Abstract
“I see resistant staph all the time,” says nurse practitioner Maggie G. Her enormous blue eyes convey both the compassion and the weariness of someone who has seen it all. Over the course of 25 years, the Western Massachusetts nurse has treated farmers, hill-town hippies, and teens seeking treatment for STDs and fevers, as well as men, women, and children who walk for miles and wait patiently with festering wounds and suppurating tumors in the Sierra Leone clinic that she visits once a year. One constant throughout all of Maggie’s experiences is methicillin-resistant staph, or MRSA. Back in the late eighties, when Maggie was just finishing nursing school, MRSA was rare. But over the years she has witnessed the rise of this drug-resistant bug, tending to countless cases—one of the most memorable involved a young camp counselor whose infected toe turned into a life-threatening hole in her heart. When we spoke, Maggie was working with recovering addicts at a psych hospital. MRSA spreads so easily in needle-using addict populations through needle sharing or festering open wounds that Maggie says addicts are often treated “presumptively”—meaning the staff doesn’t always test but assumes drug resistance. It’s a reasonable assumption. In some places, nearly 50 percent of the needle-using population may be positive for community-acquired MRSA.
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Notes
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For more about the history and treatment of MRSA, see: Maryn McKenna, Superbug: The Fatal Menace of MRSA (New York: Free Press, 2010), 1–288; A. El-Sharif and H. M. Ashour, “Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Colonization and Infection in Intravenous and Inhalational Opiate Drug Users,” Experimental Biology and Medicine 233 (July 2008): 874–80, doi:10.3181/0711-RM-294. (“Maggie G.” is a pseudonym.)
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For a review, see: Davies, “Microbes Have the Last Word”; also see: Davies, “Vicious Circles.”
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Bacteria can acquire new genes by engaging in the processes of transformation, transduction, and conjugation. Transformation refers to the direct uptake of DNA from the environment (say, from a neighbor recently broken apart by penicillin). Perhaps for obvious reasons—it is not yet considered a major route for sharing resistance genes. Transduction is the transfer of DNA into bacteria by bacterial viruses or bacteriophages (phages). For example, bacterial viruses carrying resistance were recently isolated from river water and from sewage water, leading some to suggest that phages could serve as an environmental reservoir of resistance genes. For more, see: Marta Colomer-Lluch, Juan Jofre, and Maite Munieasa, “Antibiotic Resistance Genes in the Bacteriophage DNA Fraction of Environmental Samples,” PLoS ONE 6 (March 2011): e17549, doi:10.1371/journal.pone.0017549.
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Another, more complicated role for antibiotics production may be to enable cooperation within a bacterial population—rather than as a benefit to the individual bacterium. Just as our society is composed of warriors and nonviolent members who require protection, so, too, are populations of bacteria composed of antibiotic-producing bacteria and resistant bacteria—suggesting a kind of bacterial “social unit.” For more, see: Helene Morlon, “Bacterial Cooperative Warfare,” Science 337 (2012): 1184–85; and Otto X. Cordero et al., “Ecological Populations of Bacteria Act as Socially Cohesive Units of Antibiotic Production and Resistance,” Science 337 (September 2012): 1228–31.
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The role of indigenous bacteria in health is becoming increasingly important. Illness caused by the bacterium Clostridium difficile, for example, afflicts an estimated 250,000, of whom 14,000 die annually. Antibiotics are a major contributing factor by clearing out the good bacteria, leaving individuals susceptible to infection by C. dif. For more, see: Centers for Disease Control and Prevention, “Antibiotic Resistance.” Also, recent attempts to cure some illness by recolonizing patients with gut bacteria are proving effective. For more, see: “Quick, Inexpensive and a 90% Cure Rate,” For Medical Professionals (blog), Mayo Clinic, www.mayoclinic.org/medical-professionals/clinical-updates/digestive-diseases/quick-inexpensive-90-percent-cure-rate, accessed March 2014.
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Monosson, E. (2015). Discovery: Antibiotics and the Rise of the Superbug. In: Unnatural Selection. Island Press, Washington, DC. https://doi.org/10.5822/978-1-61091-500-7_2
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