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March 11, 2002
Drug-resistant bacteria turns cut into life threatening
ordeal
Critics: Drugs overused in people, animals
By Matt Carter
STAFF WRITER
PLEASANTON - Bobbie McKeon doesn't need to be told
that antibiotics are being used so routinely - and
carelessly - that bacteria the drugs once easily vanquished
are becoming immune to their effects.
The Pleasanton nurse practitioner came close to dying
when a paper cut on her finger became infected with
a drug-resistant bacteria.
McKeon was given four different antibiotics before
doctors realized that she needed an even stronger
one that's delivered through an intravenous line.
Complications from that procedure landed her in the
hospital for 21 days.
Although McKeon is working again, she hasn't recovered
completely.
"Ten years ago this (would have been) a little
Staph infection that wouldn't have lasted five days,"
McKeon said. Today, "I never feel well. Things
I used to just shake off are harder to get over."
It's not how antibiotics were used to treat McKeon
that created the problem, but how the drugs have been
used over the years. Thanks to the overuse of antibiotics
in people and animals, medical experts say bacteria
that are either naturally resistant or can develop
resistance to the drugs are becoming more prevalent.
Even when they are not life threatening, drug-resistant
bacteria can make treating once routine problems a
more complex, unpleasant and expensive proposition.
"There are two fears with antibiotic resistance,"
said Dr. David Witt, who tracks infectious diseases
among Kaiser Permanente's 3.5 million patients in
Northern California. "Once is that we won't be
able to treat things at all, and we'll be back to
the pre-antibiotic era - or what's now being called
the post-antibiotic era.
"What's also going to happen is there will be
a requirement to use more toxic antibiotics that have
more side effects and risks of complication. Bobbie
is just the ultimate example of that," Witt said.
It's been almost two years since McKeon cut her finger
at the urgent care clinic where she works. Two days
later, the cut had become swollen and red. McKeon
started soaking it in salt water and made an appointment
to see a doctor.
Doctors assumed the cut had become infected by Staphylococcus
bacteria. The bacteria live harmlessly on most people's
skin, but can be dangerous if allowed inside the body.
The first antibiotic McKeon was prescribed, dicloxicillin,
is a form of penicillin commonly used to treat such
infections.
When dicloxicillin proved ineffective, the dosage
was increased. McKeon's infection got worse.
Puss began to show under her fingernail, and doctors
considered pulling it. But first, they tried a second
antibiotic in a family called the cephalosporins.
That didn't work, either.
McKeon's nail was pulled and a doctor cut the finger
open and drained it. She was given another type of
cephalosporin antibiotic, this time by injection.
Doctors had tried three different antibiotics, but
McKeon wasn't getting better. So she took a culture
herself, sending the swab to a lab that could identify
the bacteria that had infected her. In the meantime,
she was switched to yet another antibiotic, this on
in the penicillin family. Her finger was incised and
drained again.
The lab found the infection in McKeon's finger was,
as doctors had suspected, caused by Staphylococcus.
But it was a drug-resistant strain of the bacteria,
immune to nearly all antibiotics taken in pill form.
McKeon needed a much stronger antibiotic, vancomycin,
which is administered intravenously. An intravenous
line was inserted into her left arm so she could be
given vancomycin twice a day for a week.
Finally, her finger began to heal. But McKeon's ordeal
was only beginning.
In the days after the line was removed from her arm,
McKeon's neck began to swell. She started having shortness
of breath and chest pain. McKeon visited her doctor
between two trips to the emergency room, but her symptoms
remained a mystery.
She was finally admitted to the hospital on Aug. 4,
after waking up with a temperature of 103 degrees
and a lump the size of a tennis ball on the side of
her neck. A CT scan revealed that McKeon had developed
a blood clot when the intravenous line was removed
from her arm. The clot was blocking several vessels
that return blood to the heart.
Because the clot was also infected, it couldn't be
broken up with "clot-busting" drugs, because
the infection would spread to the rest of her body.
It was left to McKeon's immune system - and a cocktail
of more intravenous drugs - to tackle the infected
clot.
"I didn't die, but what I ended up with were
some real residual problems," McKeon said.
After being discharged from the hospital, McKeon developed
another clot and had to be readmitted. Her body, it
was learned, had developed an antibody that allowed
clots to form. To prevent more clots from forming,
she was put back on Coumadin, an anticoagulant.
McKeon still takes the drug today, and believes she'll
be taking it for the rest of her life. The damage
the clots did to her blood vessels keeps her in constant
pain, and her poor circulation doesn't allow her to
exercise the way she did before. She estimates she's
put on more than 30 pounds, and is often tired.
"I miss running, and I miss having my regular
life," McKeon said. "But if my story can
help others not misuse antibiotics, maybe the next
person won't have to get" sick from a drug-resistant
bacteria.
"If we don't educate people (on the proper use
of antibiotics), forget about it," McKeon said.
"What are my little grandchildren going to take?
When they get to be teen-agers, there's going to be
nothing out there."
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