Why Resistance Matters: the Things That Don’t Show Up in the Statistics

Last night, I was reading some of the comments you leave here, and, in response to a post about a surgeon who thinks evolution is irrelevant to medical practice (Got Antibiotic Resistance?), fellow ScienceBlogling Mark left a comment. I’ll get to the comment in a minute, but tragically, I hear stories like his far too often. Mark writes (italics original):

Mike, you’ve nailed exactly what pisses me off so much about Egnor. Right now, we’re talking about something that’s become deeply personal to me.
Since January, my father has been paralyzed from the waist down. The cause of it is MRSA. He had a long-delayed circulation problem resulting from cancer surgery a decade ago, which led to having two toes amputated. But that didn’t get rid of the infection. So he had to have his entire leg amputated, followed by a six week course of IV antibiotics. And still that wasn’t enough – one week after the antibiotics were stopped, the infection got into his spine.
The beginning of this whole disaster was really unavoidable – we knew the circulation in his leg was a wreck, and that it would probably eventually come back and bite him.
But 20 years ago, he would have been forced to have the amputation – most likely of the leg – and that would have been the end of it. Even 10 years ago, a 6 week course of IV antibiotics would almost certainly have wiped out any infection.
But now – he’s got a multiple-antibiotic resistant strain of staph. It is, for all practical purposes, completely immune to anything from the penicillin family; to 1st-3rd gen cephalosporins. It’s even partially resistant to vancomycin! This is not a bug that existed 20 or 30 years ago. It’s something new – and signficantly different from “traditional” staph strains.
And a fucking *surgeon*, who should god-damned well *know* about bugs like this – who *needs* to know about stuff like this in order to properly take care of his patients – this shitbag is going around telling people that surgeons don’t need to know about evolution. That things like the dramatic rise in resistant bugs, the dramatic differences in the basic biology of some of these bugs – that these things don’t matter to surgeons.

Much of the suffering his father is experiencing doesn’t enter into the ‘statistical’ discussion of the burden of antibiotic resistance. It might, if he didn’t leave the hospital, increase the cost of the hospital stay and the length of the stay (yes, the only way this would be incorporated into ‘morbidity’ data, is if he didn’t leave the hospital, and stayed in the hospital longer. Otherwise, the effects of this infection would never be captured).
This is why antibiotic resistance matters. This is why evolution matters.

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1 Response to Why Resistance Matters: the Things That Don’t Show Up in the Statistics

  1. Slightly off the topic but do you know if Staphylococcus aureus is a an Asn auxotroph? Reason I bring it up a recent JBC paper predicts that S. aureus lacks both asparagine synthetases (AsnA and AsnB) and does not use its tRNA-dependent amidotransferase (GatCAB) to form Asn-tRNA, only for Gln-tRNA formation. It is mentioned in the last paragraph of the results section. The supplemental data has Staphylococcus lacking AsnA, AsnB and a non-discriminating AspRS (which is why they presume GatCAB can’t form Asn-tRNA(Asn), since no Asp-tRNA(Asn) is made). Curious if there is any knowledge on the subject. If it is true then you could treat Staph with L-asparaginases like they do certain acute lymphoblastic leukemias along with antibiotics.

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