In most cases, optimal levels of Minerals exist and the essential Minerals must be present in the body in their correct balance. Excessive consumption or accumulation of Minerals is generally as undesirable (i.e. toxic) as a deficiency.
Macrominerals (Essential)
% Average Human Body
Content(70 kg person)
Oxygen 65.4 43 kg
Carbon 18.2 12 kg
Hydrogen 9.5 6.3 kg
Nitrogen 3 2 kg
Calcium 1.67 1.1 kg
Phosphorus 1.14 750 grams
Potassium 0.342 225 grams
Sulfur 0.228 150 grams
Chloride 0.152 100 grams
Sodium 0.137 90 grams
Magnesium 0.053 35 grams
Silicon 0.046 30 grams
Microminerals
Microminerals
Microminerals % Average Human Body
Content(70 kg person) Essentiality
Iron 0.00638 4,200 mg Essentiality
Fluoride 0.00395 2,600 mg Essential
Zinc 0.00365 2,400 mg Possibly Essential
Rubidium 0.000532 350 mg Essential
Strontium 0.000486 320 mg Probably Essential
Lead 0.000243 160 mg Possibly Essential
Copper 0.000137 90 mg Essential
Aluminium 0.0000988 65 mg Toxic
Cadmium 0.0000608 40 mg Toxic
Barium 0.0000344 22 mg Possibly Essential
Cobalt 0.0000304 20 mg Essential
Vanadium 0.0000304 20 mg Probably Essential
Iodine 0.0000228 15 mg Essential
Tin 0.0000228 15 mg Possibly Essential
Selenium 0.0000228 15 mg Essential
Arsenic 0.0000228 15 mg Possibly Essential
Manganese 0.0000198 13 mg Essential
Mercury 0.0000190 12.5 mg Toxic
Nickel 0.0000167 11 mg Possibly Essential
Molybdenum 0.0000122 8 mg Essential
Chromium 0.0000091 6 mg Essential
Bismuth 0.0000045 3 mg Probably Toxic
Lithium 0.0000038 2.5 mg Probably Essential
Uranium 90 mcg Toxic
Boron Probably Essential
Germanium Probably Essential
Bromine Possibly Essential
Gold Probably Non Essential
Silver Probably Non Essential
Beryllium Probably Toxic
Antimony Slightly Toxic
Thallium Toxic
These Substances Facilitate the General Absorption of Minerals
Amino Acids
Cystathionine facilitates the absorption of essential Minerals.
Glutathione facilitates the absorption of essential Minerals.
Enzymes
Glutathione Synthase metabolizes Minerals in the Skin and the Muscles.
Proteins
Orotic Acid facilitates the transport of Minerals into the blood from the digestive tract.
Water
Water is an essential transport mechanism within the body for Minerals.
Forms of Minerals (Generally)
Mineral Form Mineral Bonded With Comments
Inorganic Salts: Phosphates,
Sulfates,
Chlorides Important for Electrolyte balance.
Organic Acid Salts: Ascorbates,
Acetates ,
Citrates Natural and more effectively absorbed by the Digestive System than Inorganic Salts.
Amino Acid Chelates: Amino Acids The best form of absorption of Minerals. Specific Minerals chelate best with specific Amino Acids.
Toxic Minerals
Toxic Minerals are a group of Microminerals that are not essential to human health and which are generally toxic to the body. These Substances Enhance the Elimination of many Toxic Minerals from the Body
Amino Acids
Cysteine (and Cystine) may chelate (bind) with many Toxic Minerals and may facilitate their elimination. The synthetic Amino Acid - Ethylene-Diamine-Tetra-Acetate (EDTA) - is used in Chelation Therapy to bind to and chelate (remove) many Toxic Heavy Metals from the body via the Kidneys.
Methionine may chelate (binds) with many Toxic Minerals and may facilitate their excretion.
Carbohydrates
Alginates may chelate (bind) with most Toxic Minerals in the Intestinal Tract and may prevent their absorption. references
Galacturonic Acid chelates (binds) with many Toxic Minerals and may facilitate their excretion.
Enzymes
Glutathione Peroxidase facilitates the removal of several Toxic Minerals from the body.
Lipids
Alkylglycerols bind (chelate) with many types of Toxic Minerals (especially Mercury) and may facilitate their excretion from the body - Alkylglycerols are unique in that they are one of the few oil-based chelating agents.
Minerals
Selenium binds (chelates) with many toxic Minerals and may facilitate their excretion from the body.
Organic Acids
Fulvic Acid reputedly facilitates the chelation (removal and excretion) of Toxic Minerals from the body’s Cells.
Peptides
Glutathione (usually after incorporation into the Glutathione Peroxidase enzyme) may detoxify several Toxic Minerals.
Smart Drugs
Dimethyl Glycine (DMG) may be a useful chelation and elimination agent.
Vinpocetine may facilitate the removal of some types of Toxic Minerals from the body.
Vitamins
Vitamin E may enhance the detoxification of most toxic heavy metals.
These Foods may Enhance the Elimination of Many Toxic Minerals from the Body
Algae
Kelp may facilitate the excretion of some Toxic Minerals (due to the Algin content of Kelp binding to Toxic Minerals in the Digestive Tract and may thereby facilitating their excretion).
Animal-Derived Supplements
Shark Liver Oil may facilitate the elimination of various Toxic Minerals (especially the toxic Methylmercury form of Mercury) from the body (due to the Alkylglycerols content of Shark Liver Oil).
Mineral Foods
Shilajit reputedly facilitates the chelation (removal and excretion) of Toxic Minerals from the body’s Cells (this capability of Shilajit is claimed to be due to its Fulvic Acid content).
Vegetables
Garlic may facilitate the excretion of some Toxic Minerals.
Mineral Acids
Mineral Acids are inorganic Acid compounds that use Minerals as their base. Mineral Acids are much stronger acids than Organic Acids.
Types of Mineral Acids
Carbonic Acid
Carbonic Acid is a type of Mineral Acid formed from Water and Carbon Dioxide
Derivatives of Carbonic Acid - Bicarbonate Bicarbonate is the ion remaining after the first disassociation of Carbonic Acid. It functions as a central buffering agent against Acids in the Blood.
Therapeutic Uses of Bicarbonate
Metabolism
Bicarbonate (consumed prior to Exercise) may delay the onset of Fatigue and Muscle Weakness in people who undertake strenous Exercise (e.g. Endurance Exercise) and may accelerate the recovery of Muscles following strenuous Exercise (this occurs from Bicarbonate causing Lactic Acid to be secreted out of Muscle Fibers and neutralized).
Musculoskeletal System
Bicarbonate may help to prevent and treat Osteoporosis.
Bicarbonate may Inhibit these Potentially Toxic Substances
Organic Acids
Bicarbonate may help to prevent the Muscle Weakness and Fatigue caused by the excessive accumulation of Lactic Acid in the Muscles during prolonged Exercise (Bicarbonate causes Lactic Acid to be secreted out of Muscle Fibers and neutralized).
Forms of Bicarbonate
Magnesium Bicarbonate consists of Magnesium bound to Bicarbonate. It is only present in Water and is never present in a solidified form. It is responsible for the “hardness” of Water. Potassium Bicarbonate (KHCO3) consists of Potassium bound to Bicarbonate. Sodium Bicarbonate (also known as Baking Soda, Sodium Acid Carbonate, Sodium Hydrogen Carbonate) consists of 32.5% Sodium bound to 67.5% Bicarbonate.
Dosage Recommendations
The usual dosage of Bicarbonate used by people seeking to prevent Muscle Weakness during prolonged Exercise and to accelerate Muscle recovery after prolonged Exercise is 300 - 400 mg per kg of body weight (this would equate to an average dosage of 25 grams).
Hydrochloric Acid
Hydrochloric Acid is a strong Mineral Acid produced by the Parietal Cells of the Stomach. It comprises 0.2% - 0.5% of Gastric Juice.
Biological Functions and Therapeutic Uses of Hydrochloric Acid
Digestive System
Hydrochloric Acid regulates the acidity of the Stomach to optimize Digestion. This occurs primarily through Hydrochloric Acid stimulating the conversion of Pepsinogen to Pepsin (a Proteolytic (Protein- digesting) Enzyme).
Immune System
Hydrochloric Acid may destroy some Detrimental Microorganisms that gain entrance into the body via the Mouth: references
- Hydrochloric Acid may kill some forms of Detrimental Bacteria in the Stomach and Small Intestine:
- Hydrochloric Acid is likely to be important in suppressing Campylobacter jejuni.
- Hydrochloric Acid may suppress or kill Helicobacter pylori (Hypochlorhydria (lack of Hydrochloric Acid) patients have increased levels of Helicobacter pylori).
Oral Health
Hydrochloric Acid deficiency may cause Periodontal Disease (by decreasing the absorption of Calcium in the Alveolar Bone).
Skin
Supplemental Hydrochloric Acid may be useful for the treatment of Hives (as many cases of Hives are believed to occur as a result of Food Allergies resulting from insufficient endogenous production of Hydrochloric Acid).
Vitiligo patients are often found to have sub-optimal levels of Hydrochloric Acid in their Stomachs and replenishment of Hydrochloric Acid (15 cc with each meal) has resulted in many cures of Vitiligo.
Nitric Acid
Phosphoric Acid
Sulfurous Acid
Tuesday, March 2, 2010
In Obesity Epidemic, What’s One Cookie?
March 1, 2010, 5:08 pm
By TARA PARKER-POPE
Stuart Bradford
The basic formula for gaining and losing weight is well known: a pound of fat equals 3,500 calories.
That simple equation has fueled the widely accepted notion that weight loss does not require daunting lifestyle changes but “small changes that add up,” as the first lady, Michelle Obama, put it last month in announcing a national plan to counter childhood obesity.
In this view, cutting out or burning just 100 extra calories a day — by replacing soda with water, say, or walking to school — can lead to significant weight loss over time: a pound every 35 days, or more than 10 pounds a year.
While it’s certainly a hopeful message, it’s also misleading. Numerous scientific studies show that small caloric changes have almost no long-term effect on weight. When we skip a cookie or exercise a little more, the body’s biological and behavioral adaptations kick in, significantly reducing the caloric benefits of our effort.
But can small changes in diet and exercise at least keep children from gaining weight? While some obesity experts think so, mathematical models suggest otherwise.
Saul Loeb/Agence France-Presse — Getty Images The first lady, Michelle Obama, spoke last month at the White House about her “Let’s Move” initiative, which aims to change the way children eat and play.
As a recent commentary in The Journal of the American Medical Association noted, the “small changes” theory fails to take the body’s adaptive mechanisms into account. The rise in children’s obesity over the past few decades can’t be explained by an extra 100-calorie soda each day, or fewer physical education classes. Skipping a cookie or walking to school would barely make a dent in a calorie imbalance that goes “far beyond the ability of most individuals to address on a personal level,” the authors wrote — on the order of walking 5 to 10 miles a day for 10 years.
This doesn’t mean small improvements are futile — far from it. But people need to take a realistic view of what they can accomplish.
“As clinicians, we celebrate small changes because they often lead to big changes,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston and a co-author of the JAMA commentary. “An obese adolescent who cuts back TV viewing from six to five hours each day may then go on to decrease viewing much more. However, it would be entirely unrealistic to think that these changes alone would produce substantial weight loss.”
Why wouldn’t they? The answer lies in biology. A person’s weight remains stable as long as the number of calories consumed doesn’t exceed the amount of calories the body spends, both on exercise and to maintain basic body functions. As the balance between calories going in and calories going out changes, we gain or lose weight.
But bodies don’t gain or lose weight indefinitely. Eventually, a cascade of biological changes kicks in to help the body maintain a new weight. As the JAMA article explains, a person who eats an extra cookie a day will gain some weight, but over time, an increasing proportion of the cookie’s calories also goes to taking care of the extra body weight. Eventually, the body adjusts and stops gaining weight, even if the person continues to eat the cookie.
Similar factors come into play when we skip the extra cookie. We may lose a little weight at first, but soon the body adjusts to the new weight and requires fewer calories.
Regrettably, however, the body is more resistant to weight loss than weight gain. Hormones and brain chemicals that regulate your unconscious drive to eat and how your body responds to exercise can make it even more difficult to lose the weight. You may skip the cookie but unknowingly compensate by eating a bagel later on or an extra serving of pasta at dinner.
“There is a much bigger picture than parsing out the cookie a day or the Coke a day,” said Dr. Jeffrey M. Friedman, head of Rockefeller University’s molecular genetics lab, which first identified leptin, a hormonal signal made by the body’s fat cells that regulates food intake and energy expenditure. “If you ask anyone on the street, ‘Why is someone obese?,’ they’ll say, ‘They eat too much.’ ”
“That is undoubtedly true,” he continued, “but the deeper question is why do they eat too much? It’s clear now that there are many important drivers to eat and that it is not purely a conscious or higher cognitive decision.”
This is not to say that the push for small daily changes in eating and exercise is misguided. James O. Hill, director of the Center for Human Nutrition at the University of Colorado Denver, says that while weight loss requires significant lifestyle changes, taking away extra calories through small steps can help slow and prevent weight gain.
In a study of 200 families, half were asked to replace 100 calories of sugar with a noncaloric sweetener and walk an extra 2,000 steps a day. The other families were asked to use pedometers to record their exercise but were not asked to make diet changes.
During the six-month study, both groups of children showed small but statistically significant drops in body mass index; the group that also cut 100 calories had more children who maintained or reduced body mass and fewer children who gained excess weight.
The study, published in 2007 in Pediatrics, didn’t look at long-term benefits. But Dr. Hill says it suggests that small changes can keep overweight kids from gaining even more excess weight.
“Once you’re trying for weight loss, you’re out of the small-change realm,” he said. “But the small-steps approach can stop weight gain.”
While small steps are unlikely to solve the nation’s obesity crisis, doctors say losing a little weight, eating more heart-healthy foods and increasing exercise can make a meaningful difference in overall health and risks for heart disease and diabetes.
“I’m not saying throw up your hands and forget about it,” Dr. Friedman said. “Instead of focusing on weight or appearance, focus on people’s health. There are things people can do to improve their health significantly that don’t require normalizing your weight.”
Dr. Ludwig still encourages individuals to make small changes, like watching less television or eating a few extra vegetables, because those shifts can be a prelude to even bigger lifestyle changes that may ultimately lead to weight loss. But he and others say that reversing obesity will require larger shifts — like regulating food advertising to children and eliminating government subsidies that make junk food cheap and profitable.
Privacy Policy
NYTimes.com 620 Eighth Avenue New York, NY 10018
By TARA PARKER-POPE
Stuart Bradford
The basic formula for gaining and losing weight is well known: a pound of fat equals 3,500 calories.
That simple equation has fueled the widely accepted notion that weight loss does not require daunting lifestyle changes but “small changes that add up,” as the first lady, Michelle Obama, put it last month in announcing a national plan to counter childhood obesity.
In this view, cutting out or burning just 100 extra calories a day — by replacing soda with water, say, or walking to school — can lead to significant weight loss over time: a pound every 35 days, or more than 10 pounds a year.
While it’s certainly a hopeful message, it’s also misleading. Numerous scientific studies show that small caloric changes have almost no long-term effect on weight. When we skip a cookie or exercise a little more, the body’s biological and behavioral adaptations kick in, significantly reducing the caloric benefits of our effort.
But can small changes in diet and exercise at least keep children from gaining weight? While some obesity experts think so, mathematical models suggest otherwise.
Saul Loeb/Agence France-Presse — Getty Images The first lady, Michelle Obama, spoke last month at the White House about her “Let’s Move” initiative, which aims to change the way children eat and play.
As a recent commentary in The Journal of the American Medical Association noted, the “small changes” theory fails to take the body’s adaptive mechanisms into account. The rise in children’s obesity over the past few decades can’t be explained by an extra 100-calorie soda each day, or fewer physical education classes. Skipping a cookie or walking to school would barely make a dent in a calorie imbalance that goes “far beyond the ability of most individuals to address on a personal level,” the authors wrote — on the order of walking 5 to 10 miles a day for 10 years.
This doesn’t mean small improvements are futile — far from it. But people need to take a realistic view of what they can accomplish.
“As clinicians, we celebrate small changes because they often lead to big changes,” said Dr. David Ludwig, director of the Optimal Weight for Life program at Children’s Hospital Boston and a co-author of the JAMA commentary. “An obese adolescent who cuts back TV viewing from six to five hours each day may then go on to decrease viewing much more. However, it would be entirely unrealistic to think that these changes alone would produce substantial weight loss.”
Why wouldn’t they? The answer lies in biology. A person’s weight remains stable as long as the number of calories consumed doesn’t exceed the amount of calories the body spends, both on exercise and to maintain basic body functions. As the balance between calories going in and calories going out changes, we gain or lose weight.
But bodies don’t gain or lose weight indefinitely. Eventually, a cascade of biological changes kicks in to help the body maintain a new weight. As the JAMA article explains, a person who eats an extra cookie a day will gain some weight, but over time, an increasing proportion of the cookie’s calories also goes to taking care of the extra body weight. Eventually, the body adjusts and stops gaining weight, even if the person continues to eat the cookie.
Similar factors come into play when we skip the extra cookie. We may lose a little weight at first, but soon the body adjusts to the new weight and requires fewer calories.
Regrettably, however, the body is more resistant to weight loss than weight gain. Hormones and brain chemicals that regulate your unconscious drive to eat and how your body responds to exercise can make it even more difficult to lose the weight. You may skip the cookie but unknowingly compensate by eating a bagel later on or an extra serving of pasta at dinner.
“There is a much bigger picture than parsing out the cookie a day or the Coke a day,” said Dr. Jeffrey M. Friedman, head of Rockefeller University’s molecular genetics lab, which first identified leptin, a hormonal signal made by the body’s fat cells that regulates food intake and energy expenditure. “If you ask anyone on the street, ‘Why is someone obese?,’ they’ll say, ‘They eat too much.’ ”
“That is undoubtedly true,” he continued, “but the deeper question is why do they eat too much? It’s clear now that there are many important drivers to eat and that it is not purely a conscious or higher cognitive decision.”
This is not to say that the push for small daily changes in eating and exercise is misguided. James O. Hill, director of the Center for Human Nutrition at the University of Colorado Denver, says that while weight loss requires significant lifestyle changes, taking away extra calories through small steps can help slow and prevent weight gain.
In a study of 200 families, half were asked to replace 100 calories of sugar with a noncaloric sweetener and walk an extra 2,000 steps a day. The other families were asked to use pedometers to record their exercise but were not asked to make diet changes.
During the six-month study, both groups of children showed small but statistically significant drops in body mass index; the group that also cut 100 calories had more children who maintained or reduced body mass and fewer children who gained excess weight.
The study, published in 2007 in Pediatrics, didn’t look at long-term benefits. But Dr. Hill says it suggests that small changes can keep overweight kids from gaining even more excess weight.
“Once you’re trying for weight loss, you’re out of the small-change realm,” he said. “But the small-steps approach can stop weight gain.”
While small steps are unlikely to solve the nation’s obesity crisis, doctors say losing a little weight, eating more heart-healthy foods and increasing exercise can make a meaningful difference in overall health and risks for heart disease and diabetes.
“I’m not saying throw up your hands and forget about it,” Dr. Friedman said. “Instead of focusing on weight or appearance, focus on people’s health. There are things people can do to improve their health significantly that don’t require normalizing your weight.”
Dr. Ludwig still encourages individuals to make small changes, like watching less television or eating a few extra vegetables, because those shifts can be a prelude to even bigger lifestyle changes that may ultimately lead to weight loss. But he and others say that reversing obesity will require larger shifts — like regulating food advertising to children and eliminating government subsidies that make junk food cheap and profitable.
“We need to know what we’re up against in terms of the basic biological challenges, and then design a campaign that will truly address the problem in its full magnitude,” Dr. Ludwig said. “If we just expect that inner-city child to exercise self-control and walk a little bit more, then I think we’re in for a big disappointment.”
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NYTimes.com 620 Eighth Avenue New York, NY 10018
Rising Threat of Infections Unfazed by Antibiotics
February 27, 2010
A minor-league pitcher in his younger days, Richard Armbruster kept playing baseball recreationally into his 70s, until his right hip started bothering him. Last February he went to a St. Louis hospital for what was to be a routine hip replacement.
By late March, Mr. Armbruster, then 78, was dead. After a series of postsurgical complications, the final blow was a bloodstream infection that sent him into shock and resisted treatment with antibiotics.
“Never in my wildest dreams did I think my dad would walk in for a hip replacement and be dead two months later,” said Amy Fix, one of his daughters.
Not until the day Mr. Armbruster died did a laboratory culture identify the organism that had infected him: Acinetobacter baumannii.
The germ is one of a category of bacteria that by some estimates are already killing tens of thousands of hospital patients each year. While the organisms do not receive as much attention as the one known as MRSA — for methicillin-resistant Staphylococcus aureus — some infectious-disease specialists say they could emerge as a bigger threat.
That is because there are several drugs, including some approved in the last few years, that can treat MRSA. But for a combination of business reasons and scientific challenges, the pharmaceuticals industry is pursuing very few drugs for Acinetobacter and other organisms of its type, known as Gram-negative bacteria. Meanwhile, the germs are evolving and becoming ever more immune to existing antibiotics.
“In many respects it’s far worse than MRSA,” said Dr. Louis B. Rice, an infectious-disease specialist at the Louis Stokes Cleveland V.A. Medical Center and at Case Western Reserve University. “There are strains out there, and they are becoming more and more common, that are resistant to virtually every antibiotic we have.”
The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.
Acinetobacter, which killed Mr. Armbruster, came to wide attention a few years ago in infections of soldiers wounded in Iraq.
Meanwhile, New York City hospitals, perhaps because of the large numbers of patients they treat, have become the global breeding ground for another drug-resistant Gram-negative germ, Klebsiella pneumoniae.
According to researchers at SUNY Downstate Medical Center, more than 20 percent of the Klebsiella infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide.
Health authorities do not have good figures on how many infections and deaths in the United States are caused by Gram-negative bacteria. The Centers for Disease Control and Prevention estimates that roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.
But in Europe, where hospital surveys have been conducted, Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year caused by some of the most troublesome hospital-acquired infections, according to a report released in September by health authorities there.
To be sure, MRSA remains the single most common source of hospital infections. And it is especially feared because it can also infect people outside the hospital. There have been serious, even deadly, infections of otherwise healthy athletes and school children.
By comparison, the drug-resistant Gram-negative germs for the most part threaten only hospitalized patients whose immune systems are weak. The germs can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters and ventilators.
What is most worrisome about the Gram-negatives is not their frequency but their drug resistance.
“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, Calif., and the author of “Rising Plague,” a book about drug-resistant pathogens. Dr. Spellberg is a consultant to some antibiotics companies and has co-founded two companies working on other anti-infective approaches. Dr. Rice of Cleveland has also been a consultant to some pharmaceutical companies.
Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. These drugs were largely abandoned decades ago because they can cause kidney and nerve damage, but because they have not been used much, bacteria have not had much chance to evolve resistance to them yet.
“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”
Such a tradeoff confronted Kimberly Dozier, a CBS News correspondent who developed an Acinetobacter infection after being injured by a car bomb in 2006 while on assignment in Iraq. After two weeks on colistin, Ms. Dozier’s kidneys began to fail, she recounted in her book, “Breathing the Fire.”
Rejecting one doctor’s advice to go on dialysis and seek a kidney transplant, Ms. Dozier stopped taking the antibiotic to save her kidneys. She eventually recovered from the infection.
Even that dire tradeoff might not be available to some patients. Last year doctors at St. Vincent’s Hospital in Manhattan published a paper describing two cases of “pan-resistant” Klebsiella, untreatable by even the kidney-damaging older antibiotics. One of the patients died and the other eventually recovered on her own, after the antibiotics were stopped.
“It is a rarity for a physician in the developed world to have a patient die of an overwhelming infection for which there are no therapeutic options,” the authors wrote in the journal Clinical Infectious Diseases.
In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.
Sabiha Khan, 66, went to the emergency room of a Chicago hospital on New Year’s Day suffering from a urinary tract and kidney infection caused by E. coli resistant to the usual oral antibiotics. Instead of being sent home to take pills, Ms. Khan had to stay in the hospital 11 days to receive powerful intravenous antibiotics.
This month, the infection returned, sending her back to the hospital for an additional two weeks.
Some patient advocacy groups say hospitals need to take better steps to prevent such infections, like making sure that health care workers frequently wash their hands and that surfaces and instruments are disinfected. And antibiotics should not be overused, they say, because that contributes to the evolution of resistance.
To encourage prevention, an Atlanta couple, Armando and Victoria Nahum, started the Safe Care Campaign after their 27-year-old son, Joshua, died from a hospital-acquired infection in October 2006.
Joshua, a skydiving instructor in Colorado, had fractured his skull and thigh bone on a hard landing. During his treatment, he twice acquired MRSA and then was infected by Enterobacter aerogenes, a Gram-negative bacterium.
By ANDREW POLLACK
A minor-league pitcher in his younger days, Richard Armbruster kept playing baseball recreationally into his 70s, until his right hip started bothering him. Last February he went to a St. Louis hospital for what was to be a routine hip replacement.
By late March, Mr. Armbruster, then 78, was dead. After a series of postsurgical complications, the final blow was a bloodstream infection that sent him into shock and resisted treatment with antibiotics.
“Never in my wildest dreams did I think my dad would walk in for a hip replacement and be dead two months later,” said Amy Fix, one of his daughters.
Not until the day Mr. Armbruster died did a laboratory culture identify the organism that had infected him: Acinetobacter baumannii.
The germ is one of a category of bacteria that by some estimates are already killing tens of thousands of hospital patients each year. While the organisms do not receive as much attention as the one known as MRSA — for methicillin-resistant Staphylococcus aureus — some infectious-disease specialists say they could emerge as a bigger threat.
That is because there are several drugs, including some approved in the last few years, that can treat MRSA. But for a combination of business reasons and scientific challenges, the pharmaceuticals industry is pursuing very few drugs for Acinetobacter and other organisms of its type, known as Gram-negative bacteria. Meanwhile, the germs are evolving and becoming ever more immune to existing antibiotics.
“In many respects it’s far worse than MRSA,” said Dr. Louis B. Rice, an infectious-disease specialist at the Louis Stokes Cleveland V.A. Medical Center and at Case Western Reserve University. “There are strains out there, and they are becoming more and more common, that are resistant to virtually every antibiotic we have.”
The bacteria, classified as Gram-negative because of their reaction to the so-called Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body. Their cell structure makes them more difficult to attack with antibiotics than Gram-positive organisms like MRSA.
Acinetobacter, which killed Mr. Armbruster, came to wide attention a few years ago in infections of soldiers wounded in Iraq.
Meanwhile, New York City hospitals, perhaps because of the large numbers of patients they treat, have become the global breeding ground for another drug-resistant Gram-negative germ, Klebsiella pneumoniae.
According to researchers at SUNY Downstate Medical Center, more than 20 percent of the Klebsiella infections in Brooklyn hospitals are now resistant to virtually all modern antibiotics. And those supergerms are now spreading worldwide.
Health authorities do not have good figures on how many infections and deaths in the United States are caused by Gram-negative bacteria. The Centers for Disease Control and Prevention estimates that roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.
But in Europe, where hospital surveys have been conducted, Gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year caused by some of the most troublesome hospital-acquired infections, according to a report released in September by health authorities there.
To be sure, MRSA remains the single most common source of hospital infections. And it is especially feared because it can also infect people outside the hospital. There have been serious, even deadly, infections of otherwise healthy athletes and school children.
By comparison, the drug-resistant Gram-negative germs for the most part threaten only hospitalized patients whose immune systems are weak. The germs can survive for a long time on surfaces in the hospital and enter the body through wounds, catheters and ventilators.
What is most worrisome about the Gram-negatives is not their frequency but their drug resistance.
“For Gram-positives we need better drugs; for Gram-negatives we need any drugs,” said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-U.C.L.A. Medical Center in Torrance, Calif., and the author of “Rising Plague,” a book about drug-resistant pathogens. Dr. Spellberg is a consultant to some antibiotics companies and has co-founded two companies working on other anti-infective approaches. Dr. Rice of Cleveland has also been a consultant to some pharmaceutical companies.
Doctors treating resistant strains of Gram-negative bacteria are often forced to rely on two similar antibiotics developed in the 1940s — colistin and polymyxin B. These drugs were largely abandoned decades ago because they can cause kidney and nerve damage, but because they have not been used much, bacteria have not had much chance to evolve resistance to them yet.
“You don’t really have much choice,” said Dr. Azza Elemam, an infectious-disease specialist in Louisville, Ky. “If a person has a life-threatening infection, you have to take a risk of causing damage to the kidney.”
Such a tradeoff confronted Kimberly Dozier, a CBS News correspondent who developed an Acinetobacter infection after being injured by a car bomb in 2006 while on assignment in Iraq. After two weeks on colistin, Ms. Dozier’s kidneys began to fail, she recounted in her book, “Breathing the Fire.”
Rejecting one doctor’s advice to go on dialysis and seek a kidney transplant, Ms. Dozier stopped taking the antibiotic to save her kidneys. She eventually recovered from the infection.
Even that dire tradeoff might not be available to some patients. Last year doctors at St. Vincent’s Hospital in Manhattan published a paper describing two cases of “pan-resistant” Klebsiella, untreatable by even the kidney-damaging older antibiotics. One of the patients died and the other eventually recovered on her own, after the antibiotics were stopped.
“It is a rarity for a physician in the developed world to have a patient die of an overwhelming infection for which there are no therapeutic options,” the authors wrote in the journal Clinical Infectious Diseases.
In some cases, antibiotic resistance is spreading to Gram-negative bacteria that can infect people outside the hospital.
Sabiha Khan, 66, went to the emergency room of a Chicago hospital on New Year’s Day suffering from a urinary tract and kidney infection caused by E. coli resistant to the usual oral antibiotics. Instead of being sent home to take pills, Ms. Khan had to stay in the hospital 11 days to receive powerful intravenous antibiotics.
This month, the infection returned, sending her back to the hospital for an additional two weeks.
Some patient advocacy groups say hospitals need to take better steps to prevent such infections, like making sure that health care workers frequently wash their hands and that surfaces and instruments are disinfected. And antibiotics should not be overused, they say, because that contributes to the evolution of resistance.
To encourage prevention, an Atlanta couple, Armando and Victoria Nahum, started the Safe Care Campaign after their 27-year-old son, Joshua, died from a hospital-acquired infection in October 2006.
Joshua, a skydiving instructor in Colorado, had fractured his skull and thigh bone on a hard landing. During his treatment, he twice acquired MRSA and then was infected by Enterobacter aerogenes, a Gram-negative bacterium.
“The MRSA they got rid of with antibiotics,” Mr. Nahum said. “But this one they just couldn’t do anything about.”
New York Times
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