, [but] when it comes to antibiotics and antimicrobials the dosing guidelines are too broad… and may undermine a medications efficacy. …In the face of both widespread obesity and the increasing prevalence of antibiotic-resistance, tailoring dosage for optimal results is increasingly important.”

And finally, new today:
Science Daily: Bacteria Are More Capable of Complex Decision-Making Than Thought
University of Tennessee researchers explore the ability of a bacterium (the soil bacterium Azospirillum brasilense) to sense changes in its environment, process that information and make surprisingly complex decisions in response.

Warning on ST398: Monitor this now

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Drawing your attention: I have a story up tonight at CIDRAP on a new paper by Dr. Jan Kluytmans, a Dutch physician and microbiologist and one of the lead researchers tracking “pig MRSA,” ST398. (All past stories on ST398 here.) It’s a review paper, which is to say that it summarizes key existing findings rather than presenting original research.

Still, it’s important reading because Kluytmans is one of the few scientists who have some history with this bug and understand how quickly and unpredictably it has spread across borders and oceans, from pigs to other livestock, to pig farmers and veterinarians, into health care workers and hospital patients who have no known livestock contact, and now into retail meat in Europe, Canada and the United States.

Take-away: A plea and warning for better surveillance, so that we can track not only the bug’s vast range, but also its evolution as it moves into new ecological niches — including humans who are buying that retail meat and possibly becoming colonized with it as they prep it for cooking in their home kitchens.

To honor fair use (and in hopes you’ll kindly click over to CIDRAP), I won’t quote much, but here’s the walk-off:

Because the novel strain has spread so widely and has already been identified as a cause of hospital outbreaks, it should not be allowed to spread further without surveillance, Kluytmans argues.”It is unlikely that this reservoir will be eradicated easily,” he writes. “Considering the potential implications of the reservoir in food production animals and the widespread presence in meat, the epidemiology of [MRSA] ST398 in humans needs to be monitored carefully.”

The cite is: Kluytmans JAJW. Methicillin-resistant Staphylococcus aureus in food products: cause for concern or case for complacency? Clin Microbiol Infect 2010 Jan;16(1):11-5. The abstract is here.

Questioning meat-raising and meat-eating — in eat-everything France

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Happy New Year, constant readers. I’m honored and flattered to have had the chance to spend the past few years with you here. 2010 is going to be a big year — not just because SUPERBUG will be published, but because the issue of antibiotic resistance really, really is gathering force in the public mind. I not only believe that, I see it in the news that flows through my computer everyday. The wind is shifting.

Here’s one excellent example. In France of all places, a culture that embraces meat-eating and finds the idea of animal rights quixotic, a book has been published that questions the environmental and moral effects of modern factory farming. It’s called Bidoche, L’industrie de la viande menace le monde (“Bidoche” is a slangy, dismissive term for meat), and it has made enough of a splash that the newspaper Le Monde ran both an article on the book and a readers’ Q&A with the author, journalist Fabrice Nicolino. (The article ran two days before Christmas but was called out on Twitter today by Paula Crossfield of CivilEats.com, who spotted it while on holiday, and to whom hat/tip.)

Sadly, the article is behind a paywall; you can see the first 100 words or so here. The Q&A is open though. It’s titled, “To save the planet, should we eat less meat?”and makes fascinating reading (GoogleTranslate into English here), as do the comments, some of which raise the issue of the use of antibiotics in agriculture. But what’s most striking to me is that the conversation is taking place at all, actively and in a public forum, in a place where only a few years ago the local culture would not have been open to the debate. Things are changing indeed.

MRSA in pets – a closer look

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From the research team at the University of Guelph Ontario Veterinary College — who have probably done more than any other group to elucidate MRSA in companion animals — comes a look at MRSA infections in dogs.

In order to get better data, the team used a study model that is much-employed in human epidemiology — and has often been used for MRSA — but under-employed in veterinary medicine: a case-control study matching MRSA infections against MSSA, or drug-sensitive staph. Studies matching MRSA against MSSA have been able, for instance, to show that certain (human) MRSA infections have higher death rates, keep patients in the hospital longer, and cause more healthcare expense.

The Guelph team used the same method to compare the presentation and outcome for 40 MRSA-infected dogs and 80 dogs with MSSA who were seen between 2001 and 2007 in three veterinary hospitals, in Guelph, Philadelphia and Boston. Their verdict:

MRSA is an emerging problem in dogs, and the risk factors for MRSA infections are similar to those in humans, particularly the use of IV catheters and both beta-lactam and fluoroquinolone antibiotics.

The researchers were not able to say whether MRSA in dogs causes more deaths than MSSA, because the infections that were recorded by the hospitals were mostly superficial ones in skin and ears:

Infection types for which death would be a more realistic possible outcome were limited… Comparison of mortality rates between patients with MRSA or MSSA infections would be best performed among on ly those with invasive infections and should be considered for future studies. Here, mortality rate information was obtained retrospectively and only recorded up to the time of discharge. Therefore, whether dogs died from their infections after discharge from the referral hospital, causing an underestimate of deaths, is unknown.

Dr. Scott Weese, senior author of this paper and chief of the Guelph group, has an excellent blog on infections in companion animals, called Worms and Germs. (It’s in the blogroll.) And if you are looking for further information on MRSA in pets, the best resource I know of is the UK-based, but international, Bella Moss Foundation, named for a dog that died of a MRSA infection.

Antibiotics in chickens, and links to human infections

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From the January issue of Emerging Infectious Diseases, published by the CDC (and therefore free. Must I keep urging you to read it? Go, already), here’s a roundup of bad news about bad bugs.

In Canada, researchers from that country’s Public Health Agency have found a “strong correlation” between the use of ceftiofur, a third-generation cephalosporin, in chickens; the rates of a resistant strain of Salmonella in chickens; and the appearance of that same strain in humans. The strain is Salmonella enterica serovar Heidelberg, one of the most common salmonella strains in North America, and one which can be nasty: It may cause mild illness, but also causes septicemia and myocarditis and can kill. Quebec created an unplanned natural experiment: Hatcheries there were broadly using ceftiofur until 2004, backed off from its use in 2005 and 2006, and then began using it again in 2007 in response to a growing problem with a particular infection. When the drug was withdrawn, resistant infections in birds and humans plunged; when it was reintroduced, they rose again. (Look at the black and red lines in the graph above left.)

Meanwhile, broiler chickens in Iceland are passing fluoroquinolone-resistant E. coli to humans there. Researchers at the University of Iceland were puzzled by an earlier finding that bacteria resistant to fluoroquinolones (a family that includes the human drug Cipro) were increasing among chickens raised in Iceland, despite strict controls on antibiotic use in food animals and stringent disinfection in chicken batteries after cohorts of birds were sold for slaughter and removed. They have two findings: The source of the resistant bacteria in the birds appears to be feed contaminated with resistant E. coli; and resistant bacteria in Iceland residents are microbiologically indistinguishable from those in the birds. Because E. coli is a very diverse organism, the very close resemblance between the isolates from chickens and the isolates from humans pins chickens as the likely source.

And just to make clear we’re not blaming every microbiological evil on farming: Seagulls in Portugal have been found carrying multi-drug resistant E. coli in their feces. The public health concern here is obvious: Just think back to the last time you were at a beach, or anywhere else seagulls frequent, and envision a seagull perch — and the masses of seagull droppings streaking it. Now imagine those droppings transmitting antibiotic-resistant E. coli into the surrounding environment: the boardwalk, the beach, the towels… Additional problem: Seagulls are migratory birds, so the resistant bacteria easily cross borders and oceans.