Hello readers, it’s Dr. Richard Suzuki again and I’ll be writing today’s Celling blog.  I’d like to discuss the recent surge of media attention surrounding antibiotic-resistant bacteria resulting from the unfortunate case of a 70-year old woman who died in Washoe County, Nevada. Dr. Moncivais has discussed the subject of antibiotic-resistant bacteria in a previous blog, but given the renewed discussion over these “superbugs” as they care called, I thought it would be timely to re-address the subject.

The Nevada woman was admitted to a hospital last year and it was discovered that her infection was resistant to all 26 antibiotics available in the US.  This particularly resistant strain of bacteria is known as CRE (Carbapenem-resistant Enterobacteriaceae).  It is uncommon in the US, and it seems likely the woman may have been exposed during a visit to India when she was hospitalized.

Antibiotic-resistant bacteria have been a growing concern for years.  According to the CDC, 2 million people in the US are infected with resistant bacteria and at least 23,000 die each year. The particularly resistant CRE bacteria kill about 600 people in the US each year.

This unfortunate event has renewed the public and professional discussions on the overuse of antibiotics leading to resistant bacteria.  The UN held a meeting last year to address the issue and the CDC said,

“…..very importantly, prescribe antibiotics carefully.  Unfortunately, half of all of the antibiotics prescribed in this country are either unnecessary or inappropriate.”

The CDC recommends limiting the use of antibiotics because resistant superbugs develop from antibiotic overuse.   Repeated exposure of bacteria populations to antibiotics results in a kind of accelerated natural selection, allowing the bacteria who are resistant to antibiotics to grow more common and numerous.

a decrease of infections from surgeries would lead to lower overall use of antibiotics

Regular readers of this blog can probably guess where I’m going with all of this.   For new readers, let’s revisit observations recently published by Dr. Phillipe Hernigou. Katy has referenced his 2016 study where Dr. Hernigou showed patients with infected non-unions could be treated without antibiotics. In the study, 30 patients had infected leg bone (tibia) non-unions occurring after open fractures.  After treatment with bone marrow concentrate, healing of the bone and cure of infection observed in 25 patients after 6 month.  All patients were healed at one year.   The patients were followed for an average of 10 years after treatment, and only one patient had infection after healing.   Think about that, 97% patients had their bones healed and cured of infection without antibiotics.

In a study published earlier last year, Dr.  Hernigou looked at treating ankle non-unions in diabetic patients. Diabetic patients tend to show a greater incidence of complications which include infections. Eighty-six ankle non-unions were treated with bone marrow concentrate and compared to 86 matching ankle non-unions in diabetic patients who were treated using bone harvested from their iliac crest (autograft). Of the 86 patients treated with iliac crest bone, 17 had later infections. Out of the 86 patients treated with bone marrow concentrate, only one developed a later infection.  And let’s not overlook the fact that patients treated with bone marrow concentrate also showed better bone healing and lower frequency of other complications like skin necrosis or mal-unions compared to patients treated with iliac crest bone autograft.

It should be noted that infections are particularly dangerous in frail or elderly patients. I’ve mentioned in a previous blog that Dr. Hernigou has also shown how the bone marrow concentrate from elderly patients can be used successfully, which means that even this at-risk patient population could benefit from the anti-infective property of their own bone marrow.

I’m no bacteriologist, but looking at these promising observations, I don’t believe it is a huge leap of logic to say that a wider use of bone marrow concentrate in medical treatments could lead to an overall decrease in infection rates. Infections from surgery are certainly not what the CDC would consider an inappropriate use of antibiotics, but a decrease of infections from surgeries would lead to lower overall use of antibiotics.  And that is exactly what the CDC is recommending to combat the growth of the superbugs.