Antibiotic Resistance: Hearing the alarm sound

April 5, 2013 By

Big Red BellAntibiotic-resistant bacteria have been the subject of recent news items designed to bring the issue to the world’s attention, and with the threat of widespread incurable infections, that attention may well be overdue. The story that triggered the media flurry aired on NPR’s All Things Considered, and reported on the increased incidence of carbapenem-resistant Enterobacteriaceae (CRE). CRE are resistant to nearly all antibiotics (including carbapenems, often the drugs of last resort), can transfer their resistance to other bacteria, and cause often fatal infections. The UK’s chief medical officer, Dame Sally Davies, reported to the Parliament’s Commons committee on Science and Technology that unless improvements are made, society may face an apocalyptic scenario in which routine infections are untreatable due to the lack of effective antibiotics. She also compared that risk to a catastrophic terrorist attack, a pandemic flu or massive flooding.

Here are some reasons none of us can be complacent about infection prevention:

  • According to the Centers for Disease Control (CDC) report that was the source for the NPR story, the proportion of bacteria that are antibiotic-resistant has quadrupled in the last 10 years.
  • Research by a team of doctors in Israel found that CRE infections were still present in patients a year after they were first identified, which gives rise to concern about community transmission of the bacteria once patients who had CRE are released from the hospital.
  • The development pipeline for new antibiotics is running dry.  While a new infectious disease has been discovered in each of the past 30 years, very few new antibiotics have been developed in that time. A commonly cited reason for that situation is the high cost of development and the focus of pharmaceutical companies on more profitable drugs to treat chronic conditions.

Many efforts are underway to prevent or control the growth of antibiotic resistance. The CDC and Professor Davies’ Annual Report both provide guidelines and recommendations for approaching the problem. Those recommendations include:

  • Careful antibiotic management, sometimes referred to as “antibiotic stewardship,” to avoid overuse, misuse or abuse, and to prevent antibiotic resistance at the patient and community levels.
  • Government investment in and incentives for new antibiotic research and development.
  • Infection control and prevention directed at multiple bacteria and all—healthy and infected—patients.

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Vitamin D vs. HAIs

November 30, 2012 By

Can something as simple as vitamin D help reduce healthcare-associated infections? A review by Youssef et al.1 published this past spring in the journal Dermato Endocrinology makes a strong case that it could.

Vitamin D can play an antimicrobial role, as it can reduce local and systemic inflammatory responses, and strengthen the body’s immune response. Those mechanisms may be especially important in dealing with antibiotic-resistant bacteria. At the least, vitamin D may be able to reduce inappropriate antibiotic prescriptions, and boost therapeutic response in combination with appropriate antibiotics.

Citing vitamin D’s low cost, especially when compared to the added cost of HAIs, the authors suggest checking vitamin D status when patients are admitted to a hospital and addressing insufficiencies. Many patients have lower than average levels of vitamin D on admission.

According to the studies referenced in the article, vitamin D deficiency is associated with worse outcomes and higher costs for patients with bacteremia, bacterial sepsis, pneumonia, Clostridium difficile, Catheter-associated urinary tract infections, surgical site infections, and virulent organisms like MRSA. Proving causality is obviously a higher benchmark, but this review indicates the value of more research to determine vitamin D’s antimicrobial properties, and whether vitamin D should be a common tool in the multifaceted approach to addressing HAIs.

In the meantime, it looks like Mom was right again: Drink your milk, get some sunshine, and pay attention to your vitamin D levels.

 

1Youssef D, Ranasinghe T, Grant W, Peiris A. Vitamin D’s potential to reduce the risk of hospital-acquired infections. Dermato-Endocrinology 2012; 4:167 – 175; http://dx.doi.org10.4161/derm.20789.

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NIH Outbreak Brings HAIs to National Attention

September 11, 2012 By

NIH Outbreak Brings HAIs to National AttentionThe National Institutes of Health’s (NIH) Clinical Center was open about the history of last year’s outbreak of Klebsiella pneumoniae, an antibiotic-resistant bacteria, despite their best efforts to prevent and contain it. That openness brought healthcare acquired infections (HAIs) and the issues of antibiotic use and development into the national media.

NPR’s Diane Rehm show on Tuesday, August 28th did a good job of summarizing the issues:

  • Increasing use of antibiotics creates more antibiotic-resistant bacteria, like the one that caused the NIH outbreak.
  • Widespread use of antibiotics in animals, to promote growth, exacerbates the resistance to antibiotics in organisms.
  • Some doctors start treatment with a more broad-based antibiotic than the situation requires.
  • And the relatively short term in which people need to take antibiotics makes it less attractive or profitable for pharmaceutical companies to develop the new antibiotics we need to keep up with adaptive resistant bacteria.

One of the show’s guests made a comment that could be construed to mean that human error and the inevitability of people shortcutting the protocols are what prevent us from stopping the spread of a rampant infection. Dr. Michael Bell of the Centers for Disease Control said, “we can stamp out these infections very, very effectively. Once you detect, you protect. The problem is that people cheat. It’s very, very tempting, when you’re very busy and trying to do a lot of things for a lot of patients, to cuddle to a corner, to slip into a room without putting on a gown, slip back out. And when that happens, that opens a pathway for the organism to be carried to yet another patient.” Unfortunately, the NIH case disproves that idea.

That outbreak took place at one of the most advanced and specialized hospitals in the country. The hospital took all the right precautions of isolation, education, hygiene, and environmental service protocols, and even had personnel to monitor compliance to those procedures. And yet new cases of infection arose weekly. Clearly, handwashing and those other protocols are essential to controlling infection. However, by themselves, they’re not sufficient to the task.

Healthcare-acquired infections are a complex problem that will require ongoing and multi-faceted effort: careful antibiotic stewardship, hygiene and environmental service protocols, hard and soft surface management, ventilation and education—of medical personnel, patients, and the public—must work in concert to prevent and control infections.

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