“Wikipedia Journalism” Can be Contagious and Deadly

Acinetobacter baumannii - Superbug

Via the Defense Base Act Compensation Blog

Many Injured Contractors were repatriated via the Military Medical Evacuation System which was/is badly contaminated with Multi Drug Resistant Acinetobacter baumannii.  Soldiers and Contractors alike lost lives and limbs to this dangerous Superbug.

Injured Contractors played an even larger role in the spread of MDRAb across the US and to every country of the “coalition” than did the soldiers themselves.  Injured Contractors were infected  in field hospitals, Landstuhl, Walter Reed, Bethesda Naval, and then transferred to Civilian Community hospitals.    Civilian hospitals were seldom warned their new transfers were infected with a life threatening highly contagious bacteria.

The DoD’s usual knee jerk reaction was to cover this problem up rather than deal with it.  Lie about to be exact.

Steve Silberman, Investigative Journalist for Wired, has written again, on the spread of this Superbug and the Military and “Wikipedia Journalism’s” aiding and abetting the enemy.

Is Wikipedia Journalism Aiding the Spread of a Deadly Superbug?

by Steve Silberman at NeuroTribes

Japan is in an uproar. Last week, officials at the Teikyo University Hospital admitted that 46 patients in the past year have been infected with an antibiotic-resistant bacterium called Acinetobacter baumannii, and that 27 have died. Today, the number of infected patients was increased to 53, and hospital announced that it would admit no new patients until it checks for the presence of the bacteria in more than 800 patients currently in the hospital. In a contrite press conference, hospital officials admitted that they had not promptly reported the infections to local authorities as they are legally required to do, and that this delay likely contributed to the spread of the bacteria through the wards, and to patient deaths.

Meanwhile, other Tokyo hospitals are also now reporting infections and deaths. Yurin Hospital discovered that eight of its patients — aged 59 to 100 — were colonized by the bacteria, and four of them have died. Three patients at the Metropolitan Geriatric Hospital were also infected, and one has died. The bacteria seems to be spreading rapidly through hospitals in the Japanese metropolis, aided by patient transfers, overuse of antibiotics, lack of sufficient infection control, and failure to report the infections to health authorities. Seeking to place the blame for the seemingly sudden upsurge of the bacteria, The Daily Yomiuri ominously speculated today, “Could medical tourists bring something more sinister than their own health problems with them when they come to Japan?”

Sadly, none of this is a surprise to me: not the rapid spread of the bacteria, not the deaths, and not the failure to acknowledge the problem until numerous patients had died or become colonized, and not the frantic seeking to place the blame by demonizing people from other cultures. The same pattern emerged in an epidemic of Acinetobacter baumannii infections among American and Canadian troops returning from the wars in Iraq and Afghanistan, which I wrote about for Wired magazine in 2007, in an in-depth investigative feature called “The Invisible Enemy.”

Back then, it was the U.S. Defense Department officials who were slow to acknowledge rampant acinetobacter infections in the ranks, and they were not nearly as eager to take responsibility as Japanese officials have been this week. Indeed, there seemed to be a coordinated effort to mislead the press about the true source of the infections. Antibiotic-resistant Acinetobacter baumanniiis almost always found in hospitals and other health care facilities. It is a nosocomial infection — like MRSA, Clostridium difficile, and the other horsemen of the post-antibiotic apocalypse, it preys on those who are already sick, elderly, or traumatically injured, piling agony upon agony. That’s why troops and civilians gravely wounded in war are one of acinetobacter’s favorite target demographics: all that fresh, exposed meat, left undefended by already weakened immune systems or immunosuppressive drugs. Particularly among the young — car-crash victims and the like — many acinetobacter infections go undetected, because the primary trauma alone is enough to kill the patient.

The story coming from Washington, however, was that the source of the bacteria was Iraqi insurgents who were intentionally “dosing” improvised explosive devices (IEDs) with the superbug, in the form of dog feces or rotting meat. The alternate version of the official story was that Acinetobacter baumannii lurks in the Iraqi soil itself, waiting to pounce on young American warriors like some kind of microbial jihad. In the fog of war, reporters bought these official story lines and parroted them dutifully, from CNN’s Situation Room to CBS correspondent Kimberly Dozier, who called A. baumanniian Iraqi bacteria” (as if organisms carry passports) after barely surviving an IED attack and subsequent infection in 2006. In the military and the press, the bacteria acquired the catchy nickname “Iraqibacter,” which has a darkly ironic grain of truth to it — wounded Iraqi citizens cared for in our field hospitals in the early days of the war became infected at much higher rates than our troops, and were then released back into a country with a health-care infrastructure that had been bombed back to the Stone Age.

For more information about how the Pentagon conducted a secret war against this bacteria, see my 2007 story. But I knew when I filed it that the saga of the medical battle against Acinetobacter baumannii was just beginning. Since my story ran, there have been numerous outbreaks of the superbug in hospitals in Europe and Asia, with scores of patients — both military and civilian — left dead.

In time, the “dosed IED” story slowly faded away. But one aspect of the misleading press coverage of the bacteria refuses to die: the notion — repeated by the Mainichi Daily News and other Japanese papers this week — that multi-drug resistant Acinetobacter baumannii is commonly found in water and soil. This notion — that A. baumannii is nearly ubiquitous in the natural world — has been reinforced by everyone from local TV news stations to the New York Times.

Multidrug-resistant Acinetobacter baumannii is not commonly found in water and soil. It is found in hospitals and clinics, where the tenacious organisms earn their resistance to the best drugs we can throw at them; it is particularly prevalent in intensive-care units, lurking among those moist places where medical equipment enters the body, such as catheters and breathing tubes.

To put it another way, Acinetobacter baumanniiis not a “wild” superbug. It is a thoroughly domesticated superbug, inadvertently trained and evolved by us, living alongside us in a terrible synergy, and thriving on the spoils of war, aging, disease, and the failure to implement proper infection controls.

Beyond misleading shaggy dog-poop stories from Pentagon spokespeople, the source of this problem in journalism may be tragically mundane. Acinetobacter in general — that is, not baumannii — is one of the largest and most diverse genera of bacteria on the planet, comprising more than 30 distinct species, including Acinetobacter baylyi and Acinetobacter haemolyticus. Right up at the top of the Wikipedia entry for Acinetobacter, Googling journalists on deadline are informed that the bacteria is an “important soil organism.” While that’s true of some members of the genus, it’s not true of the species causing these infections. You have to get down in the fine print to realize that A. baumannii — the evolutionary sequel — is a whole other kind of beast, native to hospitals, and worthy of its own Wikipedia entry.

This confusion has resulted in hundreds of news stories — and even a fact sheet [PDF link] put out by the Infectious Diseases Society of America — claiming that Acinetobacter baumannii is “commonly found in water and soil,” when the scientist who discovered antibiotic resistance in the organism, Lenie Dijkshoorn, a senior researcher at Leiden University Medical Center in the Netherlands, told me when I interviewed her for my Wired story, “My colleagues and I have been looking for Acinetobacter baumannii in soil samples for years, and we haven’t found it. These organisms are quite rare outside of hospitals.”

So what’s the big deal?  The big deal is that errors in medical journalism — particularly ones that proliferate everywhere in big media virtually unchallenged — can lead to bad medicine. I felt a chill pass over me when I read a 2006 paper in the Canadian Medical Association Journalthat quoted Major Homer Tien, a Canadian trauma surgeon serving in Afghanistan, saying that because he believed the windblown desert sand carries A. baumannii, “There’s talk of building an antechamber to the hospital, so you’d have a double set of doors, to help keep the sand out.”

In any health-care setting, infection-control resources are stretched thin. Hospitals — on the front lines or back home — simply cannot afford this kind of confusion. Every news story that echoes the false claim that Acinetobacter baumannii is “commonly found in soil and water” is part of the problem.

A citizen journalist named Marcie Hascall Clark — the wife of a contractor who picked up the bacteria in a hospital after being wounded in Baghdad — has been sounding the alarm for years, a voice in the online wilderness. By 2007, when I wrote my Wiredstory, many physicians in the military had already figured out what was really going on, and were starting to implement strict protocols — including rebuilding the field hospitals, increasing disease surveillance, and isolating infected and colonized patients — to minimize colonization and new infections among wounded troops. The US medical establishment and smart science bloggers like Maryn McKenna, author of Superbug, have also awakened to the growing threat of this particularly nasty and adaptive organism. “In the all-star annals of resistant bugs,” McKenna wrote in June, “A. baumanniiis an underappreciated player.”

Much of the media, however — from America to Japan — has yet to catch up.

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2 Responses to "“Wikipedia Journalism” Can be Contagious and Deadly"

  1. Dr Edo McGowan  September 9, 2010 at 10:45 pm

    To the extent that this organism is eliminated in feces, it will thus be found in sewer plants. Hospitals shed large volumes of resistant pathogens to sewer plants. Pathogens which in nature seldom get together are thrust into contact within sewer plants. Thus there is the opportunity for exchange of genetic information related to both virulence and antimicrobial resistance. The US/EPA is well aware of this but has done little with the information, the question is why? In 1982 one of the EPA studies was published discussing this. What follows is some of that text which it pulled from its web base, again why would the agency sequester this important document? This is a study demonstrating that sewer plants were principal generators of antibiotic resistant bacteria (see: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC241834/pdf/aem00183-0119.pdf) for the full paper.
    “Several researchers have pointed out that
    wastewater, treated or untreated, is a primary
    contributor of bacteria to the aquatic ecosystem
    (12, 16, 17, 20, 27, 29). Studies have been
    conducted which demonstrate that significant
    numbers of multiple drug-resistant coliforms occur
    in rivers (17), bays (9), bathing beaches (28),
    and coastal canals (13). Waters contaminated by
    bacteria capable of transferring drug resistance
    are of great concern since there is the potential
    for transfer of antibiotic resistance to a pathogenic

    Chang, later looked at enhanced virulence. “Despite the widespread use of chlorination for microbial control in aqueous environments, cellular response mechanisms of human pathogens, such as Staphylococcus aureus, against chlorination remain unknown. In this work, genome-wide transcriptional analysis was performed to elucidate cellular response of S. aureusto hypochlorous acid, an active antimicrobial product of chlorination in aqueous solution. Our results suggest that hypochlorous acid repressed transcription of genes involved in cell wall synthesis, membrane transport, protein synthesis, and primary metabolism, while amino acid synthesis genes were induced. Furthermore, hypochlorous acid induced transcription of genes encoding major virulence factors of S. aureus, such as exotoxins, hemolysins, leukocidins, coagulases, and surface adhesion proteins, which all play essential roles in staphylococcal virulence. This work implies that chlorination may stimulate production of virulence factors, which provides new insight into host-pathogen interactions and effects of chlorine application for microbial control.” See: http://cat.inist.fr/?aModele=afficheN&cpsidt=19219794

    Joan B Rose did a year-long study for the Water Environment Research Foundation (WERF) on reclaimed water as produced from six sewer plants in three states, Florida, Arizona, and California and noted that there were potential public health issues, (see: http://www.werf.org/pdf/00PUM2T.pdf.) That work was republished by Harwood and here is what that study said—“Multiple samplings conducted at each facility over a 1-year period. Larger sample volumes for indicators (0.2 to 0.4 liters) and pathogens (30 to 100 liters) resulted in more sensitive detection limits than are typical of routine monitoring. Microorganisms were detected in disinfected effluent samples at the following frequencies: total coliforms, 63%; fecal coliforms, 27%; enterococci, 27%; C. perfringens, 61%; F-specific coliphages, ~40%; and enteric viruses, 31%. Cryptosporidium oocysts and Giardia cysts were detected in 70% and 80%, respectively, of reclaimed water samples. Viable Cryptosporidium, based on cell culture infectivity assays, was detected in 20% of the reclaimed water samples. No strong correlation was found for any indicator-pathogen combination. When data for all indicators were tested using discriminant analysis, the presence/absence patterns for Giardia cysts, Cryptosporidium oocysts, infectious Cryptosporidium, and infectious enteric viruses were predicted for over 71% of disinfected effluents. The failure of measurements of single indicator organism to correlate with pathogens suggests that public health is not adequately protected by simple monitoring schemes based on detection of a single indicator, particularly at the detection limits routinely employed. ”

    The long and short of this is the question that must be raised. What are either EPA or CDC doing about the spread of pathogens by sewer plants and the byproducts of sewage processing? Can they assure us that with the wide spread use of sewage byproducts, that Acinetobacter baumannii, is not being spread into the community by the byproducts of sewage processing? These byproducts would be biosolids and the compost of biosolids, reclaimed (recycled) water of discharged effluents that become the drinking water for the next down-stream city?

    In discussing the issue of antibiotic resistance with EPA, I am told that there are no scientists looking at sewage processing and antibiotic resistance. In discussing this with CDC, that agency tells me that there is no focus on this. Government ignores this? WHY?

  2. SEEVIEW  September 9, 2010 at 1:16 pm

    Wikipedia. The world would be better off if people stopped going to that site for information. Any one with only half a brain can post crap on there and it shows near brainless. They print about anything. More so if it is in their favor to do so. Reminds me a lot like Wikileaks and the crap they put out, or should I say what is left out, instead of the full story. Example was the story on the helicopter killings where some of the voices were left out to make them look good.If I want to find out about a subject I go to a real encyclopedia. IMO___SEEVIEW

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