February 03, 2008
Sunday

At a busy microbiology lab in San Francisco, bad bugs are brewing inside vials of human blood, or sprouting inside petri dishes, all in preparation for a battery of tests.

These tests will tell doctors at the University of California-San Francisco Medical Center which kinds of bacteria are infecting their patients, and which antibiotics have the best chance to knock those infections down.

With disturbing regularity, the list of available options is short, and it is getting shorter.

Dr. Jeff Brooks has been director of the lab for 29 years, and has watched with a mixture of fascination and dread how bacteria once tamed by antibiotics evolve rapidly into forms that practically no drug can treat.

"These organisms are very small," he said, "but they are still smarter than we are."

Among the most alarming of these is MRSA, or methicillin-resistant Staphylococcus aureus, a bug that used to be confined to vulnerable hospital patients, but now is infecting otherwise healthy people in schools, gymnasiums and the home.

As MRSA continues its natural evolution, even more drug-resistant strains are emerging. The most aggressive of these is one called USA300.

Last week, doctors at San Francisco General Hospital reported that a variant of that strain, resistant to six important antibiotics normally used to treat staph, may be transmitted by sexual contact and is spreading among gay men in San Francisco, Boston, New York and Los Angeles.

Yet the problem goes far beyond one bug and a handful of drugs. Entire classes of mainstay antibiotics are being threatened with obsolescence, and bugs far more dangerous than staph are evolving in ominous ways.

"We are on the verge of losing control of the situation, particularly in the hospitals," said Dr. Chip Chambers, chief of infectious disease at San Francisco General Hospital.

Top infectious disease doctors are saying that lawmakers and the public at large do not realize the grave implications of this trend.

"Within just a few years, we could be seeing that most of our microorganisms are resistant to most of our antibiotics," said Dr. Jack Edwards, chief of infectious diseases at Harbor-UCLA Medical Center.

The strategy for nearly 70 years has been to stay a step ahead of resistance by developing new antibiotics. In the past decade, however, major drug makers have been dropping out of the field. The number of new antibiotics in development has plummeted. During the five-year period ended in 1987, the FDA licensed 16 novel antibiotics. In the most recent five-year period, only five were approved.

For drug makers, the economics are simple: An antibiotic can cure an infection in a matter of days. There is much more money in finding drugs that must be taken for a lifetime.

With antibiotic research lagging, the bugs are catching up, and infections are taking a terrible toll. The federal Centers for Disease Control and Prevention estimates that each year 99,000 Americans die of various bacterial infections that they pick up while hospitalized -- more than double the number killed every year in automobile accidents.

Of the 1.7 million hospital-acquired infections that occur each year, studies show, 70 percent are resistant to at least one antibiotic.

Drug-resistant staph is rapidly becoming a major public health menace. Last fall, the CDC estimated that MRSA alone has killed 19,000 Americans. Most of these patients picked up the bug in the hospital, but it is now spreading in urban and suburban neighborhoods across the nation.

The waning of antibiotics in the arsenal of modern medicine has been going on for so long that some doctors fear a kind of complacency has set in. Increasingly, the medical profession is pointing a finger at itself.

"We have behaved very badly," said Dr. Louis Rice, a Harvard-educated, Columbia-trained specialist in infectious diseases. "We have made a lot of stupid choices."

His words brought a nervous silence to thousands of his colleagues, as he delivered a keynote speech in 2006 for the American Society for Microbiology's annual conference in San Francisco.

Rice, a professor at Cleveland's Case Western Reserve University, said doctors and drug companies alike are responsible for breeding resistance by "the indiscriminate dumping of antibiotics into our human patients."

Drug-resistant germs contaminate the bedrails, the catheter lines, the blood pressure cuffs and even the unwashed hands of doctors, nurses and orderlies. The germs keep evolving, swapping drug-resistance traits with other microbes. He likened American intensive-care units -- the high-tech enclaves where the most seriously ill patients are treated -- to "toxic waste dumps."

Drug companies, he said, have a responsibility to refill the nation's depleted medicine chest. He suggested that a tax -- similar to a Superfund tax placed on polluters to clean up toxic waste sites -- be imposed on companies that have dropped antibiotic research. It would support drug makers that are still in the game. "Your products that you've made billions and billions and billions and billions of dollars on have created this problem, and you can't just walk away," he said.

Since drug companies cannot be expected to spend money on research that could trim sales of their products, federally funded agencies such as the National Institutes of Health should do the job, Rice said in a recent interview.

He also took his own specialty to task for failing to protect the most important weapons its arsenal. Infectious disease experts at hospitals must find the "backbone" to stop other doctors from prescribing antibiotics unnecessarily, Rice said. He argued they should assert their authority to control antibiotic usage, just as cancer specialists have a say in which chemotherapy drugs are prescribed by surgeons.

And all health care professionals, he added, "have to wash their damn hands."

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