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INSIDE STORY

The Enemy Within

You Probably Don't Want to Know What Dr. David Pegues Knows About Hospitals, About Those Nasty, Drug-Resistant Microbes Lying in Wait. But What the Germ Warrior Knows Just Might Save Your Life.

October 03, 1999|Michael D' Antonio | Michael D'Antonio last wrote for the magazine about George and Pam Smith's quest for a cure for their daughter's rare disease, ataxia-telangiectasia

In 1990, Pegues was a freshly commissioned officer of the CDC locked in one of his first investigations of B. cepacia. A number of young adults attending Cystic Fibrosis Foundation summer camps had been infected, and the CDC wanted to know if this bacteria could be spread person to person in an open environment.

Pegues flew to camps in Ohio, Utah and Ontario, Canada, to investigate.

Water samples from the pools, lakes, fountains and faucets at the camps were clean, but B. cepacia was found in the lungs of 46 of 237 campers. By the time camp was over, 11 more kids were infected. Though it seemed persuasive, the evidence was merely circumstantial until Pegues' team confirmed it with a DNA study: People with cystic fibrosis face special risk from a respiratory infection.

The study led to an article in the journal Pediatrics and helped Pegues begin making a name for himself. It also drew him deeper into a specialty that is a blend of science and sleuthing. The CDC sent him to the Navajo reservation hospital in Shiprock, Ariz., where he determined that what looked like an epidemic of blood disease was actually a false alarm set off by contaminated test vials. In Alabama, he again chased his nemesis B. cepacia, eventually tracing 14 cases to contaminated intravenous fluid in a cancer-treatment center. While he was in Alabama, Pegues also was asked to look into lead poisoning in a rural county. A local hospital had detected it during blood tests on nine adult patients. The only factor that stitched the cases together was alcohol: All of the patients had been admitted for alcohol-related diseases.

The big government sedan that Pegues drove into the Alabama countryside didn't help his investigation. But eventually the proprietors of the little country taverns where he stopped were convinced that he was a doctor, not a revenuer. He managed to collect a few alcohol samples to take back to his lab, and his hunch was proven true. The lead was in local moonshine, which had been distilled in contraptions built from auto radiators with lead-soldered parts.

He loved working at the CDC. "But when this job came along, I realized that I could get in on something important. Hospital epidemiology is a hot field. UCLA is a premier medical center. They seemed to need me, and I liked the challenge, especially since I would be able to see some patients in addition to doing infection control."

When he arrived in 1996, Pegues found a hospital with a subpar surveillance system that had never had an epidemiologist assigned full time to infection control--unusual for a medical center and research site with more than 500 patients. The Joint Commission on Hospital Accreditation, which certifies hospitals nationwide, had recommended improvements to UCLA's system for tracking infections.

Pegues' counterpart at USC Medical Center was in place about 20 years ago, when the new superbugs began to appear. At the time Dr. Peter Heseltine was a fledgling hospital epidemiologist. "The general feeling then was that if someone got an infection in the hospital, it was not really a big deal because he could be cured with an antibiotic and that was that. No one really expected these drugs would begin to fail to work. But they did."

In fact, the very first drug-resistant bacteria were discovered in the 1940s soon after penicillin--the first antibiotic--became widely available. By the end of the decade researchers were warning that evolution could render so-called miracle drugs powerless. But at the time, new antibiotics were being developed so quickly that it seemed as if researchers would stay ahead of the bugs indefinitely.

Ironically, the harder scientists worked to make new drugs, the more they contributed to the resistance problem. This is because the drugs themselves are a critical part of the evolutionary process. "Imagine that the antibiotic is like some alien race that comes to Earth and kills everyone who's 5-foot-10 or shorter," says Heseltine. "What you have left over is a bunch of big, angry people who reproduce and create even more big, angry people." To make matters worse, he adds, bacteria know how to share resistance, so that a tiny, innocuous bug that just happens to be resistant to a drug can pass on that trait to a much nastier creature, which suddenly refuses to succumb to a former miracle drug.

Hospitals are perfect settings for this evolutionary process because they house plenty of bacteria in an antibiotic-rich environment. In this hothouse, the most virulent strains emerge. Once they develop, hospital-bred superbugs may attack patients rendered all but defenseless by disease or by medical interventions. At UCLA, where hundreds of transplants are done every year, every patient who receives a new organ or a bone marrow transfer is at special risk.

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