When 6 1/2-month-old Nicholas Cotten developed a fever this summer, his parents, Ann and Richard Cotten, reacted quickly and took him to their physician.
Dr. Kevin Clark examined the infant but found nothing seriously wrong. He suspected a virus.
The family took a “wait and see attitude,” Ann Cotten said.
What the Cottens saw over the next four weeks was a serious and unexplained deterioration of their son’s health.
Nicholas, a young Gambrills resident, had contracted an infection that has health officials across the country extremely worried: an antibiotic-resistant strain of the strep bacteria pneumococcus.
Such infections have “increased at an alarming rate in the past 10 years,” Dr. David Satcher, director of the Centers for Disease Control and Prevention, said last week during a news conference in Baltimore.
According to the CDC, 130 of every 10,000 pneumococcal infections in the U.S. could not be treated with penicillin in 1992. By 1995, in some parts of the country, 3,000 of every 10,000 cases were resistant.
Antibiotic-resistant infections are expensive. CDC data suggest they increase U.S. health care costs by $4 billion a year.
State health officials, in kicking off a campaign against “superbacteria,” warned in particular against the misuse of antibiotics — a factor in the emergence of drug-resistant strains.
Each time someone takes antibiotics, sensitive bacteria in the body are killed while resistant bacteria are left to grow. The resistant bacteria can then spread to other people.
Antibiotics such as penicillin must bind to bacteria to kill them. However, mutations in genes that control where that binding takes place may prevent the antibiotic’s effect, experts say.
Health officials are worried about two major misuses of antibiotics:
* Prescription for illnesses not caused by bacteria. Antibiotics are ineffective against viruses. When you insist on a prescription even when a doctor is uncertain your illness is bacterial, the bacteria normally present in the body become more tolerant of drugs.
* Failure to finish a prescription. If you stop taking antibiotics when you start feeling better, not only do you fail to get rid of what’s making you sick, you strengthen the resistance of bacteria that remain.
Anyone can catch a drug-resistant bug, mostly through bodily secretion. Clark, Nicholas Cotten’s doctor, said a runny nose or a sneeze can spread the dangerous bacteria. He does not know how Nicholas contracted his infection.
Ann Cotten watched intently after the initial visit to the doctor, but Nicholas did not get better. Clark stepped up testing.
In one blood test, he found an unusually high number of lymphocytes, important in the production of antibodies — the body’s weapon against illness. The discovery pushed his diagnosis in the direction of a virus.
Then, about two weeks after Nicholas got sick, Cotten noticed the baby wasn’t using his arm.
Clark said his leading suspicion “was that [Nicholas] had developed a bone infection.” When another blood test showed an increase in the total number of Nicholas’ white blood cells, he suspected bacteria.
“The body had clearly mobilized to fight a new invader,” Clark said.
He sent the blood tests to a lab and the infant to the University of Maryland Medical Center in Baltimore. There, x-rays and a fluid sample from Nicholas’s right arm showed his blood was mixed with bacteria that had actually eaten away at his bone and leaked into his joint.
Nicholas underwent emergency surgery to drain the bacteria, and was put on antibiotics immediately afterwards.
Lab results a few days later showed the bacteria was pneumococcus and that it was antibiotic-resistant. That meant Nicholas’ doctors had to use four strong antibiotics intravenously, instead of the conventional treatment of weaker, oral drugs.
Nicholas went home after a month — attached to an IV catheter, a sterile tube that injected medicine directly into his system.
This introduced another worry. The catheter’s point of entry into the body is susceptible to infection. “It really scared me a lot,” Cotten said, because the device goes into a vein that leads to the heart.
But the nursing staff at the hospital trained the Cottens in Nicholas’ care, and they had help from a visiting home nurse. Moreover, the catheter had a sterile covering to keep new infections from entering the baby’s body.
“After the first day we were fine with it,” Cotten said.
Nicholas remained on antibiotics for six weeks after surgery. The Cottens pinned the IV device to Nicholas’s shirt so he wouldn’t pull it loose, and kept away visitors with the potential to bring in new bacteria.
Nicholas, now 10 months old, may have growth problems with his arm in later years. But otherwise, Clark said, he has recovered.
Ann Cotten has become a champion of the safe use of antibiotics. Not only did she appear at last week’s news conference, but she teaches all her friends with children the danger of antibiotic misuse. “I knew these types of things were out there,” Cotten said of drug-resistant bacteria, “[but] I never knew these were the types of things my son was going to get.” -30-