New York Times Article on Funguses immune to drugs

The lead article in yesterday‘s New York Times was entitled, “Fungus immune to drugs quietly sweeps the globe”…”Lethal infection adds alarming information to dangers of overusing medicine.”

    For those of you who read the article there is no fear. This is a new species of the fungus Candida called Auris that is significant for people who have immune compromised systems, such as patients on chemotherapy, long-term steroid use, the very young and the very old. It is NOT related to garden-variety Candida species that are implicated in the typical yeast that exists in a majority of healthy women. These species are what we call “opportunistic” organisms. They live in balance with the many NORMAL bacteria that also share the nutrients of the vagina. If there is an overgrowth of these Candida species (once again remember they are a a normal inhabitant of the vagina) usually as a result of concomitant antibiotics which upset the normal bacterial balance of the vagina, sometimes abnormal sugar levels, pregnancy, or anything that does not allow the perineal area to “breathe” (wet bathing suit, tight leotards, non-cotton underwear, etc.) then the signs of this imbalance (a better description than “yeast INFECTION”) result in the burning, itching redness that many of you have at some point in your life experienced.

    The reason, however, I am sending this email blast out is because I have communicated to many of you the dangers of overuse of antibiotics. This is especially true in patients who believe they have a urinary tract infection. All too often many physicians and many urgent care centers will simply dipstick a patient’s urine and if positive for a substance called leukocyte esterase they will initiate an antibiotic that is broad-spectrum enough to kill virtually any organism in the urine. In the last year I have seen two examples of something that I predicted would occur for more than a decade now. I have had two patients in whom we performed a urine culture that came back with bacteria that were resistant to virtually every oral antibiotic that we normally use. I unfortunately had to call those patients and inform them that I treat urinary tract infection almost as a “courtesy” and that I was not going to start an intravenous line or give them an intramuscular shot of some new antibiotic that I had virtually no experience with. They would have to go to a urologist or their regular doctor for treatment of their urinary tract infection. The way I prefer to treat presumed urinary tract infections is by starting a patient on a medication to take the discomfort (burning, urgency, frequency, sometimes even blood) away while a culture is being obtained. If the culture shows bacteria in the urine I would choose the least broad-spectrum antibiotic for that particular bacteria. If the culture shows no true infection then such urinary tract inflammation can be successfully treated with one week of the urinary anesthetic (the drug that turns your urine in a dark orange color).

Think about it. When penicillin was introduced in the 1940s it killed virtually all bacteria. Currently almost all bacteria are resistant to penicillin. The overuse of antibiotics is leading to the development of more and more resistant strains to therapy.

    So the take-home message for this email blast is: next time you think you are having a urinary tract infection please call us. We will give you medication to take the symptoms away while we do a formal culture (takes approximately 48 hours) and then, if necessary, prescribe the appropriate non-broad-spectrum antibiotic. 

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