Show #2693
DIALOGUE edit
Silent MRSA Carriers Have Twice the Mortality Rate
with Guest, Dr. Arch Mainous, Ph.D.

Carl Lanore:
Welcome back to another episode of Super Human Radio. Today is Wednesday, April 7th, 2021.
Today’s show covers a topic we actually first discussed on a show in 2007, when I had the former Lieutenant governor of New York, Betsy McKay on. She had lost her father to MRSA, and she wanted to get the word out about MRSA and MRSA testing.  I thought it was very important show because we spend a lot of time in gyms and health spas. These are places where these types of antibiotic resistant bacteria dwell and if you have any open wound, the opportunity is there.

Fast forward to today, MRSA is not really discussed much, unless you have an elderly loved one in a nursing home or someone who goes into a hospital and comes home with it. Ironically though it is rampant in America today. According to the CDC at any given time, 2% of the population has MRSA. When MRSA first came out it was deadly to Anyone with a compromised immune system and it's killing a lot of people still today, now enter silent MRSA. There are people out there who have the bacteria, but don't necessarily present symptoms or the symptoms are misdiagnosed, which we're going to talk about here.

It turns out that if you are one of these silent MRSA people, it's going to shorten your life. There's something that we can do about that though, and we're going to talk about too.

Welcome my guest, Dr. Arch Mainous, Ph.D.

Carl Lanore: [00:04:29]
You gave me some startling statistics about the death rates currently today, from MRSA. Talk about that for a bit.

Dr. Arch Mainous, Ph.D.: [00:04:49]
In your introduction, I think you hit on something that's very, very important.

COVID has completely dominated everyone's lives and the scientific community and everything, and because of COVID, we've lost sight of antibiotic resistance. In  2019 before. COVID hit the world health organization released a report stating that if we don't get antibiotic resistance under control, it could set medical practice back a hundred years.

This has been seen by the CDC and if we don't have the ability to control antibiotic resistant organisms everything could change. A lot of that is our own fault through the overuse of antibiotics given out and in animal feed and so on.

Here are some numbers for you. There are probably 250 million doses of antibiotics that are given out every year in the United States and we have 2.6 million antibiotic resistant infections in the United States and we have 36,000 people die of antibiotic resistance.

That's a lot of people.

In 2006 MRSA had typically been seen as a hospital, acquired infection. Then we started finding it in the communities. That's what my is ultimately about. People out in the community, not people who are in a nursing home, not people who are in the hospital who are getting it.

When we think about MRSA, we don't really think about it in the way that we probably should. We need to think about MRSA as basically a consequence of overuse of antibiotics. If you look at countries where antibiotics are not really regulated or given over the counter, and you compare those countries with countries where antibiotics are controlled, the prevalence rate, according to surveillance in these countries, of resistant organisms is doubled. If we have too many antibiotics floating around, this is what happens: If you get to the point where you have MRSA or some other resistant organism, we may get to the point where we don't have any way to treat it, and you end up in the hospital with MRSA pneumonia or something.

Carl Lanore: [00:08:39]
Back in the day, people died of infections that we control today with antibiotics. They died regularly of infections.

There’s another aspect to this that I'm hoping that I cue you in on to pay attention to. Weed killers that are used in common agriculture are anti-microbial in nature, and the difference between an anti-microbial and an antibiotic is the dose and the duration. The very popular herbicides glyphosate, dicamba, and one other are leading to increased antibiotic-resistant germs. It makes sense. It's evolution. The weeds got stronger. You go from glyphosate to dicamba, then they had to mix them together because the weeds got stronger from the evolutionary process. The bacteria, especially some of these e-coli forms that have been found in animal feces that happened to be on farms where they're growing produce, are getting stronger too because of these herbicides. There are antibiotic actors in our food now that are leading to antibiotic-resistant germs in and of themselves. To me, that's even scarier because you can get doctors to not prescribe antibiotics, and we could cut back the prescriptions, but you can't cut back people eating corn and wheat and all the other stuff that's slathered with these herbicides. 

Dr. Arch Mainous, Ph.D.:
There's no doubt that when we think about antibiotics, we tend to think that the only antibiotics out there are the ones that are prescribed by your family doctor, but that's actually not the case. We have it in food. You can buy them without a prescription on the internet. This has been a big problem in places like the European Union. Some countries have very strict antibiotic regimens, like the Netherlands, and others, like Spain, don’t, and the level of antibiotic-resistance in the Netherlands is much lower. However, It doesn't take much for somebody to get on a train from Spain to the Netherlands.

Carl Lanore: [00:11:41]
So you threw a number at me that I was shocked to hear and I want to couch this in the context of current COVID deaths.

Dr. Arch Mainous, Ph.D.:
Over the last couple of weeks, the 7-day average has been a little bit less than a thousand.

Carl Lanore:
How many people die a year just from MRSA?

Dr. Arch Mainous, Ph.D.:
For MRSA itself, it wouldn't be that high, but from antibiotic resistance would be 37,000. 

Carl Lanore:
We're talking about a significant number of people. Antibiotic-resistant organisms are now becoming a really serious threat. We have one bullet left in the gun and it's vancomyocin, but eventually the evolution of these microbes is going to be resistant to vancomyocin and then we're going to be back in the 18 hundreds where a simple scrape could lead to your death.

Dr. Arch Mainous, Ph.D.:
MRSA is already resistant to penicillins and cephalosporins. We do a pretty good job of trying to control giving out vancomycin, but since 1996 we've started seeing reports of MRSA resistant to vancomycin. If we get to the point where we really don't have any sort of other treatment, then yes, the person gets a cut and that could be fatal.

Carl Lanore: [00:14:14]
Let's talk a little bit about MRSA specifically. What made you do this particular study? In most cases, if someone is infected with MRSA, they present with symptoms. What are the symptoms? 

Dr. Arch Mainous, Ph.D.:
It depends on where it is. Typically a lot of MRSA infections are on people's skin. You would have a skin infection and that would be a sort of round area that looks like it's going to have a pustule on it; a little knob with puss in it. You could have multiple knobs together and that would make a carbuncle. You can make it even bigger and it becomes an abscess, a crater that’s sort of eating it out.

Carl Lanore:
Some people will get a boil or an ingrown hair and it becomes a little mountain with yellow creamy stuff inside, that’s puss. It pops and then there's a crater left behind. When it heals it usually leaves a scar because they're fairly large. So it will look like a boil.

Dr. Arch Mainous, Ph.D.:
In this case, it could get bigger than that. It could go worse and the infection could get in your lungs. Then you could get pneumonia based off that. You could get it in your bloodstream, and get what’s called bacteremia. That's more common.

Carl Lanore: [00:17:02]
A common misdiagnosis of MRSA is a spider bite. 

Dr. Arch Mainous, Ph.D.:
It's called a brown recluse binary spider bite. Even the CDC says, if somebody thinks it's a spider bite and they can't find a spider, it’s probably MRSA. I used to be at the Medical University of South Carolina and each year they would document in the state all the brown recluse spider bites. I had a fellow who became very interested in that and he actually did a little more research on it. He contacted some etymologists and told them South Carolina had 440 brown recluse spider bites. The entomologists said, well, no, you didn’t, because the brown recluse spider’s habitat doesn't stretch that far to the east. 

Carl Lanore:
They don't occupy that region of the country. 

Dr. Arch Mainous, Ph.D.:
So they went back and looked at maps and they started saying, how many of these cases that we've had so long to treat that ended up making a big scar and all this kind of stuff, were actually MRSA and not a brown recluse spider bite? We know for a fact it wasn't brown recluse spider. So you can have some misdiagnosis as well, which complicates things. 

One of the more recent things that we're very concerned about is the opioid epidemic because it's breaking the skin’s integrity and so on. People who are injecting drugs are 16 times more likely than the the general population to have an invasive MRSA infection. Invasive means they could have bacteremia, even sepsis. They could get really sick. Opioid injection is another thing that we don't even consider as basically a complication. 

Carl Lanore: [00:18:52]
For those people fortunate enough to have a diagnosis because they have symptoms, there is treatment for them. Depending on the severity of the infection and the bacteremia organs that have been compromised, it could actually take months for people to get better from this infection. Some people don't get better. A lot of people in nursing homes die prematurely because they can't get rid of MRSA. My father had MRSA when he was in the nursing home and he was on an antibiotic IV drip for months. Every time they tested them, it still wasn't gone. But those are the lucky people, believe it or not, because at least they know what they have. How did you discover that there are people out there with silent MRSA, who don’t present any symptoms?

Dr. Arch Mainous, Ph.D.:
We were interested years ago in this idea of community carriage, colonization just out in the community. I had been talking to people at the CDC because they did a national surveillance and they did cultures on people nationally. When that data was released, we analyzed it. We looked at how many people had, not infected, but had MRSA in their nose. That published in 2006. We tried to look at other things that might be risk factors for that and that might be related to it, like drinking tea and things like that. When we kind of came back and said, what happens to people downstream? We know a lot short-term things about what happens to people who leave a nursing home or who leave the hospital, but what about these people? What happens to them? So we were able to link that same data that we looked at and published in 2006, 11 years forward to the national death index. We already had a basic awareness of what was going on, but nobody had really been talking about what happens to these people. Are they at any risk? We know about the risk in the hospital, but what about people who were just walking around with it? I mean, I can have it right now and I wouldn't know it. The most striking thing was when we looked at these people over 11 years, and we took the people who were colonized with MRSA and the people who weren't, of the people who were colonized with MRSA, 36% of them died in the next 11 years, and only 18% of the others. Now these are people 40-85.

Carl Lanore:
That's statistically significant. They’re relatively young if you're starting at 40. 

Dr. Arch Mainous, Ph.D.:
You're seeing double rate and you're seeing a huge number, more than a third, die. They weren't infected at all when we started with them, they were only colonized. They didn't know they had it. Their doctor would know they have it. It's actually quite disturbing to see just how strong the effect was. 

Carl Lanore: [00:22:51]
Obviously you can be tested for this. If somebody finds out they're colonized, would the therapeutic interventions used to treat someone who's infected work for them as well?

Dr. Arch Mainous, Ph.D.:
No, you wouldn’t do that. You wouldn’t decolonize someone who was hardly infected. You would wait until they were no longer infected. That's where the gap in our knowledge is right now. There was a very large randomized trial that came out about two years ago that took people who were colonized and looked at them when they were discharged from the hospital. They decolonized them when they were discharged and looked at them for a year. Those people who were not decolonized, who were just given information to wash their hands, were 30% more likely to develop a major infection than the people who were decolonized. The difference here is we don't know how long we would need to go in terms of decolonization of people just out in the community. The treatment for decolonization is different. The treatment for decolonization uses chlorhexadine to wash off and clean everything off your skin.

Carl Lanore:
It's well known to colonize inside the nose. How do you get chlorhexadine up in there? 

Dr. Arch Mainous, Ph.D.:
You don’t. You take mupirocin and you just rub it around.

Carl Lanore:
Is it shown that with this type of an approach, the person will become decolonized? Over what period of time?

Dr. Arch Mainous, Ph.D.:
Yes. They will be decolonized. Most of our decolonization protocols are really in the hospital. You may find somebody when they're admitted to the hospital after we screen them. Let me be very clear, there is no universal protocol across hospitals. So one hospital may screen everybody to see if they’re colonized with MRSA. They would do an animal swab and they would culture. Others wouldn’t. Some may ask if you have ever had MRSA and just automatically put them down as positive. If they come back positive, some hospitals might decolonize you. They can use chlorhexadine and mupirocin. But others may say we're not going to do anything except isolate you. The reason for that is you are putting other people at risk. You’re potentially going to infect other patients.

Carl Lanore: [00:28:22]
If I'm colonized, but I have no symptoms and I don't know, if I pick my nose, I shake hands, I do all this stuff, am I infecting other people? 

Dr. Arch Mainous, Ph.D.:
It's possible. We're always concerned about people who are colonized because you can be shaking hands with somebody who is immunocompromised and that would be bad. You can give it from one person to another person. That’s why some hospital protocols want to decolonize people when they come in so that they can't give it to somebody else.

Carl Lanore:
Is it possible to be colonized, never develop symptoms, and your body somehow vanquishes it and decolonizes you?

Dr. Arch Mainous, Ph.D.:
That happens too. People who are colonized don't stay colonized forever. It can go away on its own and it can come back. People who are colonized tend to be more likely to be recolonized. People who are colonized tend to be more likely to have a MRSA infection and invasive illness.

Let's say we decolonized you today. Two years from now, you might have it again. That's where it becomes a little bit more of a challenge, since we don't really know what happens with people out in the community. We don't know how often we need to decolonize or how often we need to check or who we need check. Maybe 5% of the people in nursing homes or who come out of nursing homes have MRSA. That's actually a lot. That can be 8 million people. Not everybody is likely to have it. We know if you’ve been on antibiotics you are more likely to have it. If we take people who are living in a country where antibiotics are available over the counter, they're much more likely to have it than people who were in another place. The research that we've just done is so important in that it sensitizes the fact that we don't have to wait until somebody is infected to know that they're at high risk. These are people who would typically be low risk. They're not in the nursing home. They're not in the hospital. They're just walking around. So it sensitizes to that. It also sensitizes to us of how big an effect this really is in a relatively short time. These numbers are so big that we felt this definitely needs to be talked about. We can find people, we can decolonize them. We just don't know the right sequence on that yet.

Carl Lanore: [00:31:15]
I wrote a blog post March of last year as COVID started to spread in the United States, and in the post I was doing research on the effects of 25 hydroxy in the realm of retroviruses, reverse transcriptase dependent viruses. Brazil is a fascinating country if you're a virologist because the most highly populated area is the North and it's on the equator. We know that population density tends to promote the transference and infection rate of anything. The south-most region is farmland and it’s less populated, but it's pretty far away from the equator because Brazil is a very long country. Brazil doesn't follow the densely populated versus less densely populated patterns that we see everywhere else in medicine. I started to read more and more about it. Vitamin D supplementation and sun exposure (which most of the dermatology community has made us think is bad for us, but it’s really not) can actually protect you from retroviruses actually being able to replicate. My question is is there any evidence of the persistence, contamination rates, and prevalence of MRSA in populations that are exposed more to the sun?

Dr. Arch Mainous, Ph.D.:
If there is, I haven't seen it. Obviously when we look at vitamin D and vitamin D receptors, there's a lot of positive things. It's possible, but I couldn’t really comment.

Carl Lanore: [00:35:14]
I think that would be a fascinating aspect to try to tease out of some available data. We have to find different ways to treat antibiotic-resistant bacteria. Once vancomyocin is vanquished, we have no place to turn. We're just going to start dying from things that we didn't die from before. How do we prepare? What do we do as a population?

Dr. Arch Mainous, Ph.D.:
There's a couple of things that I think are worth discussing. We can talk about your hand washing and that works. We've had control of a lot of antibiotics and things in hospitals. I think it's really more about potential treatments. When you look at a lot of bacteria they scam and dire. They live off iron. That's sort of their food. Antibiotics do different things to kill the bugs; they may break down the cell wall and do things like that. But one of the things you can do is deprive them of food, which is iron. That's actually effective. So there's a possibility that you could potentially have sort of an iron chelation as a natural way.

Carl Lanore:
There are a lot of people with iron overload today. Managing iron could create a less robust, less fertile environment for these types of antibiotic-resistant bugs from even taking up root in you. More importantly, we should starting to go back to some of the old antibiotics that used to work in conjunction with maybe a couple of bloodlettings. Get iron down to a safe, but lowest quartile that we know humans can function at and see if they become weak. These old antibiotics can become effective again. 

Dr. Arch Mainous, Ph.D.:
People have actually suggested that rather than doing iron chelation by itself, you would do it in conjunction with a typical antibiotic and that could be topically. MRSA typically is sitting on people's skin. If you had an iron chelation thing and you just rub it on your skin, you could get rid of it. The reason why we don't do it now is because most of the topical things that you would use that have iron chelators in them are toxic enough, you can't put it on an open sore because then it gets in your bloodstream. But at the same time, like you said, it may be something where combining these things together might be worthwhile. It's definitely a direction to look. We have to be a little bit more creative and think about things that we haven't thought about for a long time. There is value to decreasing your iron levels. 

Carl Lanore:
There’s a couple of good studies that link improved longevity and health span in regular blood donors. It’s staggering that no one talks about this, especially juxtaposed to what we just went through with COVID. The people who died and suffered the most from COVID were the people who were horribly unhealthy to begin with. This was an opportunity for our government to step up and tell people that they need to start paying attention to their health a little bit more. Regardless of whether it’s COVID or MRSA, if you are robust and healthy, you will survive one way or the other. 

[00:42:28]
We talked earlier off-air about a human cathelicodine called LL37, which is actually a native peptide our body produces downstream from 25 hydroxy. There are human trials right now using it to treat some antibiotic-resistant bacteria. From the research I've read, they're having some success. Are you familiar with LL37? Do you think that this could be a potential arrow in the quiver? 

Dr. Arch Mainous, Ph.D.:
I'm not familiar with it. I don't know what the mechanism is and that's sometimes where we always need to come back. What's the mechanism? Why would it work? Are you trying to break down the cell wall? Are you trying to keep it from replicating? Are you trying to inhibit growth? If there's data that suggests that it works, I'm all for it.

Carl Lanore:
For someone who has been colonized and/or infected and then received proper treatment, whether it was decolonization or being treated with antibiotics, is there any evidence that they see any effects on lifespan? 

Dr. Arch Mainous, Ph.D.:
They tend to do worse. If you had the infection, particularly. Just getting clear is good, but yeah, those people still have some risk.

Carl Lanore: [00:45:21]
What do you hope people take away from your research? Do you think that the average American should go out to any lab now and have them test them for MRSA or just ignore it?

Dr. Arch Mainous, Ph.D.:
There are two things I want people to take away from this. The first, and this is something that I do a lot of, is look at things where we people have risk and we don't do much about it. For example, 80 to 90% of people in the United States who have pre-diabetes don't know. What do we do? For prediabetes, we already have guidelines that suggest that people should get screened. The difference here is we're not to that point, but I do think it's important that we re-sensitize to the fact that antibiotic-resistance is a real problem that we have to address head on, whether it's through antibiotic stewardship or whether it's through alternative ways of decreasing it. What I'm hoping is that we can come up with a way to find out about some sort of decolonization that might work for the people in the general public. When you start talking about 36% of the people dying in basically 10 years, that has to be a wake-up call for something.

Carl Lanore:
We see death statistics every year that heart disease is the number one killer, but that's a lie because heart disease is usually put in place by becoming insulin-resistant and metabolically deranged. We know cancer is higher in diabetics. We could easily take the top five and say the number one killer in the United States today is insulin-resistance and metabolic derangement. Is there any correlation between susceptibility to infection or perhaps severity of infection and insulin resistance and type two diabetes? 

Dr. Arch Mainous, Ph.D.:
People with diabetes are more susceptible to infection and do worst. This is a big issue for them as well. If you're walking around with undiagnosed diabetes and then you get this, now we have a double whammy. It's always important that we try to do a better job of finding people at risk and then trying to intervene. People with diabetes are more likely to be infected and get infected and have worse outcomes. We need to think about this as not just a benign issue.

Carl Lanore: [00:49:41]
This has been a great interview and it's been a wake-up call for me as well. MRSA has been off my radar, especially after both of my parents passed away and I don't have to worry about them anymore. It shouldn't be off of anybody's radar. Antibiotic-resistant bugs kill 37,000 people a year. That is a significant number of people. We are getting closer and closer to that fine edge of not even having something that works in the most extreme cases, and it will happen. You'll hear it about it in the news. Maybe in a year, maybe in 10 years.