Disease detectives struggle to keep pace

Sunday, June 20, 1999

Surveillance is crucial to helping physicians, but technology is costly.

“Gentlemen, it is the microbes who will have the last word.” – Louis Pasteur (1822-1895)

By Ron Sylvester

Jeanie Carver says she’s horrified when she learns how her friends and neighbors take antibiotics.

She needs only to visit her hairstylist to hear their casual attitudes: They diagnose themselves. They don’t finish prescriptions. They save leftover pills and share them with others who may not have the same illness.

And when Carver, a virus specialist at Cox Medical Center South, tries to point out the errors, those people scoff.

“It’s not sexy, there’s not anything remotely tantalizing about it, and you can’t get people to talk about it,” she said.

But evidence is undeniable for Carver, who works as one of several disease detectives in the laboratories at Springfield’s two major hospitals. When they walk into the labs, they step onto the front line of the battle against drug resistance.

Each day, they look for bugs and try to figure out which drugs kill them and which don’t. Each year, the list of medicines that no longer work keeps growing, because people are abusing antibiotics.

“We’re seeing smarter bugs,” said Mike Reidle, microbiology supervisor at St. John’s Regional Health Center.

Laboratories receive dozens of blood and urine samples and nose and throat cultures each day from doctors across southwest Missouri. Investigators grow the infecting organisms, then test them against an array of antibiotics.

Their findings: Bugs that once died with a shot of penicillin are successfully fighting back.

One now immune to a variety of drugs is strep pneumoniae, a leading cause of pneumonia and ear and sinus infections.

“We never saw any resistant strep pneumoniae five years ago in this area,” said Verna Morton, a microbiologist at Cox. “Then we saw one or two isolated cases. The next year we saw 30. Now it’s so common we don’t treat it with any more respect.”

Two years ago, local laboratories began finding a bacterium called enterococcus that could outwit the most powerful available antibiotic, vancomycin.

Then last year, the search began for a potentially fatal vancomycin-resistant staph infection, after cases cropped up in Japan, Michigan and New Jersey and New York.

“My staff would just sort of panic if that would happen here,” Reidle said.

Doctors would, too.

“Vancomycin-resistant staph aureus is our worst nightmare,” said Dr. Wolfe Gerecht, infectious disease specialist at Cox. “If you have an aggressive pathogen that kills, and you have no way to treat it, you have a problem.”

That’s what health officials may be up against, after scientists at St. Jude Children’s Hospital in Memphis last week reported a strain of strep pneumoniae resistant to vancomycin.

“If a child got that, all you could depend on then would be the good Lord,” said Harold Bengsch, director of the Springfield-Greene County Health Department.

Identifying such bugs in the lab, however, takes time: a day or two to grow them, another day or two to run stringent tests against a panel of antibiotics.

Doctors usually don’t want to wait that long to begin treating seriously ill patients.

To help, the laboratories provide doctors with reports of drug resistance. But those can be weeks or months old.

So instead of waiting, doctors often try to cover all angles with a broad-based antibiotic.

“I wish there were more situations where they would do a culture, find out the etiology of the infection and hit it with a more specific drug,” Morton said.

Technology is becoming available to study tiny molecules and detect genetic codes for information such as drug resistance. That takes only four hours, not four days.

Though Springfield hospitals have begun to acquire limited molecular technology, high costs could delay significant advances for years.

But people are getting sick now.

That’s why Carver, the virus specialist, worries that too many people aren’t paying attention.

They aren’t taking medicine correctly.

All of that increases the likelihood the disease detectives will keep finding more germs able to outwit medicine.

“We reap what we sow,” Carver said. “If you told a parent that they were doing something that was going to cause serious problems for their child, no parent would want to do that. But they do it every day with antibiotics.”