Resistance is a word that gets tossed around frequently in medical contexts. It refers to a wide variety of bacteria, viruses and fungi that take pleasure in making us uniquely ill and leaving us little recourse to attack them. But what does it mean when the doctor says your specific condition is resistant to the traditional therapies?
It means that whatever cootie you had the misfortune of picking up has somehow evolved a mechanism to evade the normal medications doctors would use against it. For example, penicillin was formerly widely used to treat bacterial infections; however, that widespread use led to the resistance of many bacteria to penicillin's attack against the cell wall. The germs that cannot be killed by penicillin are termed "penicillin resistant." Therapy for HIV has also confronted the evolution of significant resistance, and in response, doctors and researchers developed a 'cocktail' of several drugs. The reason behind the triple cocktail HIV treatment is to attack the virus from many different angles in the hope that preventing the virus from focusing on one specific agent will prevent resistance from developing. Even if resistance did develop, one of the other medications would destroy the resistant virus before it would be able to spread its resistant genes to too many progeny. There are more mechanisms of resistance on the part of germs, but it would take a crash course in microbiology to provide even a cursory explanation.
One manner in which resistance develops is through the widespread use of antimicrobials (i.e. antibiotics, antivirals and antifungals) causing simple adaptive mechanisms on the part of the germs. For so many years, the medical community has been killing off various organisms through the use of these medications, but unfortunately microorganisms learned how to survive. While we were busy killing off the Neanderthals of the germ world, the more evolved species were quietly lying in wait, multiplying and spreading their evil seed to other species that were susceptible to modern medicine. These resistant varieties are often referred to as "super bugs," even though they aren't so super since they cause a lot of disease and death. To use a party example, it's like you're at the best party of the year, when all of the sudden the police show up (something about a neighbor and a noise complaint), and the party busts up. Not everyone leaves, however, because the hard core "super partiers" stick around, hiding in the bathroom waiting for the police to leave. Once the sirens have faded into the distance, the hiders come out and the party gets rocking again and even brings in a few newcomers to the scene, spreading on the party vibe (or resistant genes). Which brings me to my point: If we provide a niche for resistant species by making them the last ones standing, will the constant use of Purell and other alcohol-based hand sanitizers create more resistant strains?
The simple answer is no. In fact, especially in hospital settings, Purell has increased compliance with hand hygiene standards because of its extreme convenience -- no sink, faster to use, located in every spare wall space -- leading to a decrease in germ transmission from patient to patient via health care workers. Additionally, since these products base their ability to kill 99.99 percent of germs on alcohol and not specific antimicrobials, they don't target a specific pathway in microbes, making it difficult (perhaps impossible?) for organisms to develop a specific resistance to the killing power of those hand gels. Good news for the germophobe.
The obsession with cleanliness is not without consequences, however; recent studies of our over-sterilized daily lives have concluded that living in a germ-less environment stunts the ability of the immune system to develop properly to combat the daily assault on our bodies. This might be the cause of the increase in incidence of allergies and asthma in children. Other studies have shown a correlation between children who grow up with pets and/or those who spend time outside and a decreased likelihood of having allergies or asthma. The assumed reason behind this correlation is that exposure to allergens and microorganisms allows the body to acquire beneficial bacteria that help the immune system develop ways of protecting itself from invaders in the future. In other words, the body learns what the real enemy is and can develop specific weapons to combat an invasion in the future without attacking benign foreign particles -- like dust and pollen -- that lead to allergies.? Also, the beneficial bacteria acquired help prevent harmful ones from taking up residence in our bodies. Thus, too few (good) germs can be detrimental in equal but different ways than too many (bad) germs.
This is not to say you should leave chicken guts sitting on your counter or swear off antimicrobial cleaning products for the mold on your bathtub, but perhaps you should re-evaluate the frequency with which you use those types of products. There's no need to Lysol a counter where milk has been spilled; regular soap and water will do just fine. And washing your hands with regular soap and water for 20 seconds is enough for your average hand-washing need. But don't worry: Purell will not create super bugs.
Katie is a University Medical student. She can be reached at kmcbeth@cavalierdaily.com.
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