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Healthy Skepticism Library item: 17069

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Publication type: news

Mendoza M, Mason M
Solution to killer superbug found in Norway
The Associated Press 2009 Dec 31

Full text:

Aker University Hospital is a dingy place to heal. The floors are streaked
and scratched. A light layer of dust coats the blood pressure monitors. A
faint stench of urine and bleach wafts from a pile of soiled bedsheets
dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine.
There is no sign of a dangerous and contagious staph infection that killed
tens of thousands of patients in the most sophisticated hospitals of Europe,
North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.

Twenty-five years ago, Norwegians were also losing their lives to this
bacteria. But Norway’s public health system fought back with an aggressive
program that made it the most infection-free country in the world. A key
part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway’s model
can be replicated with extraordinary success, and public health experts are
saying these deaths ˜ 19,000 in the U.S. each year alone, more than from
AIDS ˜ are unnecessary.

“It’s a very sad situation that in some places so many are dying from this,
because we have shown here in Norway that Methicillin-resistant
Staphylococcus aureus (MRSA) can be controlled, and with not too much
effort,” said Jan Hendrik-Binder, Oslo’s MRSA medical adviser. “But you have
to take it seriously, you have to give it attention, and you must not give

The World Health Organization says antibiotic resistance is one of the
leading public health threats on the planet. A six-month investigation by
The Associated Press found overuse and misuse of medicines has led to
mutations in once curable diseases like tuberculosis and malaria, making
them harder and in some cases impossible to treat.

Now, in Norway’s simple solution, there’s a glimmer of hope.
Dr. John Birger Haug shuffles down Aker’s scuffed corridors, patting the
pocket of his baggy white scrubs. “My bible,” the infectious disease
specialist says, pulling out a little red Antibiotic Guide that details this
country’s impressive MRSA solution.

It’s what’s missing from this book ˜ an array of antibiotics ˜ that makes it
so remarkable.

“There are times I must show these golden rules to our doctors and tell them
they cannot prescribe something, but our patients do not suffer more and our
nation, as a result, is mostly infection free,” he says.

Norway’s model is surprisingly straightforward.

  • Norwegian doctors prescribe fewer antibiotics than any other country, so
    people do not have a chance to develop resistance to them.
  • Patients with MRSA are isolated and medical staff who test positive stay
    at home.
  • Doctors track each case of MRSA by its individual strain, interviewing
    patients about where they’ve been and who they’ve been with, testing anyone
    who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles
of syrups and tubes of ointment. What’s here? Medicines considered obsolete
in many developed countries. What’s not? Some of the newest, most expensive
antibiotics, which aren’t even registered for use in Norway, “because if we
have them here, doctors will use them,” he says.

He points to an antibiotic. “If I treated someone with an infection in Spain
with this penicillin I would probably be thrown in jail,” he says, “and
rightly so because it’s useless there.”

Norwegians are sanguine about their coughs and colds, toughing it out
through low-grade infections.

“We don’t throw antibiotics at every person with a fever. We tell them to
hang on, wait and see, and we give them a Tylenol to feel better,” says

Convenience stores in downtown Oslo are stocked with an amazing and colorful
array ˜ 42 different brands at one downtown 7-Eleven ˜ of soothing, but
non-medicated, lozenges, sprays and tablets. All workers are paid on days
they, or their children, stay home sick. And drug makers aren’t allowed to
advertise, reducing patient demands for prescription drugs.

In fact, most marketing here sends the opposite message: “Penicillin is not
a cough medicine,” says the tissue packet on the desk of Norway’s MRSA
control director, Dr. Petter Elstrom.

He recognizes his country is “unique in the world and best in the world”
when it comes to MRSA. Less than 1 percent of health care providers are
positive carriers of MRSA staph.

But Elstrom worries about the bacteria slipping in through other countries.
Last year almost every diagnosed case in Norway came from someone who had
been abroad.

“So far we’ve managed to contain it, but if we lose this, it will be a huge
problem,” he said. “To be very depressing about it, we might in some years
be in a situation where MRSA is so endemic that we have to stop doing
advanced surgeries, things like organ transplants, if we can’t prevent
infections. In the worst case scenario we are back to 1913, before we had
Forty years ago, a new spectrum of antibiotics enchanted public health
officials, quickly quelling one infection after another. In wealthier
countries that could afford them, patients and providers came to depend on
antibiotics. Trouble was, the more antibiotics are consumed, the more
resistant bacteria develop.

Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting
antibiotic use. Thus while they got ahead of the infection, the rest of the
world fell behind.

In Norway, MRSA has accounted for less than 1 percent of staph infections
for years. That compares to 80 percent in Japan, the world leader in MRSA;
44 percent in Israel; and 38 percent in Greece.

In the U.S., cases have soared and MRSA cost $6 billion last year. Rates
have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United
Kingdom, they rose from about 2 percent in the early 1990s to about 45
percent, although an aggressive control program is now starting to work.

About 1 percent of people in developed countries carry MRSA on their skin.
Usually harmless, the bacteria can be deadly when they enter a body, often
through a scratch. MRSA spreads rapidly in hospitals where sick people are
more vulnerable, but there have been outbreaks in prisons, gyms, even on
beaches. When dormant, the bacteria are easily detected by a quick nasal
swab and destroyed by antibiotics.

Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention
said they incorporate some of Norway’s solutions in varying degrees, and his
agency “requires hospitals to move the needle, to show improvement, and if
they don’t show improvement they need to do more.”

And if they don’t?

“Nobody is accountable to our recommendations,” he said, “but I assume
hospitals and institutions are interested in doing the right thing.”

Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA
control program launched 30 years ago at the University of Virginia’s
hospitals, blamed the CDC for clinging to past beliefs that hand washing is
the best way to stop the spread of infections like MRSA. He says it’s time
to add screening and isolation methods to their controls.

The CDC needs to “eat a little crow and say, ‘Yeah, it does work,’” he said.
“There’s example after example. We don’t need another study. We need
somebody to just do the right thing.”
But can Norway’s program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital
about 100 miles outside of London. It’s here that microbiologist Dr. Lynne
Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while
facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish,
asking doctors to almost completely stop using two antibiotics known for
provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they’ve
continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream
infections. This year they’ve had one.

“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and
grinning as colleagues nearby drip blood onto slides and peer through
microscopes in the hospital laboratory.

When word spread of her success, Liebowitz’s phone began to ring. So far she
has replicated her experiment at four other hospitals, all with the same
dramatic results.

“It’s really very upsetting that some patients are dying from infections
which could be prevented,” she says. “It’s wrong.”

Around the world, various medical providers have also successfully adapted
Norway’s program with encouraging results. A medical center in Billings,
Mont., cut MRSA infections by 89 percent by increasing screening, isolating
patients and making all staff ˜ not just doctors ˜ responsible for
increasing hygiene.

In Japan, with its cutting-edge technology and modern hospitals, about
17,000 people die from MRSA every year.

Dr. Satoshi Hori, chief infection control doctor at Juntendo University
Hospital in Tokyo, says doctors overprescribe antibiotics because they are
given financial incentives to push drugs on patients.

Hori now limits antibiotics only to patients who really need them and
screens and isolates high-risk patients. So far his hospital has cut the
number of MRSA cases by two-thirds.

In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about
conducting a small test program. It started in one unit, and within four
years, the entire hospital was screening everyone who came through the door
for MRSA. The result: an 80 percent decrease in MRSA infections. The program
has now been expanded to all 153 VA hospitals, resulting in a 50 percent
drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of
infectious diseases at the VA Pittsburgh Healthcare System.

“It’s kind of a no-brainer,” he said. “You save people pain, you save people
the work of taking care of them, you save money, you save lives and you can
export what you learn to other hospital-acquired infections.”

Pittsburgh’s program has prompted all other major hospital-acquired
infections to plummet as well, saving roughly $1 million a year.

“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA
infections, that’s all.”
Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions after
her 5-week-old daughter Madeline caught a cold that took a fatal turn. One
day her beautiful baby had the sniffles. The next?

“She wasn’t breathing. She was limp,” the mother recalled. “Something was
terribly wrong.”

MRSA had invaded her little lungs. The antibiotics were useless. Maddie
struggled to breathe, swallow, survive, for two weeks.

“For me to sit and watch Madeline pass away from such an aggressive form of
something, to watch her fight for her little life ˜ it was too much,” Reimer

Since Madeline’s death, Reimer has become outspoken about the need for
better precautions, pushing for methods successfully used in Norway. She’s
stunned, she said, that anyone disputes the need for change.

“Why are they fighting for this not to take place?” she said.


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