IRA FLATOW, host:
You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.
Next up, some sobering news about the spread of superbugs in this country. A Virginia high school student died this week from a staph infection called MRSA for methicillin-resistant staphylococcus aureus - the same illness that made headlines for sickening school kids across the country.
The new studies in the Journal of the American Medical Association show just how widespread and serious this superbug problem is. The first says that this bug, MRSA, kills more people each year in the U.S. than AIDS does.
Second document documents the appearance of a resistant strain of pneumonia bacteria in a single Rochester, New York pediatric practice that was also a staph infection. That superbug is giving kids ear infections that cannot be cured with standard antibiotics and in some cases may lead to loss of hearing.
We're joined now by researchers from both of these studies. If you want to talk about the spread of superbugs and what we can do about it, you can give us a call: 1-800-989-8255, 1-800-989-TALK.
Let me introduce my guests. Michael Pichichero is a physician at Legacy Pediatrics and professor of microbiology and immunology at the University of Rochester Medical Center, New York, and he joins us today from office. Welcome to the program, Dr. Pichichero.
Dr. MICHAEL PICHICHERO (Microbiology and Immunology, University of Rochester Medical Center): Thank you very much, Ira. It's great to be on the show. My partner, Dr. Janet Casey, is free on Friday afternoon. She said, oh my God, you going to be on the show with Ira - SCIENCE FRIDAY.
FLATOW: I at least thought I get your name right.
(Soundbite of laughter)
Dr. PICHICHERO: Yes. Michael Pichichero.
FLATOW: Pichichero, Pichichero. I'm sorry about that. But now you've joined this SCIENCE FRIDAY club of people who I've mispronounced their names.
Dr. PICHICHERO: Okay.
FLATOW: So, you really have been inaugurated to the show. Thank you for those kind words.
Dr. PICHICHERO: You're welcome.
FLATOW: William Schaffner is vice president of the National Foundation for Infectious Diseases and professor and chair of the Department of Preventive Medicine at Vanderbilt University Medical Center in Nashville.
He joins us today by phone from Fort Myers, Florida. Welcome back to the program, Dr. Schaffner.
Dr. WILLIAM SCHAFFNER (Vice President, National Foundation for Infectious Diseases): Hi Ira, and hello Mike.
Dr. PICHICHERO: Hi. How are you, Bill?
FLATOW: I'm so shocked that you know each other.
(Soundbite of laughter)
FLATOW: Let me ask you, Dr. Schaffner first. Why this paper on the resistant staph infection, MRSA - so why is it such a big deal?
Dr. SCHAFFNER: It's a big deal because it documents with great certainty that over the past five or six years, this MRSA, MRSA staph infection, has become a major public health problem throughout the United States.
And it documents, really, very importantly that what used to be thought of exclusively as a problem for older frail patients in intensive care units in hospitals has now become also a problem, in fact, in many ways, the more dominant problem of younger people in the community.
So it's a real public health issue today, and public health departments and clinicians, both, need more awareness about this problem as we go forward.
FLATOW: How - did it escape the hospital and spread to the community or is it out there just waiting to show up?
Dr. SCHAFFNER: Two things happened. Exactly as you say, the staph infection in the hospital escaped out into the community. And that's where a lot of us in public health think many of the cases are still related to previous exposure to the health care environment.
But also, we have a new strain of MRSA that's community associated that's spreading in the community causing an awful lot of skin infections. I'm sure this is true and Mike's Rochester. It's certainly true in Nashville. It now causes the majority of skin infections coming into doctors' offices and into the emergency rooms.
And they can get from the skin, the bug can get from the skin, into the bloodstream and then it can cause very serious disease.
FLATOW: Is that true, Dr. Pichichero?
Dr. PICHICHERO: Yes. Monroe County was one of the participants in the same study, and we've seen exactly the same phenomena. You know, for generations, I would say two generations or three of doctors and of patients, the patients have believed that if their doctor gives them what they want - when they come in demanding an antibiotic and the doctor gives it to them, that's good medicine and that's a good doctor. And that's wrong.
The whole problem has been the overuse and abuse of antibiotics, and that has driven the emergence of this MRSA strain into the community, and it's also what's driven the emergence of a superbug ear infection, a pneumococcus, that we've identified here in Rochester, New York.
FLATOW: Now, let me just be fair for a second. I can't let you doctors get away with blaming everything on, you know, the use of antibiotics, because I've heard other doctors say that one of the reasons they spread out of the hospital or spreads around the hospital is because you doctors don't wash your hands enough.
Dr. PICHICHERO: Well, then -
Dr. SCHAFFNER: We'll take some blame for that. There isn't any doubt that within the hospital - although we had done a terrific amount in infection control, we need to do more. And you point to one very simple, but terribly effective infection control procedure, hand washing, that all of us in health care need to do more.
But on the other hand, there now is, especially with MRSA, a new genetic variant of this MRSA that's originated in the community that conspires with antibiotic overuse and lacks infection control to spread. So it's a combination that we…
FLATOW: Let me ask you, Dr. Pichichero, about the ear infections. Is this a common infection that's gone ballistic?
Dr. PICHICHERO: Ear infections are the most common reason a child receives an antibiotic and it's the second most common reason that medical care is sought for a child after the common cold. What we found is it's not common now. Our worry is that the possibility exists that the superbug we found, the Legacy strain we're calling it, could spread to other communities, may actually be in other communities.
And it could spread from the nose and the ears to the lungs and the bloodstream and that could mean possibly drug-resistant meningitis and pneumonia. And we're very worried about that and that's why we took this article to the Journal of the AMA to warn doctors about that possibility.
FLATOW: Well, when you say warn them, what are they to do with that knowledge?
Dr. PICHICHERO: Unfortunately, as our article says, the superbug we've identified is resistant to all 18 FDA-approved antibiotics for kids. They would not normally reach for the adult antibiotic we found effective named Levoquin.
And if they don't think of the superbug and they don't find it in the proper way by doing an ear tap on the child and discovering its presence, that child may end up with permanent hearing loss. And if it spreads to the blood and the lungs, we could be talking about very serious disease here.
FLATOW: So if you're an M.D. or a pediatrician and you see an ear infection come in, you should assume that it might be one of these kinds of bugs?
Dr. PICHICHERO: The pneumococcus that we discovered was 1.5 percent of all ear infections, so no, you don't presume that it's there. You worry about it. And if you treat the child properly with two rounds of antibiotics and they still haven't come around, then you need to do an ear tap procedure or have an ear, nose and throat doctor do an ear tap procedure to pursue the possibility of a superbug, and to determine that it's absolutely necessary to use this off label adult antibiotic to stop it.
And you cannot just go and use that off label antibiotic willy-nilly because we know that the bacteria will mutate again and then we will have no antibiotic to treat these children well.
FLATOW: Wow, so you'd better use it carefully.
Dr. PICHICHERO: Yes, and I think to come back to your earlier comment, Ira, the doctors have capitulated to a society that demands quick solutions. Parents bring their children in with colds and coughs. They want antibiotics. And the doctors find it a lot easier to write a prescription than to argue with the parents or spend time counseling the parent about the fact that colds and coughs don't need antibiotics.
FLATOW: Mm-hmm. Well, Dr. Schaffner, are you as scared as I am now?
Dr. SCHAFFNER: Well, I'm not quite as scared, but Mike is on the right track. And it's a combination here. The doctors have to be willing, they and their staff, talk with patients and educate them. But also, we increasingly need to educate high school kids and young adults.
The high school kids are going to be the parents of tomorrow, that when they take their children or their future children into the pediatrician and family doctor and they say your child has a viral infection and does not need an antibiotic, you ought to be glad rather than grumpy about that even if the child has kind of green snot coming out of their nose. That ought to be something they celebrate and understand.
FLATOW: Good point. Let's go to the phones, David in Jacksonville, North Carolina. Hi, David.
DAVID (Caller): Hey, how are you?
FLATOW: Hi there. Go ahead.
DAVID: Oh, I have a question. I served in the Marine Corps camp in North Carolina for five years and MRSA was always a big issue amongst the Marines in the training pipeline there, coming out of Paris Island and coming up to the school of infantry. So I know the military has been dealing with MRSA for a long time, and I was wondering if that's just connected the same way with - out in the civilian world or is this - has this always been a problem in the military for a long time. And I'll take my answer off the air.
FLATOW: Thank you. Dr. Schaffner.
Dr. SCHAFFNER: They're all related. In the military, you have a lot of people living very closely together, sometimes not under the most ideal hygienic conditions. And they scuff each other up and themselves up in their activity. Same thing happens with football teams, all the way up to NFL, all the way down to high school and pre-high school. So skin injury and personal hygiene are two ingredients that predispose to staph infection. And you will see, going forward, coaches and school administrators paying much more attention to really good personal hygiene in their athletic teams.
FLATOW: And I - there was an article, I think, in the New York Times today about a school hygienist taking a baseball bat into the locker room to make sure that the football players wash those jerseys, and the equipment.
Dr. SCHAFFNER: Wash the jerseys, wash the equipment. But even more important -wash themselves. A lot of these fellows - and they're mostly fellows - they go home without taking a shower. And if they take a shower, they don't use soap. They'll use the same towels throughout the season. Schools may have to decide that they're going to, like the YMCA that I go to, provide towels and the laundry of the towels, and explicit education about hygiene as well as how to do various football plays. All of them are important. If you want to stay healthy to play, you have to develop good hygiene habit and the coaches have to enforce it.
FLATOW: Melly(ph) in Littlerock. Hi, Melly.
MELLY (Caller): Hello. Thank you so much for taking my call.
FLATOW: You're welcome.
MELLY: I have a question. I keep - you know, I always hear about overuse of antibiotics and all these, but what about overuse of, like, antibacterial hand soaps, antibacterial sprays. How could anti - you know, using - because everywhere you turn, it's antibacterial this, antibacterial that. How would that affect these superbugs and stuff?
FLATOW: Well, I think…
Dr. PICHICHERO: This is Dr. Pichichero. Not much at all. The main problem is when you ingest an antibiotic, because there are many more bacteria together that can receive that antibiotic signal, throw off the susceptible ones and leave behind the resistant ones. I don't think antibacterial soaps are a problem, but antibiotics given to animals is a problem that contributes to the resistance issue. So it is broader than the doctors giving the patients, but I believe it's more on the animal area.
And while I have the line, I'd also like to add on to what Bill said. You don't need to have a contact like occurs in the military to get this MRSA. The last case that Dr. Janet Casey and I had last week was a little baby that was only a month old. And the germ got in that little baby's nose, and the kid came in with a reddish nose. And within one day, the whole upper lip had become infected and progressed and we were on the brink of needing to send that child into the hospital.
Fortunately, we thought of MRSA and we used the appropriate antibiotics, and we got it under control. For both the MRSA and the superbug ear infection, both of these stories have to do with changing the type of antibiotic we might normally use to treat these types of infections. And you need to know that there might be a superbug to know that you might need you change, and that's why it's so important for your listeners and for other doctors that know this information.
FLATOW: Well, I want to thank both of you for taking time to talk with us. We're talking about antibiotic resistance of the new superbugs this hour in TALK OF THE NATION: SCIENCE FRIDAY from NPR News.
Talking with Michael Pichichero, physician at Legacy Pediatrics and professor of microbiology and immunology, University of Rochester Medical Center.
William Schaffner, vice president of the National Foundation for Infectious Diseases, professor and chair of the Department of Preventive Medicine at Vanderbilt University Medical Center in Nashville.
Dr. Schaffner is going to stay with us. I want to thank you, Dr. Pichichero, for taking time to be with us. Good luck to you.
Dr. PICHICHERO: My pleasure. Have a nice to the rest of your show and a nice weekend for you and your listeners. Bye.
FLATOW: You too.
Dr. SCHAFFNER: Bye, Mike.
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