WILL THIS BE HISTORY?
September 11, 2001 and COVID-19
As I began urology, residency patients were subjected to prolonged hospitalization, often for diagnostic evaluations. Most of these in-patients were given trimethoprim-sulfa to treat a documented urinary tract infection, or to prevent a urinary tract infection despite lack of bacteriuria. As trimethoprim-sulfa resistance emerged, quinolones, which were also enticing as a bacterial prostatitis option, emerged as the go-to treatment and preventative.
As quinolone resistance increased, better understanding developed regarding duration of treatment, of indications, and of drugs less likely to develop resistance when used for urinary tract infection therapy. In the 1990s, the American Urological Association embarked on Guideline development, starting with benign prostatic hyperplasia. The subsequent Guidelines for urinary tract infections and bacteriuria reflected this increased understanding of the pathogenesis of bacteriuria and urinary tract infections. Shorter treatment courses, nitrofurantoin as a favorite, and avoidance of therapy for urinary bacteria only resulted.
A growing realization had emerged that antibiotic overuse might hasten drug resistant bacteria, which might someday reach epidemic proportions. But the April 2, 2020 NEJM provides numerical evidence that bacterial scourges of methicillin resistant staph aureus, vancomycin resistance, carbapenem-resistant acinetobacter, and MDR P. aeruginosa resistance have decreased from 20.5 to 39.2% in hospitalized patients during 2012 to 2017. Maybe bacteria would not pose as great an epidemic risk.
Covid-19 presents a catastrophic detriment to health and well-being. It has disrupted financials for individuals on a gigantic scale. The insider trader Ivan Boesky, the too-big Lehman Brothers, Wells Fargo banking, sub-prime mortgage loans, and the junk bond king Michael Milliken caused financial difficulty, which seemed distant to the average citizen and seems (probably incorrectly) to have left no lasting mark. Milliken’s legacy (pardon me!) of prostate cancer research generosity is notable, especially for the urologic community.
While the world kept vigilant for the next viral world-wide scourge, it seemed to many that a resistant bacteria would more likely be the next to ravage.
Holiday season 2019 brought the world the Covid-19 pandemic, a viral - not bacterial -catastrophe. While the financial impact is all too pressing and-up ending lives the world over, the financial devastation will eventually pass, like the previous financial downturns brought on by the ways of man, not a virus.
Like September 11, 2001 which permanently changed everyone’s lives through enhanced security measures, the lives of all are forever altered by this Corona virus. Covid-19 viral transmission prevention will not pass and will become a living history through more guarded social interaction.
Reg Bruskewitz, MD
Department of Urology
University of Wisconsin
- Jernigan JA, Hatfield KM, Wolford K et.al. Multi-Resistant Bacterial Infections in U.S. Hospitalized Patients 2012-2017. NEMJ April 2, 2020; epub