Warning for the squeamish, this is about to get graphic.
Inside Tony Love's fingers they found pockets of puss the size of nickels. There was one in the center of his hand. It was the size of a golf ball. Orthopedic surgeons probed Tony's hips and shoulders with a long, wide boarn needle, looking for infection trapped behind the joints cartilaginous sheaths. His left knee, the one he couldn't bend, was rigid and swollen. When they slid the needle in, puss pushed out under pressure, forcing back the base of
the syringe. They got out enough to fill a baseball. One of the orthopedic surgeons sliced into Tony's left thigh and eased a part the muscles. There was puss underneath them, creamy and dull. There was too much to evacuate through the small incision they had cut, so they kept cutting, looking for the end of the pocket. They laid his thigh open from his knee almost to his hip joint. Wherever they cut they found a dense deposit of puss
wrapped around the bone. They used a tool like a dentist jet to work it free, rinsing the cavity between bone and muscle with high pressure water and sucking the slurry away. The abscess was so deep that they could not trust they had cleaned out all the infection, and so they left the gash open. They wrapped it in dressings that would let the mess drain, and rolled him back to the ICU.
I'm erin Welsh and i'm erin almond updyke.
And you're listening to this podcast will kill you?
Yep.
Yeah, yikes.
That's like pretty gnarly even for our standards.
Oh absolutely wow. So that was a little excerpt adapted from Superbug by Maren McKenna.
Shout out Marey McKenna making it grud.
Oh my gosh. So it's it's part of Tony Love's story, who was a thirteen year old boy from Chicago who in two thousand and seven became infected with a deadly strain of Staphylococcus aureus, the star of our show today. Yeah, and this strain was not only methicine resistant, but also slightly resistant to vankamisin, which is the last resort antibiotic.
But we're going to get all into that, so just wait. So, as you may have guessed, this week we are covering Staphla caucus oreus, specifically MERSA mersa.
What is mersa so mersa is mephicillin resistant Staphylococcus aureus. Okay, we'll get into all of that, but first there's really important business we need to take care of that. It's what we're drinking.
This week is a real doozy. I must say. Yeah, we've outdone ourselves even as.
Far as quarantine needs go for us, Like we've we've tried some things. Yeah, and this time is.
The visual is striking. We encourage you to make this please do, and then please post pictures of it, please do so. We are calling it hard to say without.
Laughing, Fruit of the wound, Fruit.
Of the wound, ladies and gentlemen. So it is a gorgeous looking cocktail.
It's truly something spectacular.
Basically a gin fizz with.
A nice big old scoop of vanilla ice cream on top.
Yeah, so that it slowly oozes down into the blood cavity.
And make sure you top it with a cluster of grapes.
Okay, I guess we should move past what we're drinking. Yeah, and I want to know what is STEPH forrius.
Yeah, let's talk about it. Okay.
So the first thing to know about MRSA, which is its colloquial name, I suppose, is it's it's kind of a weird one for us because most of the time when we cover a disease on this show, we're covering something pretty specific. Right, Tuberculosis is transmitted in a certain way, it causes a certain set of symptoms, blah blah blah.
Right, and this is the epidemic and this is though exactly right.
So MRSA is a little bit different because it's kind of a specific form of a specific pathogen that can cause so many different diseases, as we'll see. So MRSA, we already said it stands for methicillin resistant Staphyococcus oreus. So what is staph oreus? That's the first question that we have to answer, am I right, You're totally right, I know. So staph aureus is a gram positive coxi, which means it's a bacteria that's shaped like a ball.
Okay, Weirdly, usually.
I can say, you know, this bacteria is transmitted in this way like fecal, oral or respiratory droplets.
Right.
These are things that people who have been listening you know these terms, and you're familiar with them, right, But I'm not going to say any of those things right now because the thing about staff is it's absolutely everywhere.
It just exists.
So it's probably on your skin, it's in your nose, it's on your food, it's in your butt.
We're talking staff oreas, not necessarily MRSA.
Right, staff orious. So I'm going to focus on staff Orias for the whole first part of this biology section just so we can get a feeling for what bug we're talking about.
And that would include both strains that are resistant like MRSA, but also ones that are completely susceptible to all antibiotics.
Yes, exactly, staff orioas staff Orius. Yeah, the bigger, big old essay. Okay, So yeah, it's just it's everywhere. It's you know, it's probably statistically on at least one person in this house right now, just living on us.
Yeah, thirty three percent.
Yeah, there you.
Go, boom, way to go. But most of the time it doesn't matter that it's everywhere. It just hangs out. It's like a mutual not even a mutualistic It's just like an organism that lives on you. It doesn't cause you harm. It probably doesn't do much that we know of. It just hangs out and it's fine. It exists as a part of you. But every once in a while
it can cause disease. And honestly, because we try and keep these episodes in an hour, I can't even talk about all of the different diseases that it can cause, because that's just how many diseases staphylococcusorius can cause.
It's so crazy.
It causes these diseases like these, so many different diseases because it where it infects or how it infects or yeah.
Both.
So I'll go through some of the different things that you can get from staff, and then we'll talk more specifically about both MRSA and probably what most people think of when they think about a staff infection. Okay, okay, So first of all, there's a range of different diseases you can get from staff. You can get pneumonia if, for example, you get a viral infection in your respiratory tract that then maybe causes some damage and leaves you susceptible,
like your immune system becomes compromised. Staph oureus that lives in your nose can sort of travel down into your respiratory tract, infect your lungs and cause pneumonia. Boom number one, number two. It can cause pretty long. It can cause what's called acute endocarditis, which acute just means rapid onset, which in this case also means more serious. Doesn't always.
It can cause like a rapid onset that endocarditis, ENDO means inside card means your heart, like cardio itis is inflammation, So we're talking inflammation on the inside of your heart.
Okay, that sounds pretty pretty dangerous.
It's pretty bad.
And we're not even talking about whether or not it's susceptible to antibiotics. This is just stapf orous grabbing on to your heart valves. No big deal, No big deal, Well big deal.
Actually it's a huge deal. It's quite a big deal. Uh. Yeah, So that can happen.
Uh. It's especially common in IVY drug users because staff can live on your skin. So if you inject into your veins through your skin, that bacteria can travel straight to your tri cuspid valve and grab hold fun.
Try cuspid valve is in your heart, in your heart.
Yeah, yeah, that's in your heart right side.
Pretty cool, all right?
Number three disease. It can also cause osteo myelitis.
Break that down for me.
Osteo bone Okay, Mile, I guess you don't know about that one. Ignore it itis inflammation.
Bone inflammation.
I really wanted to on Mile too.
I mean, like Mile, like mayle In is sheath, so it must be sheath, I think, because I do think it. It affects like the very first layer of your bone. But it is like a bone infection that it can cause, super common in children. Probably what uh, your friend Tony Tony Tony Love not actually friends, but you know what I mean, our first hand account, our first Tony Love most likely had some form of osteomyelitis based on his symptoms.
God sounds terrifying. It is.
It's super scary, especially because in like super young kids, you'll just have this like crazy joint pain. And you know, if you're a parent or whatever, you're like, what could possibly be wrong? Like you might not have any visible outer issues, Like you had a scrape a couple of weeks ago that completely healed, and now all of a sudden you can barely walk because your knees infected with staff oreas.
Kids are scraped all the time, they're rough and tumbled like you, I can't. I still have gravel embedded in my knees. I have some in my head, and so to think like, oh, well that must be the cause of it.
Oh it's crazy.
Yeah. It can also cause various forms of arthritis. So if it infects your joint rather than your bone directly, yeah, it's everywhere.
Also not done.
Staff Orias produces several toxins, right, so each of those could probably like we could have a whole episode on all the various toxins that staff Orias produces. But some of them you've probably heard about. So one of them is an exfoliative toxin. Doesn't that sound nice? It's foliant, great for your skin. Sure, Nope, it causes like your skin to just sluff off.
I don't like the word sluff sluf.
That's the word I'm gonna use. Yeah, it can also cause have you heard of it? Toxic shock syndrome? Oh yeah, oh yeah, that's staph orious bip. We're not going to get into soups detail about it because like, again, it could be a whole episode, but it's basically a toxin called it's called a super anigen because it basically makes your it's an anigen, which is something that that your body reacts to and makes antibodies against, and it makes your body make so many antibodies, like it is like all.
The antibodies come to me.
And so then your body goes crazy and it goes into shock because you just have so much immune system action that your body is like, can't just your immune system goes crazy kind of And that is from staph orious.
Can I ask a stupid question?
Of course?
What is going on biologically with shock?
I feel like that's a whole. That's a whole, but like, give me the So there's a lot of different forms of shock. There's septic shock, which usually is from some kind of bacterial infection, and then there's also things like cardiogenic shock, hypovolemic shop shock. All of these basically involve
a drastic drop in blood pressure. So that's the underlying mechanism that's going to make you end up dying, is that your blood pressure essentially plummets, and then your organs start to fail because they're not getting blood perfusion to your organs, and then you die.
Okay, yeah, cool, right.
So toxic shocks and toxic shocks in wonderful.
So shock induced by a toxin not done, by the way.
Oh god, there's more.
There's another toxin that it can produce that causes very rapid onset food poisoning. Drink that drink, air, and drink that drink. You're probably fine.
Oh god, as the as the ice cream curdles.
It does, it is curdling.
But yeah, this food poisoning is like super super rad rapid onset, like within one to eight hours. Because what's basically happening is if you leave out a plate of let's say, spam and eggs, because that's a really good example, or for you Midwesterners, potato salad, okay, potato salad, mac salad, anything mayonnaise, meat.
Anything that's called salad only because it has mayonnaise added to it.
Yeah, yeah, truth, yeah yeah, salad, tuna salad. Yeah, you leave that out on the counter. It's covered in staff oreos. It's everywhere that staff aureus starts producing a toxin and then it just sits there. So then you're like, oh, I forgot, I'll put this back in the fridge. It doesn't matter. The toxin's already there. And then you're gonna eat that mac salad because it was so good yesterday.
And then eight hours later you're barfing all over the place and it is preferentially barfing and not diarrheating.
So interesting. Okay, yeah, okay, So if you ever have food poisoning, barf.
Yeah, like super right after you ate something where you were like, I probably shouldn't have eaten that. Oh god, probably it was my wrap.
Today you're not barfing.
Yet, not yet. It's almost eight hours.
Yeah, So that's a lot. That is a lot, and there's one more. This is crazy, isn't it crazy that all of these different things can be caused by the same bacterium.
It's bizarre, is what it is.
It's so it is so so interesting to me. But probably the most common thing that people associate with staph infections. I know what I used to associate with staff infections goes a little something like this. I saw a bump. Maybe it was on my butt, maybe it was on my arm.
I don't know. I just had a bump.
I thought it was a pimp, so I tried to pop it, or maybe I thought it was a bug bite, but it didn't itch. So I was like, that's kind of weird, huh. But it's just like a bug bite, it's fine, it's gonna go away.
Maybe a spider bite.
Maybe definitely a spider bite, but it wasn't. And then it just didn't go away. And then the next day it was kind of bigger and it was kind of like leaking and oozing. And then the next day my entire butt was covered in a giant, bloody pussy absss. It was just oozing and it was bleeding. Oh God, this did not happen to me, by the way I'm saying me, but I'm just saying the royal me.
It could have.
It could have.
Luckily it hasn't as much as I'm willing to say at least. But that's sort of the classic staph infection, and that would be a staff skin infection. Okay, Right, So staff gets into any kind of open wound, super common to happen after shaving, where you get like infected hair follicles.
Stop shaving your puobes peopes.
Seriously, seriously seriously. And yeah, and so that's kind of the prototypical staph infection.
YEA, that is skin infection.
You end up with this open, absessing wound that kind of just doesn't heal and maybe keeps growing or maybe kind of stays the same size but just doesn't heal. Like you put neosporin on it and it just doesn't go away. So that's super common, and that's staff areous. How crazy it is that staff can infect so much of your body? Yeah, right, like so many different parts. So one of the questions is how on earth can it actually do that?
Right?
Like, how can it infect your lungs and give you pneumonia but also give you a skin infection? Like that's weird.
It's like the jack of all trades bacteria.
Yeah, it really is.
So there's a few different and it manages to do this and it mostly just centers around evading your immune system full stop. Okay, it's just kind of really good at that. So one of the things it does is produce exotoxins, which we already talked about, right, some of the toxin mediated diseases like toxic shock syndrome and barfing food poisoning for example. Okay, but it also has another way that it is able to cause disease, and that's
by this particular surface protein that it has. It's called protein A, which is not creative, but it basically is just a protein that is really good at both evading our immune system, So it's good at hiding from our immune system and it's really good at invading our epithelial cells. And epithelium are the cells that line basically everything in your body. So your skin is epithelium, but also the inside of your lungs that's epithelium, The inside of your
heart also epithelium. Your entire GI tract also epithelium. So this protein allows it to invade those cells very very easily.
Okay, So this bacterium lives on the surface of a lot of our body, Yes, but it also possesses the key to invade the surface of our body.
Yes.
That seems highly sus right.
It is. It's a highly sub.
I think I use that perfectly correctly, perfectly correctly. So can we talk for a second about resistance.
Yeah, that's I think what we need to talk about now. Okay, So, yeah, so Mursa is a resistant form of this horrible staff bacteria that we've.
Been talking about.
So antibiotic resistance in general just for people who might not be aware. Just means that when you try and give somebody an antibiotic, which normally would help cure an infection of bacteria, it doesn't work.
Okay.
MRSA happens to be a strain of staff aureus that is resistant to what are called beta lactam antibiotics, which means like methicillin, penicillin, a bunch of the sillins, silins, ellins, chillins. And the way that it does that, it's basically just changes a protein so that the antibiotic can't bind.
To it anymore. Okay, it was pretty much it.
But I know the question that you want to know is how on earth can it become resistant?
Yeah?
Right, like, how how does that happen? I want to talk for like an hour about this.
Oh that sounds like a great idea. Should we maybe do a future antibiotic?
I think, yeah, We're going for antibiotics, antibiotics and antibiotic resistance because it is really fascinating the way, like the evolutionary arms race that happens between a bacteria and what you treat it with. Most of the antibiotics that we have actually come from other bacteria. Or fungi or plants. So these are substances that are produced in nature in
order to fight off bacterial infections that invade them. So whether it's a bacteria fighting off another bacteria, or a fungus trying to fight off a bacterial infection.
Or what have you.
And so bacteria are constantly evolving ways to fight off these defenses, and then other bacteria and funguses and plants and people are constantly evolving ways to try and fight off those bacteria. But basically what can happen is that once you get a mutation, for example, in the case of MRSA in this single protein, essentially you can then change this protein just enough that this antibiotic can no
longer bind. Once that single bacteria has that protein, anytime you give it penicillin or methicillin, it's gonna survive, which means it's gonna still hang out in your body and reproduce and reproduce. So now that the new colony that's in your body now or in your nose is now all of them are resistant. And even if you have other bacteria, like let's say you've got like six different kinds of staff living on your body, because that's not insane.
Staff is everywhere, right, Once you start hitting those staff with an antibiotic, if there's one that happens to be resistant, bacteria can do something called conjugation, which is kind of like bacteria sex yep. Basically they can give each other the ability to also resist penicillin, and so it can spread both by a single bactium replicating, but it can also spread from bacterium to bacterium via conjugation.
And it's really more it becomes a numbers game. Yeah.
Absolutely, you just have.
So many bacteria reproducing or replicating that one just by probability, Yeah, to evolve that mutation exactly right, or it's going that that mutation will emerge and then it will.
Spread in that population. Yeah, yeah, yeah exactly. So yeah, that's pretty much. That's pretty much MERSA in a nutshell. It's not an all bad news game because most MRSA is still susceptible to another antibiotic called vanko mycin.
Okay, okay, so we it's not.
Like we've run out completely of treatment options, but yeah, I mean that it's it is really scary because if you don't identify an infection as a MERSA infection and you start treating it with penicillin or methicillin, it's not going to do anything, and in some cases it might make it worse because now you're going to have, you know, your resistant populations spreading that gene to susceptible populations within
a single individual. So tell me, Aaron, how did we get to this horrible, horrible place.
It's a great question. Do you remember the first time that you heard about MRSA.
No.
I don't remember like the first time, but I feel like when I was in maybe middle school or high school, it started to be talked about a lot.
Huh.
I think I didn't hear about staff infections until I was in college and I wanted to go to Marea to do work and my mom was like, ya, just gotta staff infaction from my coral And I was like, Okay, why.
Is mother's No. I remember hearing it, probably on like Channel one News or something like that, but I remember all of these scary headlines about locker rooms and Jim Matts and the pimple that brings death. And I feel like a lot of these headlines focused on individual stories of parents losing a child or someone losing an eye or a leg or something like that. I feel like there was this larger story to it where MRSA seemed
to represent the failings of modern medicine. It was this wake up call where suddenly we could no longer rely on the antibiotics that we had taken for granted in
some ways over the past fifty or sixty years. It was kind of like we were being sent back in time before for antibiotics, you could easily die from that scratch on your leg that you got walking through some bushes, a little swelling, a little redness, a little fever, a lot of pus, and the next thing you know, you could be dead from systemic infection.
Yeah.
And if you were unfortunate enough to have surgery in pre antibiotic days, forget.
It, like you're gone or dead.
You're gone or I don't know how anyone survived surgery. But infection was such an everyday part of life that we don't really have a written history of something like staph oreus the way we do for the other big names and infection.
Yeah, that makes sense.
So let's go back to around eighteen eighty. I know that you're gonna be thrilled with this. I'm always thrilled because you are a Scottish man. Oh my god, you've been practicing for this. I had an amazing mustache church. You can say the one word that you know how to say in my Scotch accent. So you are a surgeon and professor I at the University of Aberdeen. I and your name Alexander Augusten.
I'm not even gonna try to do that in a scent.
You're welcome everyone.
Yeah, now I've listened to it. It's pretty bad.
It's awful.
It's really bad. Not that I could do better.
But but why do I keep trying?
Is the question? But I will continue anyway.
Okay, So you happen to be one of the surgeons who got into medicines that you could help people and improve their lives, which is great, But there's one problem. About half of your patients seem to die after you stitch them back up. I now, as part of your quote med school training, you have been told that pus production from the incision site is an essential stage in the healing process. Oh, but something about that doesn't sit right with you. In your search to try to find
out how to quote do no harm. You come across someone named Joseph Lister.
Love him right.
Joseph had this crazy idea that maybe surgical tools and wounds should be cleaned before and after surgery.
It's so fun to think of how novel this, I mean, it's not even novel.
It was revolutionary.
Yeah, it was completely yeah yeah. But that also he also thought that maybe a seeping wound wasn't a good thing. You know, you decide to try out his approach, which was applying carbolic acid to wounds, which had been shown to be pretty dang effective. And it works for you too, congratulations.
Thank you.
And you actually become such a fan of the practice that your students make up a song about it.
Do I get to sing it?
Yes?
Okay?
And so the song goes like this, sing it the spray, the spray, the antiseptic spray. A oh would shower it morning, night and day for every sort of scratch where others would attach a stinking plaster patchy gave the spray.
I think it was sticking plaster. Pet Is it stinky?
I don't know? It does say sticking?
Good enough enough? Good enough?
It probably stunk if we're being honest.
Oh, yeah, absolutely, that was amazing.
Thank you. That was a beautiful song.
If I do say so myself, this is pretty great, wonderfully done.
So yeah, lister thinks that the wounds are putrefying because of bad air.
M he's close.
You, on the other hand, are a bit more forward thinking and suspect that it's some kind of infection. So one day you take some puss from an abscess on one of your unfortunate patients and smear it on a microscope. Slide under the microscope, you see some round clusters of
cells that look like grapes. Later you journal about it. Quote, my delight may be conceived when there were revealed to me beautiful tangles, tufts and chains of round organisms in great numbers, which stood out clear and distinct among the pus cells and debris.
I love it.
Yeah. The name staphlococcus is given to the bacteria staphile, from the Greek meaning bunch of grapes and caucus meaning berry. Later, aureus is given to the staff's species that grows yellowy clusters on a plate oureous from the Latin orum meaning gold gorge. There you go, Okay, enough etymology, though clearly you are thrilled about this finding, and you figure that the rest of the medical establishment would also be pretty pumped. Right. No,
they're not not at all. They're skeptical and resistant to any challenge to the long held view that infection was just a natural part of wound healing typical. So you have to perform a public presentation of your research to prove that you covered all your bases and went through all of the postulates, and finally they accept that you might beyondto something and you get all the praise and
blah blah blah blah. Okay, So at this point, it's eighteen eighty one, and microbiology is an exciting new field to be in. New bacteria and parasites and viruses are constantly being described, and vaccines are in the works and being really least and so on. In the first half of the twentieth century is also where we see some really amazing medical developments that seem like magic for both
patients and doctors. In nineteen forty one, penicillin, which is an episode in its own right, begins to be used to treat infections of all kinds. At first just soldiers in World War Two, just restricted to them. But a few years later it begins to be widely distributed to the public and it was viewed as this wonder drug.
Which it really was in the forties.
Nineteen forty I think four was when it was distributed to the public.
That is insanely recent.
Yeah, very recent. So before penicillin, eighty to ninety percent of people who had staph areas bacteremia infection of the blood died eighty to ninety percent Jesus see. And I don't have exact numbers for the number of people every year because again, like I said, it was such this it was a common thing, but it wasn't It didn't happen in outbreaks and cluschase, and so you didn't write it down.
Yeah.
And it also wasn't a single disease, right, It was like people were dying from staff Orius, but from so many versions of staff Orius.
Yeah, yeah, it was really hard to keep track of.
Yeah.
But anyway, after the introduction of penicillin, those deaths due to any version of staff Orias dropped hugely. Man In addition to a lot of other bacterial infections. Penicillin became the default treatment for many infections and was handed out like candy at Halloween. You could get penicillin in the grocery store without a prescription, without any information or instructions on how long you should take the pills, how many
each day? Oh my gosh. H and its early effectiveness led to some hygienic practice is falling by the wayside.
Oh no.
So basically, now that you could cure these common infections, focus shifted away from prevention and more towards treatment, not consciously necessarily, but just because prevention was no longer as crucial as it once was.
Wow.
And as you can guess, the overuse and misuse of penicillin even in these early days led to resistant strains of staff areas popping up and spreading almost immediately after penicillin was introduced, like really almost immediately.
Yeah, I mean even currently, it only takes like a matter of months to a couple of years for resistance to develop to new antibiotics.
Yeah, it's insane.
It's insane. Within five years of penicillin being introduced, fifty percent of staff oreas strains that were isolated were resistant, and that number would just continue to climb.
Oh my god.
So sitting here now seventy years later, it's easy to go, well, yeah, duh. Of course antibiotic resistance evolved. Look at how you dosed people, look at how you were irresponsible. I can't believe the lack of.
Fuer side everything wrong, right.
But it's I think it's really worth noting that the threat of resistance had been recognized almost immediately by many people really oh yeah, including Alexander Fleming, who was the dude who discovered the mold that made penicillin.
Wow.
So in nineteen forty five, in his Nobel Prize acceptance speech, he said, quote, there is the danger that the ignorant man may easily underdose himself and, by exposing his microbes to non lethal quantities of the drug, make them resistant.
WHOA yeah, so right, like right, literally right out of it.
He had already been thinking about this clearly for years.
He's like, guys, listen, seriously, I know this is great noll, but we can't mess it up. And then people were like, yeah, cool, wait, great, by take your price piece, right. Yeah.
So, despite this warning, by the mid nineteen fifties, penicillin resistance staff had become a public health crisis around the globe.
In Australia, women who had just given birth were showing back up at the hospital with their severely sick newborn, covered in broken blisters or blue with pneumonia, and the mothers were often sick themselves, with open weeping abscesses on their breasts often no yeah, and the strain of staff causing these infections proved to be both extremely infectious and extremely resistant, not just a penicillin, but to many of the other antibiotics that had been developed at that point.
Oh no.
And it didn't take long for these outbreaks to appear in the US, and the thousands of cases and dozens of deaths prompted an emergency meeting of the American Medical Association. Something had to give, better hygienic practices, better drugs, and definitely better record keeping. It wasn't a reportable disease. Yeah,
staph infection was normal. This was something of a rude awakening to hospital physicians everywhere, especially those who had joked that infectious disease doctors would soon be made obsolete by antibiotics.
Never.
No, really, never.
I'm counting on that for a job, quite honest.
Many hospitals instituted practices and appointed committees specifically to control the spread of this resistant Staph aureus. Newborns were placed into infected or uninfected rooms based on whether they showed any signs of infection. WHOA, but it wasn't working. No cases were still on the rise, and babies that had no apparent contact with an infected person were still becoming infected. This infection was such a problem for newborns because newborns are so fresh and new.
I thought you're going to say, so fresh and so clean, clean.
Fresh and so clean clean. So when they're born, their skin and mucous membranes are immediately colonized by bacteria from their mom's vaginal canal, from breast milk, and from the surfaces they encounter after birth. And this goes towards building the microbiome of this tiny human. But there's still a lot of open territory for other potentially harmful bacteria to colonize. And this resistant steph Oreus strain was so infectious and such a fast grower that it pushed out all the
other bacteria and basically became the microbiome. Whow So, what on earth do you do about a bacterial strain that wipes out all competition instantly? And is untreatable by the drugs.
You have, you come up with new ones, well, or you die.
There's a third option. Okay, so what does seem pretty hopeless? But one doctor had an idea. So this guy was named Heinz Eichenwald, and he remembered an old practice that was used to get rid of diphtheria infections from carriers of the disease in days before the vaccine. It was called bacterial interference. Yep, you're pretty.
Thrilled, shaking with excitement.
So the idea was that you expose these people to a different harmless bacterium that's a better competitor than the one causing the problem. This new bacterium then takes over and pushes out the harmful one, and voila infection. Gone.
I love it, clean, classy.
It's really innovative. Yeah, and very much in line with some technologies and treatments that are becoming popular nowadays, which is why I spent so much time talking about this.
And also what year is this again?
This is in the late nineteen fifty.
Okay, wow, so this is like still super early on, like even antibiotics are pretty brand new.
Yeah.
Well, and I think it's really fascinating that bacterial interference was developed in like nineteen the early nineteen hundreds, like nineteen teen. Wow, I think before the dip theory of vaccine was invented in nineteen twenty.
Cool.
So yeah, it's just very it seems very forward thinking. Yes, yeah, very cool. People stopped using bacterial interference in the nineteen twenties when the dip theory of vaccine was released, but Eichenwald hadn't forgotten about it, fortunately, So he set out to find a strain of staff that was more infectious than the drug resistant staff strain but not harmful, and once he found it, he set to exposing these newborns to the new strain. It was a pretty revolutionary idea
for the time, but people were desperate to try anything. Yeah. Lives had been really ruined by this persistent infection showing up. Children who were infected weren't allowed to go to school. At least one couple had divorced whoa over it. Yeah, But eichenwald strain worked. The deadly infection was eliminated. It was miraculous.
Wow.
And for the next few years it was used occasionally to treat stubborn infections.
That's pretty cool.
Yeah, But bacterial interference once again slipped out of practice in the late nineteen fifties when a new antibiotic was released. Here we are nineteen fifty nine, well into the history of staff orias, and I haven't yet introduced you to who was, in many ways the star of the show,
methicillin methicillin resistance staff orias. The new antibiotic that I just mentioned was methicillin, and when it was released it was advertised as quote effective against all resistant staffholcocky resistance unlikely to develop.
It, oh dear.
Within a year of its release, resistance to methicilline had already been found, and by the nineteen seventies, MRSA was widespread in hospitals in the UK and making its way to the rest of the world, and cases weren't appearing as one offs. It was more like a wave of infection. It would start off slowly with just a few people infected, and then it would rapidly jump across hospital units, affecting the most vulnerable patients, like those just out of surgery
or with severe burns. Deaths from MRSA were becoming more common, and the periods between MRSA outbreaks were becoming shorter and shorter, and while MRSA may have popped up a bit later in the US and in some parts of the globe,
it made up for lost time. In nineteen seventy five in US hospitals, two point four percent of strains were methicine resistant, in nineteen ninety one thirty eight percent, and jumping ahead of it in two thousand and three, sixty four point four percent in ICs intensive care units.
Of just like when they swabbed, like the equipment that's in there.
Or it's yeah, I think it's like of all isolates from laboratory isolets, from hospitals. Yeah, MRSA was becoming the new norm, and it's spread and persistence was helped along
by the hospital setting itself. In a hospital, nurses and doctors are constantly on the move between rooms, between floors, different units, and while hygienic practices like hand washing and isolation work to a certain degree, MRSA is also carried really easily on the surfaces that we don't really think about as much, like your nose, well, yeah, a doctor's coat, Yeah, the pen that a nurse or a doctor carries from room to room ties, brought ties ties are found to
be like one of the most like they're very ridden.
They're very controversial right now in medicine.
Well, it's funny. Even bed curtains were found to be ridden with staff MRSA. So these people were unknowingly spreading the infection around the hospital, between hospitals and so on. And because hospitals are filled with people in poor health vulnerable to infection, the bacteria found easy marks. Thousands of people every year suffered MRSA infections that they had picked up at a hospital or nursing home, and many died.
And I don't use the words suffered lightly because for many people this was at least a life altering and often a life ruining infection. Recurrent MRSA infections are really common, and you can go from seemingly healthy one day and on death's door in what seems like a matter of hours without a whole lot of warning or a whole
lot of like whoh obvious for risk factors whatever. So I do want to mention that several countries such as Denmark, the Netherlands, some Nordic countries in force really strict hygienic practices that greatly reduced MRSA infection incidents compared to other parts of the world, including the US. Yeah, so they were like very.
And we're gonna this thing in the butt, wash your hands, no worse serious.
Yeah, really's and it really reduced, yeah, disease incidents. But in the other places, MRSA infections and hospitals became so frequent that it was basically second nature to look for signs of infection and jump on treatment right away, often relying on vankamycin, which is the antibiotic that MRSA was
still susceptible to, which sometimes worked and sometimes didn't. Yeah, but being in a hospital meant that you were simultaneously in the worst place you could be because MRSA was everywhere, but also the best place for rapid diagnosis and treatment, because MURSA was a hospital infection.
Right right, right right, Yeah, I mean.
Yeah, sure, for a while, it was until it started popping up in the nineteen eighties in a few people here and there who had no history of being in a hospital or nursing home or similar setting. But when these people showed up at the er with an extremely painful pimple or rash or something, else, MRSA wasn't at the top of the list of possible causes, and so people were often misdiagnosed and sent home without the immediate
medical care and abscess cleaning that they needed. And it took a while for MRSA to be recognized as something that you could pick up outside a hospital setting, but eventually MRSA infections became grouped into either hospital acquired MURSA or community acquired MRSA, and these labels existed not just for patient history, but also because the strains were noticeably different. Hospital strains were all very similar to one another and
were resistant to many different antibiotics. Community strains, on the other hand, tended to be much more diverse, resistant to only a couple antibiotics, but extremely virulent and infectious.
WHOA interesting, Yeah, logical?
Actually, yeah, exactly.
And so by the early two thousands, which is when I was in high school, a large proportion of all MRSA cases were community acquired an Epidemiologists had traced the source of many community outbreaks to places where staff thrives, warm, moist, full of people, So places like gyms and locker rooms. Right, so, young athletes showing up to the hospital complaining of a sore ankle and within a few hours lying on operating table while a surgeon scrapes away infected tissue and washing
puss off leg bones. You know those kinds of places. That's what happened. Once this pattern of MRSA showing up in athletes was a parent, many schools and gyms and professional athletic organizations took steps to prevent infection. No more sharing towels or razors grows and both counts. Anyway, who shares razors? Nast I don't know, but apparently it was a problem.
Groad.
Don't do it. If you do it, no judge, but don't.
Do it, judge, I'm judging.
Also regularly cleaning surfaces, but with antibacterial soap, hand washing soap available, you know, just basic hygiene stuff. And this really did help decrease cases of MRSA in these places.
But the thing is is that not all school districts or gym facilities or other high risk places like prisons can afford to maintain these practices, and so we see again these health disparities arise, which are then reinforced by the fact that poorer people are at higher risk for infection, so they have to spend more money and treatment, which in the US is often very expensive, and then the cycle just sort of continues. It's this positive feedback loop.
For a while, the distinction between hospital acquired and community acquired MRSA was very important for treatment and for predicting the severity of the infection and where it might go. And doctors and researchers began to worry about the rise in community acquired mercy cases, not just because it caused deadly, horrific infections that were difficult to treat, but also because they were worried about what would happen if, to quote
the Spice girls to become one. So if hospital acquired MRSA and community acquired MRSA met and exchanged genes, and so if the hospital strain transferred some of the super resistance to the community strain, or if the community strain kicked over a few genes for toxin production, Yeah, yeah, problematic, very well, as you can probably guess. It was just
a matter of time. Yep, two did indeed become one, and a distinction between a hospital or community acquired became less important, Rather worrying about whether we can actually treat This thing became the primary focus because a few cases
of MRSA earned a new name VISA or versa. Uh, and those mean either vancom ion intermediate or vancom icein resistant staphorus, basically distinguishing between the different levels of resistance for this level of staphoras against vancomycin, which had been used as the last resort antibiotics.
Right, So whether like using vancomycin could kill it at all or whether you just have to intermediate would be you'd have to use like a really high dose of vancom issin.
Right, And because MRSA is still treatable with antibiotics, yeah, we mostly, but VERSA and VISA no. So yeah, these these infections were truly terrifyingly untreatable. Staph areas had come full circle so earlier. When I was researching this episode, I kept telling you that this is probably the first time that I have been genuinely freaked out by one of these infections. Yeah, and there's definitely plenty to be scared about with these other diseases that we've talked about,
but there's something different about this one. I don't know what it is exactly.
It's everywhere I think that's what it is.
I think a part of it is that I think a big part was Maren mckennon's really eloquent descriptions of like puss filled cavities and oozing sutures and like horrible, very tragic stories in people's lives being hugely impacted. But also that, yeah, staff is everywhere. Yeah, and so far our medical relationship with it has gone in one direction that we're running just to keep up. We've maybe had one foot ahead for the briefest amount of time.
Right, and then it catches right up with us.
Yeah. Yeah. But so the question is now what comes after? How do we fight MSA or VISA or VERSA without antibiotics? And so that is where I'll hand it off to you.
Yeah, Unfortunately I don't have great news. Cool, So just let's talk about the news that I have.
All right.
So, the CDC has this monitoring program. It's active in a few different states California, Georgia, Minnesota, New York, and Tennessee. Not the entirety of those states, but several counties in each of those states. That basically means that they are actively surveilling about fourteen and a half million people and they haven't compiled all the numbers from the last couple of years, So the most recent numbers that you can get are from twenty fifteen, and they're not extrapolated out
to the whole US. But I did the math for you because I'm a.
Math You had math model in your dissertation.
Yeah, yeah, yeah, yeah, I did math. So in twenty fifteen, which is the most recent numbers, I could find in those fourteen and a half million people that they actively surveiled, there were two thousand, six hundred cases. So I heard that and I was like, well, Marshall's not even a big chill out, guys, everyone relaxed.
It seems like a lot of cases.
And then there were only three hundred and thirty two deaths in that population. I mean, like on the scheme of things, right, I was like, that's not so bad. Then I was like, also, I'm heartless, and yeah, like maybe maybe I have lost my humanity. But I wanted more numbers because that made me feel like I was a bad person for thinking that wasn't a lot of people.
So if you extrapolate out those numbers, if we assume that that population that they're surveilling is representative of the whole country, which is kind of the point of surveillance.
So let's hope they did a good job.
Then that would mean that in the US in twenty fifteen, there were over fifty three thousand MERSA infections, forty two thousand of those would be high hospital acquired and eleven one thousand community acquired. Wow, and over sixty six hundred deaths.
Yeah, I mean, and those numbers do match.
Yeah, those numbers that I just calculated on my own are similar and in line with what the CDC's estimates from twenty fourteen were, which were a total of sixty one thousand cases and nine thousand deaths. But overall, about one in three people are carriers of some form of staff areas, like they're just walking around with staff growing on them. And it's estimated that about two in every one hundred people, so two percent of the global population are carriers for some kind of.
MRSA and carriers meaning they.
They're growing it, they're breathing it, they're licking it, they're touching it onto their door knobs.
But not necessarily.
Probably never getting maybe getting infected with it, right if they get a cut, and then that MRSA that's on their skin gets into them, but maybe they never ever ever see an infection from it, but they give it to their brother and their cousin, and their neighbor and their barista.
Yeah, the most important people.
Yeah, And so that that two percent is just in the general population. There are some populations where this situation is even worse, like hospitals, right, like you said, hospitals are just if you're going to get staff in the hospital, it's probably gonna be MRSA. But also places like correctional facilities. You can imagine that many correctional facilities aren't exactly sanitary places, and many inmates in correctional facilities have various situations that
would make them immunal compromise. So MRSA is described as hyper.
Endemic does not sound good. It is not good.
I had never heard that word before, but I can guess what it means, and that is like super and it's everywhere. It's not even just like, yeah, we have this disease. It's like no, it's everywhere. There are some estimates that between four and a half to seventeen percent of inmates were carriers from MRSA.
That's crazy.
It's so high it's insane.
Yeah, I mean it's at least twice as high as the general population, if not like nine times as high.
Right, you know, it's seen.
The question now becomes what do we do and how do we move forward from this? And I that's a yeah, that's why I want to know.
I don't have a great answer.
Okay, yeah, okay, okay.
Yeah, I don't. I don't have a great answer for you. I mean, like you can find things that say the number of infections is decreasing, you know, and we're doing a great job. But I don't know how to believe any of it because I don't know where they're even getting these numbers from.
Right.
But the real issue is with new treatments. Right, we're talking about now versa and with the other one called visa. Right, vankoycin resistant, oh, visa whatever, it's not, it's bad news, right, But anyway you slice it, the fact that we are now seeing resistance to vanko mycin is very very bad news. And so the thing is, I found an article that was that was basically talking about new novel ways to find antibiotics. Right, They were using sequencing to find different
compounds that could then be used as antibiotics. It was very cool. I'll link to the paper. There's another group out of Brown who's getting a lot of POPSI articles right now written about them because they're doing a lot of research on all these novel compounds and they've found a few that seemed promising. And that's awesome and it's necessary and it's great, but it doesn't solve the problem that is the fact that these bacteria will inevitably evolve resistance.
You're playing the same game that we have been playing, right that we are losing at. Yeah, and have never won it.
So I was really hoping when I started researching this that I was going to find phage therapy and imm you know, globulins, And yeah, I found nothing.
You didn't find any phage therapy.
I found that it exists, but I found no details on what.
The state of the research actually is.
Okay, what about bacterial interference.
I found nothing on bacteria.
Wow.
Yeah, So it doesn't mean it's not out there. It just means that it's maybe not the first steps that people are working on, which is kind of a bummer. But also maybe I'm just totally wrong and was looking in the wrong places, and someone listening is going to tell us that they're working on a new phage and bacterial interference and biofilm treatments something, you know, because it has to be happening, right, like I would hope, unless it's just that there for some reason, there's no money
in it. But it seems like if we're going to put money anywhere, it should be in finding alternatives to antibiotics because we're.
Going to need them for so different many infections.
It's a good, good place with some money.
Yeah, but I don't have a great answer. I don't have like here's the newest thing and it's going to solve all of our problems goop.
Yeah. So okay, So how scared should we be of MRSA.
I mean, I don't want to tell you like like don't interact with other humans or something.
Not that level.
That ship has sailed.
Yeah, well that's just for different reasons.
No. I think Merca is a really scary one. I think it's maybe up there with maybe maybe not up there with flu, but but it's up there.
Yeah. I feel like they're all scary in there.
In there, it's a different scary. I think it's not as much like we're gonna have this giant outbreak. It's more just like this thing already exists everywhere and we're kind of running out of options to treat it.
So yeah, it freaked me out. Don't look up videos. Do look up videos? Yep, well.
Devil Angel, Devil Angel's who.
But I do. Do you have any sources that you'd like to use sites?
I do, yes. So I got most of my information from Superbug by Maren McKenna, which I is where I got the first hand account and it's a really great overview of the history of drug resistant staff us, not just MRSA but in general, and she's an amazing writer and so it's very fun to read.
I don't have any real sources. I'll post a couple of articles that we're interesting about MRSA, antibiotics, new antibiotics. Oh, we should also say thank you to Bloodmobile for the music as always, so thank you for listening. Yeah, oh yeah, we love you.
Thank you so much for listening.
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All of our sources are available on our website, This podcast will kill You dot com. You can find every single episode with all of our sources listed. We keep it legit and that's it.
Yeah.
I think really the only thing that we can say for this episode.
Is really, do please wash your hands.
You're you're filthy animals.
We're filthy, all of us. Yeah, I'm gonna go wash my hands.
Yeah, let's go do that.