In previous articles, I’ve discussed the risk of overuse of antibiotics leading to antibiotic resistance. Recently, I reported good news in the development of a new antibiotic, Teixobactin. This antibiotic was discovered through a new method that allows evaluation of many microbes that live in soil. Although promising, we may have to wait years before new antibiotics receive approval from the Food and Drug Administration (FDA). This means that we still have much to worry about with regards to resistant bacteria.
In 2001, a North Carolina hospital noted that some bacteria normally found in our intestinal tract, Enterobactericeae, were becoming resistant to antibiotics given for hospital-based infections. There have since been many such incidents: In 2012 alone, more than 200 medical facilities in 42 states reported at least 1 case. Hospital-acquired infections are called “nosocomial infections” and present a major issue to those taking care of patients who required advanced care, such as ventilator support.
These resistant bacteria, including common pathogens such as E. Coli and Klebsiella, are known as Carbapenem-Resistant Enterobacteriaceae, or CRE. The concern is that the Carbapenem class of antibiotics are often the last resort used to cure infections in those that are weakened by chronic disease or require nursing care. In these patients, presence of CRE in the bloodstream is associated with a 50% death rate, much more than more well-known troublesome bacteria such as MRSA (Methicillin-Resistant Staph. Aureus).
It’s uncertain how CRE first originated, but the food industry, with its almost-indiscriminate use of antibiotics in livestock, may be the culprit. 80% of antibiotics used in the U.S. today go to the animals we eat. This is not to cure an illness, but to make them grow faster and get to market sooner. It’s my belief that our issues with resistance stem, at least in part, from this practice.
In recent news, some medical instruments used in hospitals appear to be a source of contamination, even after “sterilization” according to manufacturer recommendations. Hospitals in Seattle and Los Angeles have seen outbreaks in the last few weeks.
How do we stop the upsurge in resistant bacteria? It’s not easy, but we should start by adjusting our attitudes towards the drugs we use. You shouldn’t use antibiotics for every minor ailment that comes along. This goes for doctors, but also for patients that believe that they are a quick fix for a respiratory infection. Most respiratory infection are viral in nature, and antibiotics do not affect viruses.
Liberal use of antibiotics is a poor strategy for a few reasons. These include:
• As previously mentioned, overuse can foster the spread of resistant bacteria. Antibiotics routinely given to turkeys caused a resistant strain of Salmonella that put over 100 people in the hospital in 2011. 36 million pounds of ground turkey were recalled.
• Potential allergic reactions may occur. the worst cases could lead to anaphylactic shock.
• Making a diagnosis may be more difficult if you take antibiotics before you’re sure what medical problem you’re actually dealing with. The antibiotics might temporarily “mask” the symptoms, which could cost valuable time in determining the correct treatment.
Although CRE is currently limited to medical facilities, there is nothing that says that it may not spread to a community at large. Enforcement of strict infection control guidelines, including additions implemented in the 2014 Ebola scare, should decrease the number of events and the risk of CRE moving out of the hospital and into your home.
Joe Alton, MD
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