DDP Newsletter July 2018 Vol. XXXIV, No. 4
According to the Centers for Disease Control and Prevention (CDC), infections caused by microbes resistant to antibiotics are increasingly prevalent and can spread like wildfire. Many of these are bred in hospitals, which give bacteria selected by heavy use of antibiotics the opportunity to share genes conferring resistance.
“Nightmare bacteria” (carbapenem-resistant Enterobacteriaceae, or CRE) were isolated more than 200 times in 2017 (https://tinyurl.com/yb2n9qzq). Half the patients infected with this organism die. It is resistant to all antibiotics available in the U.S. The most common medical care-associated infection is probably Clostridium difficile (“C diff”), which affects about 500,000 patients each year and is the direct cause of about 15,000 deaths (https://tinyurl.com/ycfbrcpd). Other threats include resistant Staphylococcus aureus, streptococci, and Pseudomonas. Now a hypervirulent form of Klebsiella pneumoniae (“Klebsi”), widespread in Chinese hospitals, has apparently combined with CRE. Highly contagious, it can kill healthy young adults. NPR calls it the triple threat new pneumonia (https://tinyurl.com/y8nh72us).
These germs may lurk in the hospital bed itself. A study of all identified cases of nosocomial (hospital-acquired) infections in four New York hospitals from 2006-2012 found that the odds of cases having been exposed to a prior bed occupant with the same organism were 5.83 times that of controls (95% confidence interval [CI], 3.62–9.39), and the odds of cases having been exposed to a roommate with the same organism were 4.82 times that of controls (95% CI, 3.67–6.34) (Infect Control Hosp Epidemiol, May 2018, https://tinyurl.com/y7aa4utp). Patients can acquire C diff from the mattress even if the previous patient had been asymptomatic, despite standard “terminal cleaning” methods in use by hospitals. Use of a launderable mattress barrier cover can reduce the C diff infection rate by 50% (https://tinyurl.com/y7bo9ge2).
Hospitals ignore the risk because they’re rushed to turn over rooms, writes Betsy McCaughey. They need to adopt high-tech cleaning methods to rapidly disinfect the whole room, including mattresses (IBD 4/11/18, https://tinyurl.com/ycbrpyhm).
The advent of antibiotics in the 1930s stopped research on other antimicrobial methods; with the emergence of resistance, interest is reviving. Copper was recognized as the first metallic antimicrobial in 2008 by the Environmental Protection Agency (EPA). But it has been used since ancient times. Egyptian and Babylonian soldiers would sharpen their bronze swords (bronze is an alloy of copper and tin) after a battle, and place the filings in their wounds to reduce infection and speed healing.
Copper alloys kill microbes on contact: bacteria, viruses, and fungi are all affected. With routine cleaning, when copper alloy is used on regularly touched surfaces in busy wards and intensive care units, there is up to a 90% reduction in the numbers of live bacteria on their surfaces. This includes bed rails, chair arms, call buttons, over-bed tables, IV poles, and door handles. Studies in three hospital intensive care units in the U.S. also showed a remarkable 58% reduction in infection rates. Copper alloy touch surfaces are now being deployed worldwide in airports, trains, train stations, busses, restaurant kitchens, and gyms. The payback time for installing copper fittings in hospitals is estimated to be only 2 months. Copper is no more expensive than stainless steel. The latter may look shiny and clean, but it has no antimicrobial properties and has tiny crevices where microbes can escape cleaning (https://tinyurl.com/y8lnwblv).
Copper can also be used in particle form, or as nanoparticles. For example, no infectious viral particles were recovered from copper oxide-impregnated face masks after 30 min, unlike with control masks. Bacteria have some survival mechanisms, but no complete resistance to prolonged exposure to copper has been found.
Copper has great public health potential, as against rapidly mutating influenza virus, or against norovirus, which is not killed by hand sanitizers.
Doctors frequently name silver as a metal with antimicrobial properties, but it does not work as a protective surface coating when dry (https://tinyurl.com/yalp98dt).
A MEASURE OF DESPERATION?
Having exhausted new, toxic, expensive antibiotics that have been approved after extensive randomized, double-blind controlled trials, might doctors try an old, nontoxic, cheap, but unapproved remedy, possibly risking medical staff privileges or their license? Vitamin C has been discussed here (July 2003, November 2005). After Dr. Paul Marik reported a case series of sepsis patients treated with a cocktail of intravenous vitamin C, hydrocortisone, and thiamine, more than 50 medical centers are said to be using his protocol. While some experts may call vitamin C “as effective as healing incantations,” nurses treating the patients do not share this skepticism. Of the more than 150 patients he has treated with his cocktail, only one has died of sepsis. Previously, 19 of 47 sepsis patients had died. More than 1 million of Americans fall ill with sepsis each year, and between 28% and 50% die (Smithsonian.com 6/27/17, https://tinyurl.com/y9rgqdrt).
Cures of a wide variety of human conditions by high-dose vitamin C have been reported (Thomas Levy, Curing the Incurable: Vitamin C, Infectious Diseases, and Toxins). Harri Hemilä of the Department of Public Health, University of Helsinki, has reviewed human studies and 148 animal studies of vitamin C in diverse infections (Nutrients 2017 9:339, https://tinyurl.com/yct5swx9). Infectious agents included tuberculosis, other bacteria, viruses, Candida albicans, and protozoa. Vitamin C was also protective against tetanus toxin, diphtheria toxin, and endotoxin.
In children aged 1 to 12 years with tetanus in Bangladesh, there were no deaths in the group receiving 1 g/day of intravenous vitamin C, whereas there were 23 deaths in the control group (p = 10-9). Five controlled trials showed significant benefit in pneumonia.
There is a paucity of data, but no large-scale controlled trials have shown ineffectiveness. Hemilä attributes loss of interest and the low level of acceptance in the medical community to the success of antibiotics and to misconceptions and prejudice. Vitamin C has been placed in the category of “alternative medicine” by the National Institutes of Health and the Cochrane collaboration. Goodwin and Goodwin described the “tomato effect” (JAMA 5/11/1984): “If the treatment bypasses the medical establishment and is sold directly to the public…the temptation in the medical community is to accept uncritically the first bad news that comes along.”
With antibiotic-resistant superbugs, why should an “alternative” treatment without known serious adverse effects be a last resort, instead of the first thing tried, along with meticulous isolation and control measures?