Superbug ate my arm: Woman's terrifying encounter with flesh-eating bacteria

KERRYN Harvey lost her arm and shoulder to flesh-eating bacteria. The rise of drug-resistant superbugs is threatening medical practice everywhere.

It was Thursday, January 24; Stage three of the Tour Down Under with a route that wound from Unley to Stirling in the Adelaide Hills.

Kerryn Harvey was visiting from Melbourne to ride parts of the Tour with a group of friends. She is a fitness fanatic who runs, swims, rides and does triathlons. Towards the end of the day she and hundreds of other recreational cyclists left Stirling to ride back to the city.

As she descended past Eagle on the Hill, another cyclist crossed her path, leaving her nowhere to go. She clipped his back wheel and came off.

“I came down pretty hard but I didn’t break any bones,” she says. “I was pretty shaken up. My elbow was bleeding, it blew up like a balloon and I hit my hip really badly. They carted me off to the RAH.”
 

Her right elbow was stitched and she stayed overnight for observation. The next morning she returned to the Hilton Hotel with a couple of her friends who stayed with her while the others rode the Bupa Challenge Tour. At around midday, her arm was getting worse.

“I thought there’s definitely something wrong, something must be broken in there,” she says.

X-rays showed nothing amiss and she was given stronger painkillers. Nothing pointed to what was about to happen. She went to bed early Friday night with her partner, Renee, but woke during the night with her arm swollen to twice its size.
Plastic surgeon Dr Yugesh Caplash

Plastic surgeon Dr Yugesh Caplash. Picture: Tricia Watkinson

“I turned the light on and I had these blisters going all the way up my arm, like blood blisters,” she says. “They were literally popping before our eyes. We were just going ‘oh my God’. I was really scared because I could hardly feel my arm.”

She was rushed by ambulance back to the RAH where a surgery team was marshalled. A senior plastic surgeon, Dr Yugesh Caplash, came in at around 3am to start trying to get ahead of what was diagnosed as necrotizing fasciitis, an aggressive soft tissue infection associated with the streptococcus group. Kerryn’s life was changing forever.

In the operating theatre, Caplash began radical debridement. The skin, fat and portions of the muscle on her arm were removed. She was stabilised and placed in intensive care.

In the morning, another plastic surgeon, Dr Marcus Wagstaff took over. Kerryn’s blood was not coagulating and her arm was oozing badly, her vital signs were poor and the infection was progressing.

The first operation had finished at 4am. At around 9am she went back into surgery where more dead muscle and part of her shoulder was removed.

During the surgery it became clear to Wagstaff that there was nothing much holding her arm on. He left the theatre and consulted with Renee and Kerryn’s mother, then returned to remove what remained of her arm and shoulder.

It was a one in a million piece of bad luck caused by something too small for the eye to see. Bacteria on the road – organic matter of some sort, a dead animal perhaps – entered Kerryn’s body through the gash on her elbow.
Kerryn Harvey

Kerryn Harvey and her partner Renee. Picture: courtesy Kerryn Harvey

She could have landed a metre either side and nothing might have happened.

Medicine is powerless in the face of necrotizing fasciitis. It moves so fast antibiotics are useless. The patient’s only hope against this wildly aggressive bacterial infection – nicknamed the flesh-eating disease – is to outrun it by cutting off the infected part.

“It’s supreme back luck,” says Wagstaff. “Someone who is immune suppressed or diabetic may be prone to it but generally speaking it can happen to anyone. It could happen to me tomorrow.”

This is what happens when drugs are powerless because the infection moves too fast. It is a rare event. The RAH might see 10 cases a year, and those as severe as Kerryn’s would normally be fatal. She survived because she was very fit. It is a powerful reminder of our modern dependence on antibiotics.

For decades we’ve been able to stop most bugs in their tracks but that can no longer be taken for granted. A crisis is looming.

Commonplace infections are becoming harder to treat as strains of bacteria develop resistance to antibiotics. Medicine calls these resistant strains superbugs, not because they are particularly virulent but because they are difficult to kill.

This resistance has been slowly building since the 1940s when antibiotics were first introduced. At the outset, almost all bugs were susceptible to penicillin. Those that survived were knocked out by the next round of antibiotics. By the 1970s, more resistance emerged but again, more antibiotics came on-stream.
Superbugs pose mortal threat

Prominent virologist Professor Frank Bowden says the clock is already ticking at five minutes to midnight. There are more and more resistant bacteria and fewer antibiotics with which to treat them.

“We’re on the steep part of the exponential curve and it’s visible to us now,” says Bowden who is professor of medicine at ANU and author of Gone Viral, about the emergence of resistant bacteria.

“Infectious disease doctors have been banging on about this for 20 years and many of us have felt like voices in the wilderness. Now because it’s going outside our specialty, people are starting to see it.”

This is not about pandemics where an exotic mutant bug cuts a swathe around the globe. It is a more commonplace scenario in which doctors slowly lose the ease with which routine infections are treated. Eventually, it could mean not being able to treat them at all.

This is already the case in India where antibiotics have been sold over the counter for years and resistance is particularly high. There are cancer hospitals in India – well-equipped, private hospitals that look smarter than many of ours – where immune-compromised chemotherapy patients fall sick with infections and very little can be done.

“The only antibiotic that is left to treat them is one that only a handful of people have used and we don’t even know what the proper dose for it is,” says Bowden. “If that one fails, there is nothing. Absolutely zero. And that’s the rule in many parts of India.”

The India problem has been brought about by the ready availability of antibiotics which actively works to select resistant bugs. A normal gut may contain a mutant strain of E coli that sits among other bacteria without causing problems. Take an antibiotic that kills E coli and you will get rid of all except the mutant strain. It is now free to flourish.
Kerryn Harvey

Kerryn Harvey has had her bike modified and cycles using a wind trainer. Picture: courtesy Kerryn Harvey

“It’s called a selection pressure for pre-existing mutants – it reveals resistance that is present,” Bowden says.

Australia has tough protocols that regulate antibiotic use but we are part of a global community. Visit India and you are likely to return with a resistant bug that will sit there unnoticed and clear the system within about six months.

But if something happens – a urinary tract infection – it may not be treatable with oral antibiotics. A prostate biopsy may accidentally usher the resistant bug into the bloodstream and there may be no antibiotic with which to treat it. This is already happening.

“Australia’s contribution to resistance is real but it’s not nearly as important as what’s happening overseas,” Bowden says. “And because international travel is now normal for people, the movement of bugs is really easy.”

Then there is golden staph, not so much a new problem but an intractable one. Patients going to hospital with one problem can pick up a sometimes fatal golden staph infection untreatable with known antibiotics.

In 2011, 67 RAH patients went into hospital with one ailment and acquired golden staph infections during their visit. No figures are kept for golden staph deaths but the mortality rate is high.

In the past 12 months staff at the RAH have undergone massive back-to-basics hygiene re-education and the number of hospital-acquired cases has dropped almost by half. The response is due to something as simple as making sure everyone washes their hands. It turns out the worst offenders – everywhere, not just in Adelaide – were the doctors.
Kerryn Harvey

Kerryn Harvey lost her arm to a flesh-eating disease in January 2013. Picture: Andrew Tauber

“You would think that something so simple would be followed by all doctors – this is not just the Royal Adelaide, this is around the world,” says RAH infectious diseases consultant Dr Brett Ritchie. “Doctors are slow to move on board but they are now increasing their compliance. The nurses have been outstanding and they spearheaded this.”

While the number of hospital-acquired golden staph infections fell, community-acquired infections have risen from 59 at the RAH in 2009 to last year’s high of 93. These infections, which show up as persistent boils and abscesses, are untreatable with ordinary antibiotics and may require admission to hospital and IV therapy.

While this looming resistance builds, another problem is silently unfolding. The rush of antibiotics that kept treatment ahead of resistance has slowed to a trickle as drug companies invest money elsewhere.

“There has not been a new class of antibiotics released in the past 15 years,” says Bowden. “There have been new antibiotics but they belong to classes that have been developed in the past.”

No one is accusing the drug companies of conspiracy. Modern medicine demands an investment of up to a billion dollars to develop a drug and get it through animal and human trials before it comes onto the market. Not every drug gets that far so there is enormous risk attached to drug development.

A pharmaceuticals company seeking to maximise profits will choose to invest in something patients need in the long-term – cholesterol, blood pressure, heart drugs – over an antibiotic that may be used once a decade.

“Look at the explosion of anti-viral drugs in the past 15 years – HIV drugs, Hep C, Hep B, all of which target diseases that require prolonged courses,” Bowden says. “I’m not meaning to ascribe any malign intent on the part of the pharmaceutical companies. It’s where you spend your money.”

Medicine without the underpinning structure of antibiotics is a very different beast. Before the 1940s, humanity survived but individual families regularly lost children in infancy from simple illness. Appendicitis was fatal. An infected finger could cause death.

Bowden thinks new drugs may eventually trickle through but not before some kind of crisis hits.

“It’s a bit like global warming,” he says. “Not until we actually see our holiday houses slipping into the sea do we realise that sea levels are actually rising. When we start to see the kind of level of resistance that we are seeing in India, people will start to realise there is money in it. If the only antibiotic that worked cost thousands of dollars then people would be willing to spend that money.”

Kerryn stayed in the RAH for three months, recovering and receiving treatment. There was no moment of horror when she came out of surgery and realised her arm and shoulder were gone. She remembers only the “amazing drugs” that protected her as she gradually got used to the idea.

“I remember snippets of conversations,” she says. “I remember them saying ‘we have to take your arm or you’re going to lose your life. This is potentially fatal’.”

A couple of weeks later she began having skin grafts. Skin was taken from her legs and planted over her chest, back and sides. She suffered kidney failure, was on dialysis for six weeks and had numerous blood transfusions. There were 11 operations in all.

She returned to Melbourne in April and is slowly rebuilding her life. In June she took possession of a foam prosthetic shoulder that fits into the compression top she wears to promote healing. She has a wind trainer allowing her to cycle while stationary in the backyard and her bike has been modified with the gears and brakes on one side.

“I am rebuilding my life and part of what helped me is I’ve started running again and I’ve started to learn to swim,” Kerryn says.

She is not bitter about what happened. In the end, she felt lucky to be alive.

“It was pretty incredible. You’re just sitting there and from the time I had my accident, 36 hours later they were taking off my arm to save my life,” she says.

Frank Bowden says no one can say how long it will take in Australia before our last line drug treatments begin to fail. But for 20 years he has watched the gap between infection and cure slowly widen and nothing is being done to stop it.

“There is no question that with each year, the percentage of bugs that are resistant to normal antibiotics increases,” he says. “What’s happening now is telling us that we’re five minutes to midnight whereas everyone had assumed it was half past 10.”