MRSA - a ’superbug’ explained

There has been a lot of media buzz about MRSA recently. In a way, it is good that finally some attention is being paid to this problematic ‘superbug’. There should be more health education in this country, as evidenced by the palpable fear spread by these news headlines.

MRSA or Methicillin Resistant Staphylococcus Aureus has actually been around for decades. Humans and microbes have been engaged in an ongoing battle ever since the development of the first antibiotics. Penicillin came into widespread use in the 1940s. Staph aureus or ‘Staph’ pretty soon figured out a way to overcome this ‘poison’ and resistant strains started emerging. Penicillin at first seemed like a ‘miracle’ drug. Patients who were supposed to have died from infections were saved!

I remember an old retired doctor, Dr. Chotkowski, who lived at the end of our street. He described to me his first time using penicillin in 1943 to save the life of a young girl from Staph sepsis. In those days, big doses were given with big needles in the butt. Painful to think of, but at least this girl lived thanks to this new medical breakthrough.

The story of Rose, AIDS survivor

I just had lunch the other day with ‘Rose’, one of my AIDS patients.  It was the greatest thing, to see her – just like a ‘normal’ person. 

Who would believe that just last year, Rose nearly died from a terrible opportunistic infection called ‘Cryptococcus’. 

When Rose came into the hospital, she was thin, wasted and very weak.  She had been having fevers for sometime.  AIDS had been ravaging her immune system and without those defenses, she was extremely susceptible to infection.  Certain types of infections tend to occur in advanced AIDS, and she was now fighting a battle with Cryptococcus neoformans, a nasty fungus.  By the time she came in, this fungus was ‘everywhere’ – it was growing out of her blood. 

We put her on the most powerful medicine we could – amphotericin, or ‘ampho-terrible’.  It was a difficult medicine to take, especially for someone so sick.  Her blood levels dropped to less than half of what they should have been, her electrolytes were profoundly deranged , she felt weak and feverish.  There weren’t any options though – we had no choice but to try and treat her, or face certain death. 

What a save!

A small miracle happened recently.  Actually this one wasn’t really that small – it was ‘huge’ considering the stakes.

 

A middle-aged man, who considered himself otherwise healthy had developed some chest pain after hiking.  He didn’t do anything about it for a whole day such as calling his doctor, which turned out to be a big mistake.  When he finally went to the hospital, the doctors ran a few tests and found out he was having a massive heart attack.  As fate would have it, he survived just long enough for the doctors to start treatment.  If he had waited only a few hours longer, he would have died.

 

The doctors had to perform an emergency surgery to bypass the areas of the heart where no blood was flowing.  He struggled after the surgery, requiring a special machine called an intra-aortic balloon pump to help his circulation.  This type of intensive treatment is very concerning as a lot could go wrong.

 

I got called in on the case because the patient developed pneumonia while on the breathing machine after his cardiac bypass operation.  I’m an infectious diseases doctor, and I knew we had to start some broad spectrum antibiotics, but he was critically ill and I didn’t think he was going to make it.  He had multiple organ failure because of his weakened condition – his heart wasn’t able to pump enough blood for quite some time.  The cardiac surgery and the intra-aortic pump helped, but his kidneys had shut down, his liver was damaged from shock, and he remained dependant on machines to keep him alive…  after all, he remained in extremely critical condition.