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Drug resistant bacteria cause fresh concerns

BMJ 2000; 320 doi: (Published 06 May 2000) Cite this as: BMJ 2000;320:1228
  1. Scott Gottlieb
  1. New York

    Infections caused by so-called “superbugs,” resistant to most available antibiotics, are causing renewed concerns worldwide. Four recent outbreaks of new and more virulent strains of disease caused by contact with animals or contaminated food have been reported in the New England Journal of Medicine.

    “The underlying cause of why these things happen is the changing food supply, growing world population, international travel, and overuse of antibiotics,” said Dr Michael Osterholm, the chief executive officer of Ican, a medical information company and author of an accompanying editorial on the topic (2000;342:1280-1).

    In one of the four studies a 12 year old boy was infected with a drug resistant strain of salmonella bacteria, most likely from infected cattle (2000;342:1236-1241). Although most cases of salmonella do not require antibiotic treatment, the finding worries specialists because the salmonella strain that infected the boy was resistant to the antibiotic ceftriaxone, the drug of choice for serious cases of the illness. Although researchers are unsure exactly how the boy became ill, they found that a bacterial sample taken from him exactly matched one from a salmonella outbreak in cattle near his home.

    In a second study reported in the same issue (2000;342:1250-3), a 12 year old boy with poorly controlled diabetes became seriously ill and was admitted to a US hospital with enteritis necroticans, a potentially life threatening intestinal infection that is rare in the United States and causes severe stomach pain, vomiting of blood, and low blood pressure. The boy eventually had to have surgery to restore his intestinal function, according to Dr Toni Petrillo of Children's Healthcare of Atlanta in Egleston and colleagues. The culprit turned out to be a bacterium that contaminates chitterlings, known as Clostridium perfringens type C, which is typically more common in developing countries.

    In a third study (2000;342:1229-35), researchers reported on an outbreak of 94 cases of viral encephalitis due to Nipah virus in Malaysia, a newly discovered paramyxovirus that was associated with recent contact with pigs. The new virus caused severe and rapidly progressive encephalitis with high mortality and features that suggested involvement of the brain stem.

    Finally, in a fourth study (2000;342:1236-41), contaminated sweetcorn salad served in Italy caused more than 1500 people—mostly schoolchildren—to develop high fevers and diarrhoea. The outbreak was unusual because it was caused by Listeria moncytogenes, a bacterium that is not thought to commonly cause disease in healthy people. The bacteria, which usually contaminate meat products, can cause miscarriage and stillbirth, and serious, sometime fatal, infections in infants, elderly people, and those whose systems are immunocompromised.

    Researchers said that economic factors such as poverty, overcrowding, poor sanitation, and lack of access to clean drinking water or adequate health care, play a key part in the spread of contagious diseases. Overuse or misuse of antibiotics to prevent disease and encourage growth in animals raised for food also fosters the growth of drug resistant strains of bacteria.

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