Read this: Superbug


Superbug is not about an entomological caped crusader.

It's more like a grown-up version of Scary Stories to Tell in the Dark.

The bug in question is MRSA, an antibiotic-resistant bacteria that kills more Americans every year than AIDS. Superbug is the story of how we created our own monster-under-the-bed, how it spreads through hospitals and communities, and why it's damn near impossible to control. If you have a cut or a pimple while reading this book, you are pretty much guaranteed to freak yourself out. And I mean that in the best possible way.

MRSA is the pumped-up version of a ridiculously common bacteria. One in three of us carts around Staphylococcus aureus on our skin or up our noses without ever noticing a difference. It never was benign—S. aureus is still the most common hospital-acquired infection in the U.S., and it can cause everything from rashes to toxic shock syndrome. But S. aureus mostly attacks the weak, people whose immune systems are too sick or too old to hold it in check.

MRSA throws all that out the window. The issue with MRSA isn't just its resistance to antibiotics. It's that it attacks the healthy, as well as the sick. And that it can kill the healthy, too.

I was used to hearing about MRSA mostly in the context of hospital-acquired infections. Superbug disabused me of that notion. MRSA may have first been noticed in hospitals, but it can come from the playground as easily as the emergency room, and it's actually gotten to the point where community-acquired and hospital-acquired strains cross into each other's territory often enough that researchers aren't sure such clear-cut categories even make sense anymore.

Written by journalist Maryn McKenna—a "Scary Disease Girl" who used to cover the CDC for The Atlanta Journal-ConstitutionSuperbug does a great job of explaining how hospital- and community-acquired MRSA evolved, and how they've intertwined with our modern way of life, from the doctor's office to the dinner table. Like any in-depth discussion of bacterial genetics, it does occasionally get mired down in acronym soup, but McKenna handles it well, reminding the reader at the right times what that concept from a few chapters ago means—and managing to do so in a way that doesn't feel textbook-y.

The book doesn't offer easy answers, because, frankly, there are none at this point. There are search-and-destroy policies that seem to be able to keep MRSA in check in hospitals, but they're expensive and difficult to employ in the United States, where MRSA rates are only voluntarily reported and enforcement of sanitary rules varies widely from hospital to hospital. (Countries with socialized medicine—and the standardized policies and consolidated medical records that come with it—have had better luck.)

The important thing here is awareness, and not just of the fact that MRSA exists. That does matter—particularly for doctors who don't always recognize what they're dealing with fast enough—but from an Average Person standpoint there are plenty of scary diseases in the world and you'd go nuts if spent too much time worrying about them all. Instead, Superbug's importance lies in making us aware of how daily choices in familiar places influence the evolution and spread of disease.

When I was 14, I read a book called The Coming Plague that sparked my interest in the stories of science. Its big question: "Where will the next major epidemic come from?" I remember that book being full of locations I thought of as exotic. (Though, to be fair, from my position in central Kansas, "exotic" meant just about anywhere else.) Combine that with reading The Hot Zone around the same time period, and small me was left with the idea that disastrous diseases were things that rose up out of the evolutionary ether in some dark corner of the globe, and swooped in on unsuspecting Americans via international travel or disgruntled research monkeys.

Superbug starts in Chicago.

Where will the next major epidemic come from? According to Superbug, that epidemic is already here. It grew out of our hospitals, our prisons and our high-school locker rooms. We fed it with our demand for antibiotic ointments, prescriptions we didn't need and factory-farmed cows packed together and pumped full of their own antibiotics. We spread it with unwashed hands. The story of MRSA is more prosaic than tales of tracking Ebola through the African jungle, but that's exactly what makes it terrifying, and fascinating.

Buy Superbug

Read the Superbug blog

Disclaimer: I received a free review copy of this book from author Maryn McKenna, who I personally know. That said, I receive a lot of free review copies of books. I only tell you about the ones I think you really need to read.

Image of MRSA growing in culture courtesy Flickr user Simon Goldenberg, via CC.


  1. Cool. I contracted a six-week-long bout of pneumonia immediately after finishing “The Coming Plague” about 15 years ago, so I’m sure reading “Superbug” will lay me up with something vile for several weeks. :-)

    1. All this brings up the underlying failed premise of conventional medicine (and agriculture) which overwhelmingly focuses on “kill the bug”. The focus should primarily be on building up the ability to resist the disease. Notice, not everyone contracts an illness when coming in contact with the Scary “Bug”. With generalized strengthened immunity we wouldn’t have to keep chasing the tail of every mutating bug.

  2. Interesting timing. I just did a voiceover for a management system for hospitals so they know how much they can spend to mitigate MRSA issues and still maintain a profit.

    1. How was it that you broke in to voice work? I’ve been looking to do the same thing. Still doing preliminary research into agents and classes. I’m based out of NYC.

      1. I do industrial voiceovers for the medical, educational, and scientific field, and some major companies (I’m in San Diego). I don’t wish to actually hijack this thread, but I couldn’t help but point this poster in the right direction. Got a great speaking voice? Check. Are you a prolific reader and can you read text out loud and make it sound interesting? Check. Got any good reputable classes (not 4 hour fly-by-night classes) you can take that will teach you the ropes and help you make a demo “tape?” Check. Then it’s up to you to shop it around to talent agencies or you can approach online “agencies” such as voice123. Good luck!

  3. MRSA is just the tip of the iceberg. I recently had a patient on the unit with Acinetobacter baumannii, a recently emergent bug that is inherently multidrug-resistant. Unlike MRSA, A. baumanii is not killed by alcohol-based hand gels that are so popular everywhere.

    This represents a sea-change in hospital infection control, because recent teaching has held that it is OK to use hand gel between patients when the hands have not been visibly soiled. We now need to return to full handwashing; 30 seconds or more with appropriate sanitary technique before and after every patient contact, with no exceptions.

  4. Maggie, thanks so much for posting this. As an Infectious Disease specialist, I deal with these organisms on a daily basis.

    A big part of the problem has been overutilization of antimicrobials which results in ecologic pressure. Among the most critical factors in reducing the emergence of antimicrobial resistance is the optimization of usage of our quickly dwindling antimicrobial resources. While many hospitals are focusing on this issues, consumers can do their part as well. We squander our antimicrobial resources when we use them inappropriately for non-bacterial infectious indications such as colds or most ear infections. Widespread usage of antibiotics in agriculture is certainly playing an important role as well.

    The unintended consequences of antimicrobial use are just now starting to make it on the public radar, although physicians have been struggling with this problem for years. Europe is far ahead of the US in this area but this problem is easier to address from a policy level with government oversight of the healthcare system.

    We are increasingly using antibiotics such as colistin, which was previously almost never used because it was considered far too toxic. We face the very real threat of having patients develop severe infections for which there are NO effective antibiotics.

  5. I just went through a bout of MRSA after having back surgery. The surgical wound needed to be re-opened, and “washed out.” I then required 6 weeks of daily intravenous antibiotic treatment with daptomycin. No fun whatsoever. While I was going through this, I read Superbug and everything the author says there about this amazingly frightening organism is true. The future of drug resistant organisms is horrifying.

  6. Good luck trying to keep hospitals free of environmentally based infections. Patients come in with projectile vomiting, explosive diarreha, homeless and the disabled with maggot infested wounds and caked on feces, mentally ill and dementia patients who play with (and eat) whatever comes out of themselves, etc, etc. This is on top of the usual people with MRSA filled abcesses already, infected surgical sites, skin ulcers, etc. Trying to keep a hospital free of something like MRSA is like trying to stay dry outside in a hurricaine.

    Another lovely bacterium to worry about is clostridium difficile.

    I fear our future antibiotics will run out of unique pathways to fight microbes and start becoming toxic to human cells.

    Also, be careful what you wish for in medical procedures. Medical care is already brutally expensive, just add even more labor costs on top of it and MRSA won’t matter cause you won’t be able to afford entry to a hospital anyway.

    1. MRSA is not transmitted through feces, maggots or blood. It is transmitted from skin to skin contact and through the air. don’t be such a jerk.

  7. What scares me most is that different strains can swap traits via phages. Yikes. That makes mutation potentially so fast it looks almost Lamarkian.

  8. Another huge issue is that patients don’t follow instructions when taking antibiotics. They start taking them, then when they feel better they stop and that lets the few bacteria that are partly resistant rapidly multiply and further mutate.

  9. I work at a medical school, and have yelled myself hoarse at students and staff whose common-sense habits are nonexistent.

    Example: I have lost track of the number of guys I see leave the Men’s room without washing their hands or flushing the urinal. Responses when asked why they did not do these simple acts of hygiene range from baffled stares to nervous laughter to incredulous statements about “saving water” and “being green”. But most will continue such habits, despite education, requests, rules or shame.

    Worst of all, many make a bee-line for the kitchen immediately after, using the communal coffee maker and other appliances. So much for disease control.

    These are your doctors of tomorrow. Be afraid.

    1. @Anon#11: So basically the students weren’t killing 99.9% of the bugs and letting the other 0.1% mutate into something drug-resistant, and that made you mad?

      You can’t have it both ways: you either accept a certain amount of dirtiness, or you wage an arms race with evolution.

      1. Robert: I think you may have an incorrect understanding of the problem if you think that this superbug came about because too many people washed their hands after using the bathroom.

      2. Don’t spread ignorance! Normal sanitation with soap and water DOES NOT affect mutation rates. Antibiotics are targeted killers. Soap and water washes microbes down the drain, away from people. It doesn’t kill them, but it greatly reduces their numbers, thus greatly reducing the chance of spreading them by contact.

        Bleach (an oxidizer) and other sanitizers are to microbes what being engulfed in flames is to humans. If we started burning people alive almost to death, do you think human beings would evolve to be flame-retardant super-humans? No! It doesn’t work like that. There is no gene for invulnerability.

  10. Gotta say, although I may end up reading the book. MRSA isn’t new or different. There’s also Vancomycin resistant enterococcus (VRE), which is an ugly but not uncommon bug in hospitals. C diff isn’t a resistant bug, but one that overgrows in the colon when antibiotics wipe out the normal flora.

    I must agree with MichaelRN though, that Acinetobacter baumannii scares me more than all of the above. It is an emerging nosocomial infection.


  11. What scares me most is that different strains can swap traits via phages. Yikes. That makes mutation potentially so fast it looks almost Lamarkian.

    It is Lamarckian. It is the inheritance of acquired traits. But it’s worth noting that bacteria have to be very, very economical with how much DNA they store. If antibiotic resistance isn’t advantageous to them, they will not be able to afford the cost of maintaining it, and they will drop it.

    Civilization has an antibiotic arsenal that at this point is huge. If we do the sensible thing and strictly regulate the use of antibiotics, including a ban on non-medical use in animals (and frankly, I’d favor banning medical use in animals too. It’s horrible, but homo sapiens should come first.), and strict monitoring of patients who receive antibiotics, we will be in a situation where there will always be long-forgotten antibiotics ready to return into rotation. And bacteria forget as quickly as they learn. Won’t take long.

  12. Thanks for talking about this. I started paying attention to this in 1988. The writing was on the wall earlier than that. Scary to see more and more antibiotics/antibacterials pumped into dish soap, hand soap and other products with no regard for the health hazard they’re exacerbating. We had a whole war on drugs, and few really worried about the drugs we were pouring into our food animals. Amazingly irresponsible.

    My guess for the future is better assays for the PCP to better screen bugs for susceptibility, and more concern about enhancing protective microflora on people and in the environment rather than thinking “bacteria bad, sterile good”.

  13. While some socialized medical systems have had luck with controlling nosocomial infections, using draconian restrictions (Sweden), others have not. Quebec has a terrible problem, and England still outpaces the U.S.A. And one wonders what the response of the average America would be to the Swedish model: “Yes, this antibiotic sometimes cures your horrific and possibly fatal infection. However, it is not currently authorized to be used for it.”
    It is also alarming to note that there is only one significant new antibiotic in development. We’d better start sweating and hoping for some sort of breakthrough.
    (My doctor once responded to criticism of the U.S. policy, versus many systems of socialized medicine, of “pushing” patients out the door of hospitals. “The longer they’re in, the longer they’re in,” he said, meaning the longer you stay, the more chances of nosocomial infections and other hospital-acquired problems.)

    1. I worked in hospitals for almost 20 years, and the first rule of Staying Alive Club is you don’t go to the hospital unless you absolutely have to.

    1. The important content of that link deserves highlighting here:

      “Norwegian doctors prescribe fewer antibiotics than any other country, so [bacteria carried by] people do not have a chance to develop resistance to them.

      Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections.”

      The solution is simple: don’t use antibiotics for infections that do not require them.

    2. Following from the reference to the article provided by Anon in #17, above — I found it revealing that one of successful measures Norway has taken to reduce antibiotic use is to ban advertising of all prescription drugs.

      Supports the idea that such advertising is just contributing to a dangerous “pill-popping” mentality in this country.

  14. I have had several MRSA infections in the past. They are not fun at all, and I am a testament to the fact that healthy people can be infected. What I’ve found to be the best prevention is to not touch your nose and then touch your skin. It lives in the nose and spreads when itching or picking your nose. When I do get an infection, I’ve become so familiar I can spot them, I wash the area with Hippoclens and then use some prescription Muciprocin ointment and slap a bandaid on and so far they have not returned. This might not be the best way to go about it, especially considering the Muciprocin is at least a year old, but I try to avoid antibiotics at all costs.

  15. Having encountered both MRSA a few years ago, and bedbugs more recently, it’s amazing how stubborn some people are not to inform themselves. People get criticized for being “anal” when using a paper towel to touch a bathroom door know or sink tap, but after having two zits on my leg turn into mountainous pus-bubbles that needed surgery and a month of antiobiotics, I could care less to get a funny look for my hand-washing practices in public. Luckily the bedbugs in my apartment were easier to treat, but knowing that neighbours in my building have had problems with them before, I took some precautions like a mattress cover and took up a more frequent laundry regime (which doesn’t help if they’re in your walls).

    Funny how hand sanitizer dispensers are appearing everywhere now, and just yesterday I walked past a mattress shop with two prominent window displays for their bedbug-proof mattress covers, so I guess people are finding out the hard way, but still reluctant to talk about such creepy things.

  16. I don’t believe there is anything new in there.

    What we are observing is an increase in rare cases with the increased human population in which some people although healthy otherwise has a crack in their immune system favoring a particular bug. What was looking as a freak case before look more prominent now particularly with the increase in communication.

    Multidrug resistant bugs probably existed way before humans.

    There is no need to freak out. You see bacteria can not be resistant to everything since their genome is too small for that and since it would have no evolutionary advantage for this.

    These being said the existence of “super-bugs” is still an issue even if it is not new and researching strategies and new compounds to overcome multidrug resistance is a worthwile task.

        1. @loonquawl – I think the previous ORLY was targeted at the fact that you can’t have antibiotic resistance unless you have antibiotics. Sure, bacteria have been evolving over the millions of years, enabling their growth in new niches.

          But no, antibiotic resistance that is being referred to here is due to the overuse and improper use of antibiotics.

  17. Yeah. I am currently finishing up oral antibiotics (Clindamycin) after being in the hospital with advanced cellulitis. Turns out that not cleaning my wound from an ingrown toenail removal introduced bacteria (either my own staph/strep or that of the hotel room bathroom floor) which decided to spread past my knee and involve the lymph node in my groin. Hobbled to ER, got grams of iv vancomycin and iv clindamycin, admitted to hospital for 3 days of more iv vanco and clinda, finally released with oral clinda (450mg 4xday) after spread stopped. Of course now I am paranoid about C-diff, so I am eating yogurt and taking Culturelle to try to beef up my decimated normal flora (and secretly hoping those 3g of Vancomycin helped decimate the C-diff in my intestines).

    They swabbed my nose to see what it was, and the cultures came back negative (antibiotics knocked it down?). I have eczema, meaning i don’t make an antimicrobial peptide that is normally secreted on the skin, so I am more likely to get skin infections (same reason I can’t have the smallpox vaccine).

    I think i am pretty lucky that the antibiotics worked. I am allergic to penicillin, so my choices are limited. The moral of the story? DON’T PLAY WITH YOUR TOES and CLEAN YOUR WOUNDS!!!

  18. Those of us who train in grappling arts (wrestling, MMA, BJJ, sambo, etc.) are all too aware of the dangers of MSRA. I hear that high-school wrestling programs are the worst; kids go visit their grandparents at the nursing home then come back and wrestle.

  19. “Multidrug resistant bugs probably existed way before humans.

    o rly?”

    That theory’s not new. Some doctors believe the incidences now are a result of us weakening our immune systems in modern life with things like antibiotics. I believe it could be a combination of this and mutated bugs.

    It’s even been suggested that the increase in arthritis cases is tied to our use of antibiotics over the last century. The body’s flora become unbalanced, and the immune system begins to gradually wear down certain tissues within the body.

    Compare these with the comment above about C-DIFF being a natural part of one’s system, but after other bacteria that would keep it in check are damaged, C-DIFF makes things ugly.

  20. This is part of the reason I plan to stay far away from hospitals if I ever have another baby. My first birth went fine, but at the NICU where my sister-in-law’s preemie was cared for, MRSA infections were such a regular occurrence that they referred to the nursery as the “MRSA-ry”.

  21. Antibiotics being…. ?
    Maybe substances that inhibit growth or kill? Such as Penicilin, named after the mold that had been producing the stuff for ages, before humans started bottling it?
    Have a Wikipeak: “The term “antibiotic” was coined by Selman Waksman in 1942 to describe any substance produced by a microorganism that is antagonistic to the growth of other microorganisms in high dilution.”
    Multiresistance thereby being prerequisite to survival.

  22. I’ve started in on Maryn’s book and am enthralled but only on the third page. I’m reading it because catheter-related bloodstream infection is the most under-reported but significant medical story of our time. Cook Medical, where I am the media relations director, has an antibiotic impregnated catheter (minocycline and rifampin) called the Spectrum that flat out saves lives. I want to spread the word about this life-saving product, which has been proven to offer the lowest catheter-related bloodstream infection rates of any catheter out there and is remarkably effective in protecting against MRSA, VRSA and VRE.

    More than 10 years of clinical use and a 7 year study of more than 500,000 catheter days confirm that use of Spectrum does NOT lead to baterial resistance and in fact use of this catheter results in decreased need for systemic antibiotic use and decreased resistance to tetracyclines and rifampin.

    Catheter-related bloodstream infections strike 250,0000 Americans annually with a mortality rate of 12 percent to 25 percent and may be costing the U.S. healthcare system as much as $2.3 billion annually. Our Spectrum has achieved rates as low as .36 infections per 1,000 catheter days but a rate of 1.4 infections per 1,000 catheter days is generally achievable with sterile process bundling….that is, Spectrum is four times more effective than sterile prcess. Hospitals are usually satisfied with 2 or 3 infections per 1,000 catheter days, although many hospitals have rates that are far, far higher.

    If you need a catheter, request Spectrum by name. If you need more information, reach me at

    1. At first i thought the antibiotic was somehow confined to the catheter, but on the site it says that the antibiotics ‘permeate the biofilm’ – how then do you prevent resistances from forming?

  23. I worked in a prison for four years and MRSA was a huge concern along with TB. As for me, I take Don King’s route and wash my hands before I touch my dick.

  24. I recently spent 2 weeks in hospital with MRSA that infected my urinary track and went into bloodstream.I had a previous bout with MRSA urinary track infection as well as numerous absesses prior to that. After getting out of the hospital and being told I might deal with MRSA for the rest of my life, I did research and found that stabilized garlic which has allicin kills MRSA as well as Oregano oil and colloidial silver and the MRSA can’t build an immunity to it. Doctors, who get kickbacks from pharmacutical companies for prescribing antibiotics and other prescriptions will not even consider homeopathic and natural cures when it is right under their noses. I had been dealing with MRSA over and over and since taking the Stabilized garlic and oregano oil, I have not had another problem with Mrsa. If you deal with MRSA, do some research and don’t depend completely on the prescription route. If you don’t believe me, research it yourself..

    1. Doctors get kickbacks from drug companies? Oh really – I’d like to hear about the mechanism for such a thing, and how it evaded the FDA, AMA, Medicare, and other organizations.

      1. Drug companies hire physicians to push their products to other physicians. Lots of money involved. Lots of sleaze, too.

      2. I cannot fathom whether your question was ironic or not. In case it was in earnest, just enter it into Google, question mark and all.

  25. My 3 year old daughter (at the time) contracted MRSA. She was eventually given vancomycin and we were told that if that didn’t work, there was nothing the hospital could do. And to top it off, she was in a “teaching hospital”, so every Tom, Dick and Intern had to come gawk at her since MRSA was only seen at the time in elderly patients. She had a relapse after one week and was readmitted. Finally she fought it off. It was real and very frightening. Come up with the next gen antibiotics already! (She is fine, but we have to keep her infections in check. 14 yrs old now!)

  26. Let me give you some history about Acinetobacter Baumannii.

    The problem originated in US Field Hospitals in Iraq: the idea was (and still is) to keep keep the place clean without constant cleaning and clean-after-contact protocols for patient care.

    This brilliant idea relies on the pervasive use of antibiotics and antimicrobial agents. They’re still doing it. And the result is a network of hospitals that turned into a playground for a bug that you can cultivate in a bucket of disinfectant.

    That last statement is not an exaggeration. A. Baumannii can be cultured from a swab left overnight in a bucket of Lysol. It can be *cultured* in a bucket of Lysol, and every other disinfectant you can use in a space where humans coexist with the cleaning operation.

    So what did we get next? Baumannii infections came home with wounded soldiers, and military hospitals in the USA (and Europe!) started reporting cases, which have now spread out into the civilian hosptal system.

    In my darker moments, I wonder whether someone in the command chain is an evolution denier. In a more generous mood, I recall that it’s labour-intensive (read: expensive) to maintain hospital-standard hygeine, even in a purpose-built hospital; and very difficult indeed in a field station that might be nothing more than a tent city, with a fine dust of dried camel-dung blowing in on the wind.

    Whether I’m in a generous mood or not, the result is inescapable: the overuse of antibiotics in field hospitals gave an illusion of safety that now kills more soldiers than the post-trauma infections that the Army thought they were preventing.

    And now the Iraq war has delivered a killer bioweapon into every city on the USA: just as well it only infects the wounded. And the bug doesn’t actually grow at all well in places where it’s out-competed by a healthy bacterial flora. I’d call it Saddam’s revenge, but we did it to ourselves.

  27. ESBL anyone? Yet again another scary superbug starting to emerge in our community and in our healthcare facilities.
    Extended-spectrum beta-lactamase (ESBL) is one of many that are surfacing. Hand washing is the only real prevention. Soap + H2O + Lots of Scrubbing = Cleaner than Antimicrobial Foam or Gel.

  28. That’s kind of interesting. Just got over having a MRSA on my back. All better now. :)

  29. Never take an antibiotic unless you’ll die tomorrow without one. Never use antimicrobial cleansers on your skin. Never use any soap that’s harsher than what you are trying to wash off. Never bandage a wound unless you have to do it to stop bleeding, and then take it off as soon as possible. Replace all your stainless steel doorknobs and handles with uncoated solid brass. Do not drink from plastic or eat food from plastic blister packs. Sneeze in your elbow. Carry a handkerchief or bandanna. Stay away from hospitals unless you’ll die otherwise. Grub around in the dirt at least once a week. Eat raw vegetables and lots of fish. Don’t drink anything containing corn syrup.

    And most importantly, never take advice on health matters from doctors or random pseudonymous people on the Internet.

    1. I think your suggestions are the most useful tips for health prevention I´ve heard until now and, if followed, many people would avoid dangerous things and bad harms we are exposed today due to the human madness.

  30. Many antibiotics are fed to livestock because it makes them grow faster and heavier. Last I heard, the exact mechanism behind this “side effect” is unknown, but the growth difference is worth $$$

  31. My towns school headlined because of MRSA a while back, i freeked kuz of it, and we all stayed home the next day, if we did all go there would have been a shooting at the school that very day, crazy hu?

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