At Pepper's Hideout, A South Side Party To Remember

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MRSA: The Drug-Resistant 'Superbug' That Won't Die

TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

A lot of people that are admitted to hospitals worry not only about the
problems that got them there, but also about hospital-acquired infections,
infections from antibiotic-resistant bacteria that live in hospitals and can
find their way into surgical incisions, IV sites or catheter sites. These
bacteria are known as MRSA, M-R-S-A, an acronym for methicillin-resistant
Staphylococcus aureus.

My guest, Maryn McKenna, has written a new book about the menace of MRSA called
"Superbug." In the book, she describes how a strain of this antibiotic-
resistant bacteria is now living outside hospitals, in the community, and how
it's spread into the food chain.

McKenna is a science and medical reporter who covered the Center for Disease
Control for the Atlanta Journal-Constitution. She's now a contributing writer
at the Center for Infectious Disease Research and Policy at the University of
Minnesota.

Maryn McKenna, welcome to FRESH AIR. We've talked about MRSA on the show
before, but your book was really, was really scary because I learned all these
things I didn't even know about it. So let's start with the basics.

MRSA isn't just resistant to antibiotics. It's more lethal than many other
bacteria. What kind of damage can it do?

Ms. MARYN McKENNA (Science and Medical Reporter, Atlanta Journal-Constitution;
Author): The interesting thing about MRSA is that it does an extraordinary
amount of things that it's taken a number of years for people to figure out.

So MRSA is an acronym, M-R-S-A, and the S-A stands for Staphylococcus aureus,
which is a very large grouping of bacteria that have been with mankind for
probably as long as we've been human, and you can tell that because there's a
lot of tricks that it has for getting around our immune systems.

And it lives with us on our skin, in our nostrils, often without causing very
much difficulty - until it can get inside our bodies through a scrape or a cut
in the skin or an incision made for, say, a catheter. Then it can cause
infestations of the valves of the heart. It can infect the inside of bones. It
can cause very large abscesses, collections of pus that are walled off inside
muscles.

More recently, it's been discovered that it doesn't actually need a cut or a
break in the skin in order to cause disease, to cause illness. It can also
start an infection on what looks like intact skin and cause what medicine calls
a skin and soft-tissue infection, which sounds like not a big deal, but can
turn into a very large infection that requires surgery to get better.

GROSS: So tell me: Can the benign - seemingly benign staph that's residing in
my nostril turn into this antibiotic-resistant infection if it enters a wound
in my own body?

Ms. McKENNA: Yes. That was probably figured out first in the 1960s, when they
started to be really good at microbiology, and they noticed that people who had
staph infections, the infections were caused by the same strain that these
people were carrying around in their nostrils.

So it's possible either that someone is carrying a staff strain with them and
infects themselves, or that, in a setting like a hospital, they pick up a
strain from, say, a health care worker or someone else coming into the hospital
and have an infection caused by that instead.

GROSS: Not to dwell on this too long, but does that mean, like, don't pick your
nose if you have a cut? Or, like, what does it mean?

Ms. McKENNA: Right. It means, you know, for this bacterium that is causing a
worldwide epidemic that we haven't really fully sussed out the size of yet, it
turns out that some of the things we can do to defend ourselves - in fact, have
to do to defend ourselves - are the sort of things that your grandmother would
have told you to do: Don't pick your nose. Wash your hands a lot. That's pretty
much it.

GROSS: Okay, so MRSA is famous for being a hospital-acquired infection. Why
does this resistant bacteria dwell in hospitals?

Ms. McKENNA: People who are in hospitals are really good targets for infection.
If you were a bacterium, you'd probably really like to live in them because
their immune systems are damped down in a number of ways.

They might be elderly. They might be taking chemotherapy, either for HIV or for
cancer. They might have had a lot of other antibiotics already that damp down
the immune system. They might have a lot of cuts in their skin because of lines
and IVs going in and out. So they present both a lot of portals through which
bacteria can enter, and also reduced defenses in the body once the bacteria get
in.

And in addition, there's really tight concentrations of lots of people who
share those conditions, who are friendly places for bacteria to grow. And so
there's a sort of – it's just a very sweet target for bacteria. Once they're in
there, they find it a very fruitful place to be.

GROSS: And why are hospitals so difficult to get rid of the resistant bacteria
once they're in a hospital, whether it's on the floors or the bedrails, let
alone being carried by your own health care workers?

Ms. McKENNA: It's so challenging for so many reasons. You know, if it were
easy, I think they would have fixed it already, though there are some things
that are probably easy that aren't being done yet.

There are, as I've just said, lots of sick people. And there are also lots of
really busy health care workers who, because medicine is so complicated, so
technological, and also now with managed care so very, very busy, have a lot of
things to do. So there are steps that they may miss.

There's a lot of surveys now that say that health care workers often miss
simple opportunities to wash their hands, sometimes as many as 50 percent of
opportunities - not because they're evil or because they intend to infect
people, but because they're distracted and have very, very busy days.

And in addition, as you say, there are bacteria - and staph is one of them -
that can live on surface in hospitals. So unless things were absolutely sterile
all the time, it's unlikely that we would be able to make hospitals completely
resistant-bacteria free.

GROSS: I've known about this antibiotic-resistant bacteria. I'm sure a lot of
our listeners have known about it. One of the many things I didn't know before
reading your book is that resistant bacteria has spread to the community.

So it's already been a menace in hospitals, but it's gotten out of hospitals,
too. How is it being spread outside of hospitals?

Ms. McKENNA: MRSA lives not just in people who are debilitated and ill and in
hospitals, but on all of us walking around all the time. But it was always
thought - from about the 1960s, when it first sparked up, into the 1990s - that
the only place where it was successful in attacking people was in hospitals,
because they're debilitated and ill.

And then in the 1990s, a group of researchers at the University of Chicago
noticed that they were seeing infections in children that looked very like
those hospital infections, and yet these kids had never been anywhere near a
hospital. I mean, they were at University of Chicago because they'd come to the
emergency room with these infections, but they had not been in the hospital
before.

And it turned out that there was a slightly different strain of staph that had
adapted itself to live in the community and cause infections that are as
serious and sometimes more serious than the ones that were being caused in
hospitals.

GROSS: So how does it compare to the hospital version?

Ms. McKENNA: The first signal that something different was going on was that
the kids that came to University of Chicago in the mid to late 1990s had
infections that were caused by staph, and the staph was resistant, but the
resistance pattern of the bacterium was slightly different. It was not
resistant to quite as many drugs as the hospital variety.

And the second was that it was causing syndromes, illnesses that were slightly
different than what was going on in the hospital. In the hospital, someone
might have MRSA on the valves of the heart, a staph infection of the heart,
endocarditis, because it had gotten into their bloodstream.

The ones - the kids at the University of Chicago were showing up with very
large abscesses buried deep in their muscles. That was not anything that anyone
had seen in the hospital patients before.

Later on, people started to see abscesses in bone, osteomyelitis, infection of
the bone. Those were a slightly different category of illness, and they were
also showing up in people who were a new category of patient.

GROSS: So in hospitals, when MRSA, this antibiotic-resistant bacteria spreads,
it's kind of understandable. People are lying there with open wounds and with
catheters. How does the community version of this antibiotic-resistant bacteria
spread?

Ms. McKENNA: It's still somewhat mysterious, because it's only been about 10
years that people have been studying this, and not very, many people studying
it. But it seems that there are a couple of factors, the kind of predisposed
people.

The first is it happens in situations where there's a lot of crowding. Think of
a prison or an Army barracks. It happens in places where maybe hygiene isn't
very good, so that there's a lot more bacteria staying on the skin. Again,
think of a prison.

It happens when people have close skin-to-skin contact, and that probably
explains why this tends to happen a lot in athletes, both pro athletes and kids
who play school sports, because if a child crashes into another child in a
football tackle and one child has this on their skin and the other child gets
scraped, then the bacteria can enter their skin there.

GROSS: Do parents have to worry about their children playing sports in school?

Ms. McKENNA: I think they should worry about their kids being clean when they
play sports in school. And that sounds so simple, and yet, you know what? I
spend time in some schools when I was reporting this book, and there are things
that kids do, such as not bringing their uniforms home to get washed very often
or letting their shoulder pads get dirty. And then there are things that
schools do, as well.

It was really astonishing to me to discover that kids no longer shower after
gym class, because showering after gym class was one of the staple traumas of
my adolescence, for sure. They don't do that anymore. And so if they've picked
up a bacterium as they're out, you know, on the football field or field hockey
or anything like that, it's going to be on their skin much longer.

GROSS: So another scary thing I learned from your book is that the drug-
resistant bacteria that lurks in hospitals and the slightly different variation
of that Staphylococcus that is now being spread in communities, have merged.
They've converged to form, like, a third kind of resistant version of
Staphylococcus. And why is this so dangerous?

Ms. McKENNA: So, for about the past 10 years, since the community strain was
first identified, you know, people thought they had this kind of sussed out.
There was the hospital strain, and it affected people in hospitals. There was
the slightly different community strain, and it affected people who were
outside hospitals. When medicine says "community" - that's got quotes around it
- it means kind of anywhere outside the walls of a hospital or a nursing home.

But what they started to notice was that people were hospital patients, and yet
were infected with the community strain, which meant that it behaved slightly
differently, caused slightly different syndromes and also was resistant to
different drugs.

And then also you can see in some of the microbiology that's been done that
people who are out in the community actually now have hospital strains. So what
this means is just sort of that it's moving in an unpredictable manner, in a
manner that's not very well-detected. The reason it's not very well-detected is
because we still don't really have very good surveillance for MRSA, either
hospital or community.

And the ultimate point of this is that this makes it much harder to say, when
someone is detected as having a MRSA infection, exactly which drugs are going
to work. So you have to use the most intense drugs immediately, until you can
figure out which of the sort of less-important drugs might work for the
hospital or the community strain. And the more that we use the most intense
drugs, the faster the bug is going to develop resistance against those, as
well.

GROSS: It's very frightening to think that drug-resistant bacteria are living
not only in hospitals and nursing homes, but they've gotten out to the
community, and it gets spread in schools and other institutions. But how
worried about this should we be? I mean, is this, like, reaching epidemic
proportions? Or is it just that we've documented a few cases where this new
strain of the antibiotic-resistant Staphylococcus has spread?

Ms. McKENNA: I think we should be worried, which is not the same thing as being
panicked about it. But here's why we should be worried: first, because there
does seem to be a really large amount of this out there. One of the best
estimates that's been done so far, out of not very many estimates, is that
about 1.5 percent of the population - which is more than four million people -
walks around with this on their nostrils or in their skin – that's MRSA, not
just staph. And we still don't have a perfect understanding of when that
carrying around - that bacterial carriage, as it's called - turns into an
infection. So we can say that those people are at some degree of risk.

The second is that, the second reason to be concerned, is that since we know
there's a large amount of it out there, and since we know that bacteria are
really good at kind of exchanging and trading resistance factors, it means that
there's a big pool of bacterial population out there that is potentially
getting more resistant or becoming resistant in unpredictable ways that isn't
well-measured and detected because we're not looking for it.

GROSS: What advice would you have for us to try to protect ourselves? Wash our
hands? Anything else?

Ms. McKENNA: I'm smiling because it's such an overwhelming problem, and yet
something as simple as washing our hands does seem to be personally protective.

I mean, there are policy things that we should be doing: counting it better,
looking for it more. But on a personal level, washing your hands and asking
your kid to shower after football is not a bad idea.

GROSS: Why is it that bacteria that are resistant to potent antibiotics are
vanquished by soap?

Ms. McKENNA: So I have to preface this answer by saying that I'm not a chemist
and I'm not a microbiologist, but here's my understanding of it. The way that
antibiotics attack bacteria is in a particularly designed way. It's as though a
key is fitting in a lock. And so when bacteria respond to that and evolve a
protection against or a workaround, it's as though they've shut off the lock.

Things like soap and water and hand sanitizers which contain alcohol or salt,
don't attack in that fine-pointed way. They're really kind of more like
whacking the bacteria over the head with a hammer. I mean, they simply break
them open, kill them, and then the friction of either massaging your hands with
soap and water or massaging them with a hand sanitizer actually physically
washes them away.

GROSS: If you're just joining us, my guest is Maryn McKenna. She's the author
of the new book "Superbug: The Fatal Menace of MRSA." And MRSA is the acronym
for Methicillin-resistant Staphylococcus aureus. In other words, it's bacteria
that are resistant to antibiotics, and it's become pretty dangerous. And she's
a science and medical reporter. Let's take a short break here, and then we'll
talk some more. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Maryn McKenna. She's a science
and medical reporter, and her new book is called "Superbug: The Fatal Menace of
MRSA." MRSA is Methicillin-resistant Staphylococcus aureus. In other words,
this is the bacteria that is resistant to antibiotics.

I was alarmed to read that there have been a few instances where this
antibiotic-resistant bacteria has spread from human to pet to human. How much
is that happening? How much has that been documented?

Ms. McKENNA: How much it's been happening and how much it's being documented
are unfortunately two separate questions. This was really kind of discovered by
accident. What turns out to happen is that pets can pick up the human strain of
MRSA from their humans when – because they live with us closely, because we
smooch them on the noses.

They can hang onto the strain - not very long term, necessarily, but just long
enough that if, say, the human has an infection, recognizes the infection and
goes to their doctor and gets antibiotics that do take care of it, by the time
the antibiotics are done and the human is clear of the infection, the pet still
is holding onto it and passes it back to the human in that same kind of daily
interaction that gave it to the pet in the first place.

There are families who have had a kind of ping-ponging infection in their
household for months or years, and it's not until someone has the thought to
check the pet - the cat or usually the dog - that it turns out that that's the
missing piece of the family puzzle.

Now staph aureus, the staph strain that infects humans, the S-A in M-R-S-A, is
not naturally something that lives in animals. Animals have other staph strains
that are unique to them. So it's not surprising that it took a while to figure
this out, because no one was really looking for MRSA in household pets, and
it's just a fairly recent discovery - and again, not yet a lot of research, not
a lot of counting to see how much it happens.

GROSS: Any advice for people who have pets?

Ms. McKENNA: Well, veterinarians who have looked at this worry that people are
going to overreact, and they say, you know, first, if it happens, it's not your
pet's fault. And second, it probably doesn't happen all that often. But if you
are one of those unfortunate people or families that seems to have a recurrent
staph infection where you get one of these severe skin and soft tissue
infections or even something more serious, and you get it treated, and it
doesn't go away, and you do the kind of things that might chase it out of your
household, like washing everything down with bleach, and it still doesn't go
away, and you have a pet in the household, that would be a good time to check
your pet.

GROSS: One doctor who you follow in the book described MRSA as the perfect
pathogen. What makes it perfect in a diabolical way?

Ms. McKENNA: The astonishing thing about this bug, once I started reporting on
it, I really understood why people spend their entire lives in research on it,
is that it's very difficult to not act as though it has a personality, because
it seems so smart.

Now, it's not, in fact, smart. It's the blind persistence of natural selection,
but natural selection seems to be working really well for staph.

So, first, it has all this ability to live with us in a manner that is pretty
much unchallengeable. We can't eradicate staph. It's part of our personal flora
and part of our environment. Then it has this really sophisticated array of
defenses and workarounds for our immune system. It's got abilities to turn on
resistance factors. It's got a wide variety of genes that are specific to that.
It also produces toxins that destroy muscle and burst cells.

And in addition to all that virulence and all this ability to live in our
environment and on our bodies, it is very smart in developing resistance, as
well. It - I understand why that particular researcher called it the perfect
pathogen. And when he said that, it was with a rueful kind of admiration.

GROSS: Maryn McKenna will be back in the second half of the show. Her new book
is called "Superbug: The Fatal Menace of MRSA." I'm Terry Gross, and this is
FRESH AIR.

(Soundbite of music)

GROSS: This is FRESH AIR. I’m Terry Gross, back with science and medical
reporter Maryn McKenna. We're talking about her new book "Superbug: The Fatal
Menace of MRSA." It's about a strain of antibiotic-resistant bacteria that
lives in many hospitals and can infect patients. MRSA - M-R-S-A is an acronym
for methicillin resistant Staphylococcus aureus. MRSA now has entered the
community and as we'll hear, it’s entered the food chain through livestock.

What are some of the drugs that stand the chance now of being effective against
antibiotic resistant bacteria?

Ms. MCKENNA: MRSA turns out to be a really interesting case because on the one
hand, it has become resistant to a wide variety of antibiotics that we use
everyday. And what all of those antibiotics have in common is a sort of central
feature in their chemical structure called the beta-lactam ring. We talk about
it as though it's methicillin but methicillin gave that structure to several
families of antibiotics, there are now dozens of them.

And so particularly with the more serious cases, there are only a few
antibiotics that are already on the market that are left. The one that everyone
talks about is one called vancomycin but there are some other newer ones,
daptomycin and linezolid. The interesting thing is that there are also some
older drugs, drugs that have been around for a very long time that are off
patent, so they're relatively inexpensive, that may work against this as well.

The problem is that since they're older drugs, people tend not to do that much
research on them because they’ve been around for a while, they don’t make
anyone a lot of money when they're sold, and they're just not high on the list
of anything that anyone wants to look at. And for the very simple infections,
it may turn out that the best thing to do may be not to give people drugs at
all. If you just have a simple abscess it may be that what you do is just kind
of incise that and let it drain and heal.

So the odd thing about this very challenging bug is that sometimes it takes the
very newest things that pharmacology can produce, the very most difficult and
expensive drugs. But sometimes it may take only some very simple drugs that we
haven't looked at yet, but we need to start looking at and sometimes maybe no
drugs at all.

GROSS: Antibiotics are such commonly prescribed drugs. I was astonished to read
in your book that pharmaceutical companies are not making antibiotics a
priority. In fact, they’ve become a pretty low priority. They're not seen as a
financial winner in the industry. Why not?

Ms. MCKENNA: That actually really amazed me, too. But if you think of a
pharmaceutical company as, you know, a business concern that is responsible to
shareholders, unfortunately it makes a lot of sense. Imagine that you are a
pharmaceutical company and you want to come up with an antibiotic against
something like MRSA. So maybe it’s a new antibiotic. So you think the older
drugs don’t work. This one is going to have a very significant market.

So the estimate that you hear a lot is that it takes about $800 million and at
least five years, maybe 10 to bring a new drug to market. You spend all that
money. You invest all that time. And at the end, you have a product for which
the bacteria are going to develop resistance within a year or two years or five
years.

In some areas, if a hospital sees resistance in maybe 15 or 20 percent of the
particular class of bacteria they're giving that antibiotic for they’ll stop
prescribing it because they can't guarantee that it's going to work. So now you
have a drug for which you invested tons of time and tons of money that only has
a marketplace life of a couple of years. And in addition, maybe people take it
twice a day for 10 days. If they have a very bad infection, maybe they take it
for a couple of months.

If I were that pharmaceutical company, it would make a lot of sense to me to
instead make insulin which people take everyday for the rest of their lives, or
Cialis or Viagra, which people probably take everyday for the rest of their
lives as well. There's a much more return on a safer investment there than it
is for an antibiotic.

GROSS: So does that mean our antibiotic research has really fallen behind?

Ms. MCKENNA: It means that companies have turned away from antibiotic research.
There's a point in the book where I run down the names of companies that used
to make antibiotics that don’t make antibiotics anymore. Now if you talk to
people in the pharmaceutical industry they will say that the market structure
for antibiotics needs to change and they need more incentives from the
government in order to do the research that's necessary.

I find it difficult to take the position that pharmaceutical companies need
more help. And yet, it seems pretty clear that the marketplace is voting, that
fewer companies are making antibiotics than used to. And if we want more
antibiotics or better antibiotics there has to be something in there that needs
to change.

GROSS: What about the possibility of a vaccine that would inoculate us against
resistant strains of bacteria?

Ms. MCKENNA: If you talk to people who spend their lives researching Staph,
they will all bring up the possibility of a vaccine. I myself am skeptical of
this. Not so much that I think it can't be done, although there have been
several attempts that have not done very well so far. They look promising in
their early steps and yet, they don’t make it all the way through all the
trials that are necessary.

But what I think is dismaying about this is that we have become a culture that
is not at the moment very interested in taking vaccines. This recent flu
pandemic is a very good example. People are skeptical of vaccines in a way that
they did not use to be. So if we said, well, here's a new vaccine, which was
very expensive to produce and we'd like people to take it so they will protect
themselves against MRSA, I do not think we can guarantee that the uptake for it
would be very good. It's possible that if a vaccine were achieved, that you
could define certain groups of people who ought to take it.

Maybe you give it to people just as they're going into surgery to be sure that
they aren't going to have a surgical infection. Maybe you give it to women just
as they're going to give birth so that they don’t pick up a community infection
in the birthing suites, which seems to be happening more and more. But the
likelihood that a brand new vaccine is going to be broadly accepted by the
population seems a kind of low probability to me.

GROSS: If you’re just joining us, my guest is Maryn McKenna. She's a science
and medical reporter and the author of the new book "Superbug: The Fatal Menace
of MRSA." And MRSA is the antibiotic-resistant form of Staphylococcus.

Let's take a short break here and then we'll talk some more. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Maryn McKenna. She's a science and medical reporter. Her new
book "Superbug" is about MRSA, which stands for methicillin resistant
Staphylococcus aureus. In other words, this is the Staph bacteria that is
resistant to antibiotics. It spreads often in hospitals and nursing homes but
there's a strand of this Staphylococcus that has kind of escaped from hospitals
and is spreading in the outside world as well.

One of the problems that we're facing with this antibiotic-resistant bacteria
is that it's gotten into the food chain, and the way it's gotten in there is
through the tons and tons of antibiotics that is fed to livestock animals. So
where is MRSA in the food chain now? Can we pick up this drug-resistant
bacteria by eating certain foods? Is it by touching animals? Is it just getting
out in the air?

Ms. MCKENNA: There's a couple of layers of risk here. The first is that this
new strain of Staph that seems to be resident in livestock has been found in
varieties of food animals throughout the European Union and in Canada and in
the United States. In addition, it’s been found in people, people who have
direct contact with animals - with farm animals who are getting antibiotics.
It's pretty clear they are picking it up. We don’t yet know how much - how
often they pick it up.

The second is that there's a separate set of study - again, just a few people
are doing it, that have found this bug, this animal-adapted strain of Staph on
retail meat in several countries. If you took the meat home and had it in your
kitchen and cooked it and ate it, you probably would not be made ill by
swallowing it.

The kind of Staph that we're talking about is not the kind that survives in
your stomach and gives you food poisoning. But what is very likely is that you
could handle it - handle that meat and get the strain of Staph that it is
harboring on your skin. So now you have a resistant bacteria - a different
resistant form of Staph that's joining that population on your skin and could
cause an infection at some unpredictable future time.

The third layer of risk is that here we have another enormous population of
livestock worldwide that could be harboring a resistant strain of bacteria that
is not being very well tracked and could be serving as a kind of pool in which
resistance could spread or merge or change in a way that's not being keep track
of.

GROSS: Now, how has the use of antibiotics in livestock contributed to the
development of this drug-resistant strain that is now in livestock?

Ms. MCKENNA: There's a couple of different ways that antibiotics get used in
food animals. The first is a process that's still somewhat mysterious but goes
back more than 50 years that's called growth promotion. A couple of researchers
discovered a number of decades ago that if you gave very low levels of
antibiotics - much smaller than a treatment dose - to animals, they would grow
faster. They'd put on weight faster.

And when the point of raising animals in a farm is to get them up to market
weight as fast as possible, that seems like a good thing. So that's smaller
than treatment does of antibiotics. The second is that if you think of the size
of a farm, if you have disease in your flock or herd or the threat of disease
you’re not going to single out a single pig or a single cow. It's much more
efficient to give treatment doses of antibiotics both to the sick animals and
to their near neighbors.

When we do that in humans, give antibiotics to people who are not sick, we call
it inappropriate use of antibiotics and a parallel thing is happening in
farming where, especially on these very large industrial farms where animals
are confined very closely and are at more risk of disease, they get
antibiotics, they then become essentially breeding grounds for unpredictable
varieties of resistance.

GROSS: So all of the measures that we're taking to prevent the spread or the
development of drug-resistant bacteria in humans, we're not taking those
precautions with livestock and that's becoming a real problem.

Ms. MCKENNA: So the best estimate at the moment for what proportion of
antibiotics are used in humans versus in animals at any time is that only about
30 percent go into humans and 70 percent go into livestock and food animals.
And the 30 percent that go into humans are tracked much more closely than the
ones that go into animals are.

GROSS: What do you think we should be doing now as a society to stop the
further spread of drug-resistant bacteria?

Ms. MCKENNA: It's a really challenging question because this is a problem that
has a lot of strands in it. The first is, of course, that there are individual
protective steps we can take. You know, there are things like washing our hands
and asking our kids to shower after sports. But there are things that are kind
of designed into the way we live our lives right now that make it very
difficult.

For instance, there are large numbers of antibiotic prescriptions written for
humans every year that really aren't necessary. People go to the doctor. They
have what feels like a cold or bronchitis or an infection and they ask for
antibiotics. Or even worse, it happens more frequently, they ask for
antibiotics for their kid and the doctor tries to say, well, this may not be a
bacteria infection. We'd like you to wait a couple of days.

But we haven't come up with anything else as a society that kind of signals a
successful encounter with a doctor other than an antibiotic prescription. If
the doctor says to us, I'd really like you to watch for a couple of days and
see if this is a virus or a bacteria we feel kind of unsatisfied, as though we
haven't gotten what we go for.

In addition, if it's a child you’re talking about, we all live very busy lives.
If you have a child and you need to get that child into day care, that day care
probably not going to want to hear that you want to keep your child in day care
with an active infection for three days until you figure out exactly what that
infection is.

They are probably going to want to know that your child is some kind of drugs.
So there's a way that we have structured medicine so that it all leads toward
the desire to prescribe and to receive antibiotics, and nothing else feels
quite as satisfying. We’ve also, with the advent of managed care - not that
that's brand new anymore - we have so squeezed the days of doctors and other
health care professionals that it's actually quicker for them to give us a
prescription than it is to spend another 10 or 15 minutes explaining to us why
we don’t really need that prescription after all.

And when people try to do this on a hospital level, when they try to say in a
hospital we really don’t think you should be using those drugs, we don’t think
you should use this category of drug or we think you should hold back from
using these drugs, it gets into further levels of complication beyond just the
individual encounter between a patient and a doctor.

It gets into issues of what the hospital funds, what it's willing to pay for,
how much the physicians who may not actually be employees of the hospital, but
may be subcontractors, how much they're autonomy feels threatened because they
being told they can't use particular drugs. It’s very, very complex.

GROSS: You know, because there's so much drug-resistant bacteria in hospitals,
although a lot of hospitals are working really hard to prevent the spread of
that, a lot of people are afraid to go into the hospital when they need
something done. They're afraid that they'll acquire an infection.

What precautions can patients take when they're going into a hospital or a
nursing home?

Ms. MCKENNA: So the first thing I want to say in response to that is that while
I don’t want to frighten anyone away from going to a hospital or a nursing
home, I do think that that concern is legitimate. The people I talked to in the
course of reporting this book who had hospital infections had just grievous
infections. Their lives were changed by them. So it’s not a paranoid concern to
worry about this.

So what do you do? It seems pretty clear that the most common point of
infection is in the encounters between patients and the health care workers.
What that requires is that patients or their family members really have to be
defensive in their own behalf. And it's an easy thing to say but a hard thing
to actually do, to be in the vulnerable position of being a patient in a
hospital and say to the health care workers walking in and out of your room,
please don’t touch me until I see you wash your hands, and yet that is in fact
what may be necessary.

GROSS: Because of the H1N1, people are going crazy with Purell and with
disinfectant sprays, spraying doorknobs and, you know, there's Purell. Wherever
I go there's like Purell dispensers now or some, you know, some equivalent of
that. What would you recommend in terms of a hand cleanser? What ingredient
should we be looking for so that we protect ourselves without creating more
resistant bacteria?

Ms. MCKENNA: There's things you want to look for and things you want to avoid.
The things that you want to look for are things that have just alcohol or salts
in them. What you want to avoid are things that have other antibacterial agents
in them as well, because that's just another version of overusing antibiotics.

If we overuse antibacterial agents, then that could breed resistance in our
environments as well. And that's actually kind of hard to do, to avoid those
because they are now antibacterial chemicals in so many everyday products, in -
not only in hand sanitizers but in cutting boards, in kid's toys, in things
that you would have everyday in your kitchen, sort of appliances and so forth.
It's an expression, I think, of our being paranoid about germs - of being
germaphobic - that there's a market for those.

GROSS: What is the greatest myth about how germs are spread that you would like
to tell us about?

Ms. MCKENNA: You know, I acknowledge that in writing about scary diseases and
in particular the scary bacteria MRSA, that's it’s entirely possible that I'm
making people paranoid. One of the first readers of the book, when he returned
the draft to me, said this makes me want to take a thousand showers. And while
on the one hand I was pleased because that was kind of what I was going for and
I'd really had had an impact, on the other hand, I don’t want to make people so
germaphobic that they do not - that they cannot live their lives.

So I think the things to be aware of are the things that we can control. You
can control washing your hands a lot. You can control if you live in a city
where there's a subway and lots of people are holding on to the subway rail.
You can control having a bottle or something uncomplicated like Purell in your
purse or in your pocket. You can control when you go to the doctor or take your
kid to the doctor, whether you’re using drugs in an appropriate way.

To go around our lives feeling as though there's this cloud of threat around us
all the time puts us in the position where we tend to over-respond, and when we
over-respond we use too many antibacterial products, we use antibiotics
inappropriately. And then without realizing it, we make worse the situation
that we’ve already gotten ourselves into with this international epidemic of
drug-resistant bacteria.

GROSS: Maryn McKenna, thank you very much for talking with us.

Ms. MCKENNA: Oh, thank you for having me.

GROSS: Maryn McKenna is the author of the new book "Superbug: The Fatal Menace
of MRSA." You can read an excerpt from "Superbug" and find expert advice on
preventing Staph infections on Web site freshair.npr.org.

This is FRESH AIR.
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At Pepper's Hideout, A South Side Party To Remember

TERRY GROSS, host:

In 1975, Michael Abramson was a Chicago college kid with an interest in
photography. One night, he took his camera to the city's South Side in search
of blues, and his life changed. The Numero Group, a Chicago-based reissue
label, has put out a deluxe book of the photographs Abramson took in Pepper's
Hideout and other clubs, called "Light on the South Side." Along with the book
comes a two-record set, vinyl albums called "Pepper's Jukebox," with some of
the music that could've been played on the scene.

Rock historian Ed Ward has a review.

(Soundbite of music)

ED WARD: When Abramson started taking his remarkable photographs at Chicago's
South Side, Chicago blues was almost finished as a popular music. It was
already in danger of becoming moribund in the mid '60s, when Junior Wells and
Magic Sam saved it by injecting some soul into it. But young people saw that
there was plenty of straight soul in Chicago, and blues became something for an
older crowd — and for recent arrivals from the South.

But of course hope springs eternal for musicians, and some of them thought it
was just a matter of updating the lyrics.

(Soundbite of song, "I'm a Streaker")

Ms. ARLEAN BROWN (Singer): (Singing) I’m streaker baby and I don’t think it's
no disgrace. I am a streaker baby and I don’t think it's no disgrace. Oh I feel
like an outhouse with not a brick out of place.

WARD: Arlean Brown was 51 when she recorded "I'm a Streaker," a wonderfully
nasty song which pits her against younger rivals but never seems to indicate
that she had the slightest idea what a streaker actually was. Still, it
launched her career in music after selling a purported 78,000 copies, and the
former cab driver and corner grocery owner became part of harmonica player Mack
Simmons revue at Pepper's Hideout — and eventually broke out with her own
Arlean Brown X-Rated Revue.

Another woman who tried to be topical was Lucille Spann, the widow of Muddy
Waters' great piano player, Otis Spann. Once again, she didn't seem to get the
concept.

(Soundbite of song, "Woman's Lib")

Ms. LUCILLE SPANN (Singer): (Singing) I'm going join the women's lib. Got to
find myself a job, oh yes I am. Said I want to join the women's lib. Got to
find myself a job. You know you don’t, you didn’t love me from the start. I'm
going to pack my clothes...

WARD: Although there were certainly women who joined the women's lib, because
they'd been treated badly by a man, Lucille seems to think it'll get her a
better man. It doesn't seem to have gotten her anything, though; she never made
another record.

Others on the scene were veterans who were updating their sound. Detroit Jr.
had been in Chicago since 1956, and was Howlin' Wolf's piano player, but to
make ends meet he also waited tables at Pepper's — and cut the occasional
record.

(Soundbite of music)

DETROIT JR. (Musician): (Singing) Young blood baby. That's my name. They call
me young blood because, you know what? I can do most anything. And all the
girls can't help it. They just got to say something when they see me here. I
can boogaloo and I can do the shing-a-ling. They call me Young Blood 'cause I
can do most anything. Now listen baby...

WARD: There was, actually, some young blood on the scene. Bobby Rush, who is
unavoidable today, being a major self-promoter, was only starting out in the
1970s.

(Soundbite of song, "Bowlegged Woman, Knock-Kneed Man")

Mr. BOBBY RUSH (Singer): (Singing) Sitting in car and the car won't go. That's
the way you spell Chicago. A knife and a fork and a plate of greens. That's the
way you spell New Orleans. Hello girl in the tight, tight sweater. Hey baby,
sure looking mellow. The girl over there with the hot pants on, turn her loose,
James Brown. Let her turn me on. 'Cause me and you baby go hand in hand. You
the bowlegged woman and I'm a knock-kneed man.

WARD: "Bowlegged Woman, Knock-Kneed Man" was one of Rush's first records, and
already the formula of blues guitar and funk rhythm section that would make his
career is in place.

Abramson's remarkably intimate photographs evoke a vanished world, one that
comes further to life listening to the record. Although most of the music on
"Pepper's Jukebox" is pretty pedestrian, lacking a real spark of inspiration,
in the context of the club it filled the bill for something to dance to. Today
the jukebox at Pepper's is silent and those of the lovers and dancers in the
photos who are still alive have gray hair. With luck, they might still have one
of the prints Abramson traded for access, and like us can look back across the
decades.

GROSS: Ed Ward lives in the South of France and blogs at wardinfrance. He
reviewed "Light on the South Side."
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Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.