The Coming Plague (130 page)
Authors: Laurie Garrett
63
E. Manso, G. DeSio, F. Biarasco, et al., “Vancomycin-Resistant Enterococci,”
Lancet
342 (1993): 616â17.
Lancet
342 (1993): 616â17.
64
Centers for Disease Control, “Nosocomial Enterococci Resistant to Vancomycin in United States, 1989â1993,”
Morbidity and Mortality Weekly Report
42 (1993): 597â98.
Morbidity and Mortality Weekly Report
42 (1993): 597â98.
65
L. L. Livornese, Jr., S. Dias, C. Samel, et al., “Hospital-Acquired Infection with Vancomycin-Resistant
Enterococcus faecium
Transmitted by Electronic Thermometers,”
Annals of Internal Medicine
117 (1992): 112â16.
Enterococcus faecium
Transmitted by Electronic Thermometers,”
Annals of Internal Medicine
117 (1992): 112â16.
66
A. H. C. Uttley and R. C. George, “Nosocomial Enterococcal Infection,”
Current Opinions in Infectious Diseases
4 (1991): 525â29.
Current Opinions in Infectious Diseases
4 (1991): 525â29.
67
R. Pallares, M. Pujol, C. Pen
a, et al., “Cephalosporins as Risk Factor for Nosocomial
Enterococcus faecalis
Bacteremia,”
Archives of Internal Medicine
153 (1993): 1581â86.
a, et al., “Cephalosporins as Risk Factor for NosocomialEnterococcus faecalis
Bacteremia,”
Archives of Internal Medicine
153 (1993): 1581â86.
68
R. Leclerq, E. Derlot, M. Weber, et al., “Transferable Vancomycin and Teicoplanin Resistance in
Enterococcus faecium,” Antimicrobial Agents and Chemotherapy
33 (1989): 10â15; and W. C. Noble, Z. Virani, and R. G. A. Cree, “Co-transfer of Vancomycin and Other Resistance Genes from
Enterococcus faecalis
NCTC 12201 to
Staphylococcus aureus
,”
FEMS Microbial Letter
93 (1992): 195â98.
Enterococcus faecium,” Antimicrobial Agents and Chemotherapy
33 (1989): 10â15; and W. C. Noble, Z. Virani, and R. G. A. Cree, “Co-transfer of Vancomycin and Other Resistance Genes from
Enterococcus faecalis
NCTC 12201 to
Staphylococcus aureus
,”
FEMS Microbial Letter
93 (1992): 195â98.
69
L. Garrett, “Superbugs” (1994), op. cit.; and L. Garrett, “Infection Fighters” (1994), op. cit.
70
S. B. Levy, G. B. Fitzgerald, and A. B. Macone, “
Escherichia coli
Transmission from Poultry to Human,”
Nature
260 (1976): 40â42.
Escherichia coli
Transmission from Poultry to Human,”
Nature
260 (1976): 40â42.
71
A very thorough analysis of agricultural and livestock use of antibiotics and the emergence of dangerous bacteria can be found in Levy's book: Levy (1992), op. cit. Levy has dedicated his professional life to the problem, and the reader would be hard pressed to find a more detailed accounting of the multitudinous ways in which overuse and misuse of antibiotics are dooming the drugs to failure and granting victory to the microbes.
72
H. P. Endtz, R. P. Mouton, T. van der Reyden, et al., “Fluoroquinolone Resistance in
Campylobactr spp.
Isolated from Human Stools and Poultry Products,”
Lancet
335 (1990): 787.
Campylobactr spp.
Isolated from Human Stools and Poultry Products,”
Lancet
335 (1990): 787.
73
E. Pérez-Trallero, M. Urbieta, C. L. Lopategui, et al., “Antibiotics in Veterinary Medicine and Public Health,”
Lancet
342 (1993): 1371â72.
Lancet
342 (1993): 1371â72.
74
E. Pérez-Trallero, C. Zigorraga, G. Cilia, et al., “Animal Origin of the Antibiotic Resistance of Human Pathogen
Yersinia enterocolitica
,”
Scandinavian Journal of Infectious Diseases
20 (1988): 573.
Yersinia enterocolitica
,”
Scandinavian Journal of Infectious Diseases
20 (1988): 573.
75
S. D. Holmberg, M. T. Osterholm, K. A. Senger, and M. L. Cohen, “Drug-Resistant Salmonella from Animals Fed Antimicrobials,”
New England Journal of Medicine
311 (1984): 617â22.
New England Journal of Medicine
311 (1984): 617â22.
76
The
Salmonella
problem was exacerbated by home microwave oven cooking. It turned out that
Salmonella
could withstand microwaves, and reheated meat dishes often proved dangerously contaminated. See B. D. Gessner and M. Beller, “Protective Effect of Conventional Cooking Versus Use of Microwave Ovens in an Outbreak of Salmonellosis,”
American Journal of Epidemiology
139 (1994): 903â9.
Salmonella
problem was exacerbated by home microwave oven cooking. It turned out that
Salmonella
could withstand microwaves, and reheated meat dishes often proved dangerously contaminated. See B. D. Gessner and M. Beller, “Protective Effect of Conventional Cooking Versus Use of Microwave Ovens in an Outbreak of Salmonellosis,”
American Journal of Epidemiology
139 (1994): 903â9.
77
S. B. Levy, “Playing Antibiotic Pool: Time to Tally the Score,”
New England Journal of Medicine
311 (1984): 663â64; Brunton, J. “Drug-Resistant Salmonella from Animals Fed Antimicrobials,”
New England Journal of Medicine
311 (1984): 1698â99; and T. H. Jukes, “Drug-Resistant Salmonella from Animals Fed Antimicrobials,”
New England Journal of Medicine
311 (1984): 1698â99.
New England Journal of Medicine
311 (1984): 663â64; Brunton, J. “Drug-Resistant Salmonella from Animals Fed Antimicrobials,”
New England Journal of Medicine
311 (1984): 1698â99; and T. H. Jukes, “Drug-Resistant Salmonella from Animals Fed Antimicrobials,”
New England Journal of Medicine
311 (1984): 1698â99.
78
J. S. Spika, S. H. Waterman, G. W. SooHoo, et al., “Chloramphenical-Resistant
Salmonella newport
Traced Through Hamburger to Dairy Farms,”
New England Journal of Medicine
316 (1987): 565â70.
Salmonella newport
Traced Through Hamburger to Dairy Farms,”
New England Journal of Medicine
316 (1987): 565â70.
79
L. W. Riley, R. S. Remis, S. D. Helgerson, et al., “Hemorrhagic Colitis Associated with a Rare
Escherichia coli
Serotype,”
New England Journal of Medicine
308 (1983): 681â85.
Escherichia coli
Serotype,”
New England Journal of Medicine
308 (1983): 681â85.
80
S. Ringertz, B. Bellete, I. Karlsson, et al., “Antibiotic Susceptibility of
Escherichia coli
Isolates from Inpatients with Urinary Tract Infections in Hospitals in Addis Ababa and Stockholm,”
Bulletin of the World Health Organization
68 (1990): 61â68; and S. Harnett, “Transferable High-Level Trimethoprim Resistance Among Isolates of
Escherichia coli
from Urinary Tract Infections in Ontario, Canada,”
Epidemiology of Infection
109 (1992): 473â81.
Escherichia coli
Isolates from Inpatients with Urinary Tract Infections in Hospitals in Addis Ababa and Stockholm,”
Bulletin of the World Health Organization
68 (1990): 61â68; and S. Harnett, “Transferable High-Level Trimethoprim Resistance Among Isolates of
Escherichia coli
from Urinary Tract Infections in Ontario, Canada,”
Epidemiology of Infection
109 (1992): 473â81.
Some remarkable E. coli strains emerged in the early 1990s. For example, outside Cambridge, England, two strains appeared on a hospital transplant ward that were resistant to the antibiotic imipenen, as well as cefotaxime, ceftazidime, ciprofloxacin, gentamicin, ampicillin, azlocillin, coamoxiclav, timentin, cephalexin, cefuroxime, cefamandole, streptomycin, neomycin, kanamycin, tobramycin, trimethoprim, sulfamethoxazole, chloramphenicol, and nitrofurantoin. Only one commonly used antibiotic remained effective: amikacin. If the strains became resistant to that drug, they would
be invulnerable to human treatment. See D. F. J. Brown, M. Farrington, and R. E. Warren, “Imipenenresistant
Escherichia coli
,”
Lancet
342 (1993): 177.
be invulnerable to human treatment. See D. F. J. Brown, M. Farrington, and R. E. Warren, “Imipenenresistant
Escherichia coli
,”
Lancet
342 (1993): 177.
In the Netherlands in 1992 a random survey of fecal samples from 310 healthy people yielded 456
E. coli
types, nearly all of which bore some level of antibiotic resistance: 89 percent were resistant to ampicillin, 28 percent to trimethoprim, 80 percent to chloramphenicol. Only 19 percent were still susceptible to all eleven frontline antibiotics, and 14 percent were multiply resistant to four or more drugs. See M. Bonten, E. Stobberingh, J. Philips, and A. Houben, “Antibiotic Resistance of
Escherichia coli
in Fecal Samples of Healthy People in Two Different Areas in an Industrialized Country,”
Infection
30 (1992): 258â62.
E. coli
types, nearly all of which bore some level of antibiotic resistance: 89 percent were resistant to ampicillin, 28 percent to trimethoprim, 80 percent to chloramphenicol. Only 19 percent were still susceptible to all eleven frontline antibiotics, and 14 percent were multiply resistant to four or more drugs. See M. Bonten, E. Stobberingh, J. Philips, and A. Houben, “Antibiotic Resistance of
Escherichia coli
in Fecal Samples of Healthy People in Two Different Areas in an Industrialized Country,”
Infection
30 (1992): 258â62.
And it was clear that plasmids and transposons that conferred antibiotic resistance traits in
E. coli
also commonly carried genes for greater virulence. See J. R. Johnson, I. Orskov, F. Orskov, et al., “O, K, and H Antigens Predict Virulence Factors, Carboxylesterase B Pattern, Antimicrobial Resistance, and Host Compromise Among
Escherichia coli
Strains Causing Urosepsis,”
Journal of Infectious Diseases
169 (1994): 119â26.
E. coli
also commonly carried genes for greater virulence. See J. R. Johnson, I. Orskov, F. Orskov, et al., “O, K, and H Antigens Predict Virulence Factors, Carboxylesterase B Pattern, Antimicrobial Resistance, and Host Compromise Among
Escherichia coli
Strains Causing Urosepsis,”
Journal of Infectious Diseases
169 (1994): 119â26.
81
B. Marshall, D. Petrowski, and S. B. Levy, “Inter- and Intraspecies Spread of
Escherichia coli
in a Farm Environment in the Absence of Antibiotic Use,”
Proceedings
of
the National Academy of Sciences
87 (1990): 6609â13; and M. Singh, M. A. Chaudry, J. N. Yadava, and S. C. Sanyal, “The Spectrum of Antibiotic Resistance in Human and Veterinary Isolates of
Escherichia coli
Collected from 1984â86 in Northern India,”
Journal of Antimicrobial Chemotherapy
29 (1992): 159â68.
Escherichia coli
in a Farm Environment in the Absence of Antibiotic Use,”
Proceedings
of
the National Academy of Sciences
87 (1990): 6609â13; and M. Singh, M. A. Chaudry, J. N. Yadava, and S. C. Sanyal, “The Spectrum of Antibiotic Resistance in Human and Veterinary Isolates of
Escherichia coli
Collected from 1984â86 in Northern India,”
Journal of Antimicrobial Chemotherapy
29 (1992): 159â68.
82
Several other cases of transmission of
E. coli
from manure to humans have since been described. See P. R. Cleslak, T. J. Barrett, P. M. Griffin, et al., “
Escherichia coli
0157:H7 Infection from a Manured Garden,”
Lancet
342 (1993): 367; G. M. Morgan, C. Newman, S. R. Palmer, et al., “First Recognized Community Outbreak of Haemorrhagic Colitis Due to Verotoxin-Producing
Escherichia coli
0157:H7 in the U.K.,”
Epidemiology of Infection
101 (1988): 83â91; and S. A. Renwick, J. B. Wilson, R. C. Clarke, et al., “Evidence of Direct Transmission of
Escherichia coli
0157:H7 Infection Between Calves and a Human,”
Journal of Infectious Diseases
168 (1993): 792â93.
E. coli
from manure to humans have since been described. See P. R. Cleslak, T. J. Barrett, P. M. Griffin, et al., “
Escherichia coli
0157:H7 Infection from a Manured Garden,”
Lancet
342 (1993): 367; G. M. Morgan, C. Newman, S. R. Palmer, et al., “First Recognized Community Outbreak of Haemorrhagic Colitis Due to Verotoxin-Producing
Escherichia coli
0157:H7 in the U.K.,”
Epidemiology of Infection
101 (1988): 83â91; and S. A. Renwick, J. B. Wilson, R. C. Clarke, et al., “Evidence of Direct Transmission of
Escherichia coli
0157:H7 Infection Between Calves and a Human,”
Journal of Infectious Diseases
168 (1993): 792â93.
83
Centers for Disease Control, “Preliminary Report: Foodborne Outbreak of
Escherichia coli
0157:H7 Infections from HamburgersâWestern United States, 1993,”
Morbidity and Mortality Weekly Report
42 (1993): 85â87; and S. Deresinski, “From Hamburgers to Hemolysis:
Escherichia coli
0157:H7,”
Infectious Disease Alert
12 (1993): 81â84.
Escherichia coli
0157:H7 Infections from HamburgersâWestern United States, 1993,”
Morbidity and Mortality Weekly Report
42 (1993): 85â87; and S. Deresinski, “From Hamburgers to Hemolysis:
Escherichia coli
0157:H7,”
Infectious Disease Alert
12 (1993): 81â84.
84
A. D. Russell, “Microbial Cell Walls and Resistance of Bacteria and Fungi to Antibiotics and Biocides,”
Journal of Infectious Diseases
168 (1993): 1339â40; and Columbia-Presbyterian Medical Center,
Infection Control: A Training Paradigm for Healthcare Professionals
(New York, 1994).
Journal of Infectious Diseases
168 (1993): 1339â40; and Columbia-Presbyterian Medical Center,
Infection Control: A Training Paradigm for Healthcare Professionals
(New York, 1994).
85
By 1994 the anti-chlorine sentiment would run so high in the United States that the head of the federal Environmental Protection Agency would advocate a virtual ban on all chlorinated products. Despite objections from industries as diverse as plastics manufacturing, cosmetics, electronics, dry cleaning, and petroleum, the EPA would move vigorously for massive reductions. In addition to public concern about cancer, the EPA would cite evidence that free chlorine ions expelled into the atmosphere acted as ozone scavengers, contributing to the depletion of the ozone layer.
86
I. Amato, “The Crusade Against Chlorine,”
Science
261 (1993): 152â54.
Science
261 (1993): 152â54.
87
Cryptosporidium
are about 4 to 6 microns in size, just a bit smaller than
E. coli
. Most water filters could only screen out organisms and particles of 100 microns or more in size. Disinfection was really the only practical way to sterilize the water.
are about 4 to 6 microns in size, just a bit smaller than
E. coli
. Most water filters could only screen out organisms and particles of 100 microns or more in size. Disinfection was really the only practical way to sterilize the water.
88
E. B. Hayes, T. D. Matte, T. R. OâBrien, et al., “Large Community Outbreak of Cryptosporidiosis Due to Contamination of a Filtered Public Water Supply,”
New England Journal of Medicine
320 (1989): 1372â76.
New England Journal of Medicine
320 (1989): 1372â76.
89
Centers for Disease Control, “Surveillance for Waterborne Disease OutbreaksâUnited States, 1991â1992,”
Morbidity and Mortality Weekly Report
42 (1993): SS5âSS22.
Morbidity and Mortality Weekly Report
42 (1993): SS5âSS22.
90
K. C. Spitalny, R. L. Vogt, L. A. Orciari, et al., “Pontiac Fever Associated with a Whirlpool Spa,”
American Journal of Epidemiology
120 (1984): 809â17; E. J. Mangione, R. S. Remis, K. A. Tait, et al., “An Outbreak of Pontiac Fever Related to Whirlpool Use, Michigan, 1982,”
Journal of the American Medical Association
253 (1985): 535â39; and CDC, “Surveillance for Waterborne Disease Outbreaks” (1993), op. cit.
American Journal of Epidemiology
120 (1984): 809â17; E. J. Mangione, R. S. Remis, K. A. Tait, et al., “An Outbreak of Pontiac Fever Related to Whirlpool Use, Michigan, 1982,”
Journal of the American Medical Association
253 (1985): 535â39; and CDC, “Surveillance for Waterborne Disease Outbreaks” (1993), op. cit.
91
E. Geldreich, “Summary Report: Investigation of the Cabool, Missouri, Outbreak for a Water Supply Connection,” U.S. Environmental Protection Agency, Washington, D.C.
92
Natural Resources Defense Council, “Think Before You Drink: The Failure of the Nation's Drinking Water System to Protect Public Health” (New York: NRDC Publication, 1993).
93
S. B. Levy, “Active Efflux Mechanisms for Antimicrobial Resistance,”
Antimicrobial Agents and Chemotherapy
36 (1992): 695â703; and H. Nikaido, “Prevention of Drug Access to Bacterial Targets: Permeability Barriers and Active Efflux,”
Science
264 (1994): 382â88.
Antimicrobial Agents and Chemotherapy
36 (1992): 695â703; and H. Nikaido, “Prevention of Drug Access to Bacterial Targets: Permeability Barriers and Active Efflux,”
Science
264 (1994): 382â88.
94
J. Lederberg, speech before the Irvington Trust, New York City, February 8, 1994.
95
Gibbons (1992), op. cit.
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