Rise of the superbugs
If you’ve read or watched the news lately, you’re probably familiar with the term “superbug,” or drug-resistant bacteria. But what are “superbugs,” exactly, and what kinds of public health risks do they pose for the average American?
The U.S. Centers for Disease Control (CDC) has issued several warnings about the increase in drug-resistant bacteria in recent years, and also has recommended limiting the use of antibiotics to help slow the development of more drug-resistant bacterial strains. But many people and physicians ignore these recommendations, and new drug-resistant bacteria continue to emerge.
“Superbugs are not necessarily new,” says Donna Lupinacci, MSN, Medical Center Compliance Officer for Kaiser Permanente’s San Diego Service Area and faculty of the University of Phoenix College of Nursing. “They’ve been a problem for as long as we’ve had antibiotics, beginning with penicillin in the 1940s.”
According to Lupinacci, drug-resistant bacteria are just trying to survive. ”Bacteria are living organisms, and they adapt however they have to in order to stay alive. We saw bacteria that became resistant to penicillin shortly after penicillin became widely available. But we were able to discover and develop new antibiotics quickly in response to that, and we continued to do that as more and more resistant strains emerged. The only difference now is, we’ve run out of new drugs and are not developing them at the same rate we were before.”
The rise of multiple superbugs and a dearth of effective antibiotics to treat them has become a serious public health problem that continues to worsen. “This is not a problem that is going to go away,” Lupinacci says. “It’s going to take us at least a generation to resolve it.”
With a growing number of superbugs and fewer treatment options, the U.S. and world is facing a major step backward in infectious disease treatment. “The major public health risks associated with drug-resistant bacteria is mortality and morbidity related to infection,” says Erich Widemark, PhD, RN, FNP-BC and Director of Nursing/Campus Chair at the Phoenix Hohokam Campus of University of Phoenix. “Before penicillin, many people died of infection. By the mid-20th century, it was unusual for a person to die from infection.” But with today’s dramatic rise of superbugs, mortality rates from infection could rise back to pre-20th century levels, according to Widemark. “Of course, the other risk is that young children and the elderly are more susceptible to infection, which increases their risks much more in comparison to say, young adults.”
What are some of the superbugs currently presenting a public health problem in the United States and worldwide? “Most people have heard of MRSA (Methicillin-resistant Staphylococcus aureus),” says Lupinacci, “but there are whole host of others. Just a few years ago, MRSA was only a problem in hospitals, but now we’re seeing community-acquired MRSA. We’re also seeing something called VRE (vancomycin-resistant enterococci), a bacteria that normally lives in the gut but can cause very serious infections if it escapes the gut.”
According to Lupinacci, VRE can cause severe pneumonia, meningitis and heart-valve infections such as endocarditis that can become both life-threatening and difficult to treat. “You can become infected by VRE if you handle fecal matter (such as a health care or day care worker), or if you have gastrointestinal diseases such as Crohn’s that can cause bacteria to leak from the gut into the bloodstream.”
The CDC has a complete list of drug-resistant pathogens on which it has issued warnings on its website, but Lupinacci cautions that there are some very new (and dangerous) emergent strains that are not yet included on the CDC list. Among them are something called bacterial enzymes, which are not bacteria themselves but the waste products produced by certain bacteria. These include extended spectrum beta lactamase (ESBL), according to Lupinacci. “These enzymes can cause severe gastrointestinal disease, urinary-tract infections, pneumonia and skin infections. And these infections have very high mortality rates, anywhere from 15 to 46 percent,” she says. Other dangerous enzymes include methylbelactinase (NDM1) and clebicella-resistant pneumoniae (CBKP) which have just emerged in the U.S. in recent months after originating in Asia; as of this writing, neither of these pathogens responds to any available antibiotics.
How can the nursing profession in particular respond to these grave public health risks? “Handwashing, handwashing, handwashing!” stresses Lupinacci. “The nursing profession and health care at large has gotten sloppy about handwashing in recent years,” she says. “Also, we need to be more vigilant about disinfecting foamites (i.e., things like blood-pressure cuffs, stethoscopes, computer keyboards, etc.) between patients.”
Much of Europe has clinical guidelines already in place that restrict health care providers’ use of things like long sleeves and lab coats as well as governing handwashing and foamite disinfection, which has resulted in lower infection rates there; Lupinacci expects similar guidelines may become standard in the U.S. in the near future.
Erich Widemark agrees. “Paramount to the nursing profession’s strategy to reduce the spread of superbugs is consistent and continuous infection control practices, including washing hands and being more alert to the concept of cross-contamination,” he says. “Furthermore, nurses need to teach patients and families the same disinfectant techniques, while instilling in them the potential seriousness and consequences of not following those techniques.”
Widemark also provides a surprising recommendation against relying upon alcohol-based hand sanitizers. “The general public should wash their hands and primarily concentrate on the length and vigorous nature of the wash,” he says. “They should also choose traditional handwashing over alcohol-based disinfectants, which dry the skin and don’t always kill all bacteria. They should also avoid treating every illness with a demand for antibiotics in cases where it is more likely a virus.”
Lupinacci offers some additional advice. “If people in the household have an active infection, be sure that they don’t share towels, linens or other personal items. Don’t ask your doctor for antibiotics if you don’t need them. And if you do need them, make sure to complete the full course; don’t stop taking them just because you feel better. That contributes to antibiotic resistance, too.”
