Superbugs On The Rise; How Can Nurses Help to Exterminate Them?

With the increase use in antibiotics in patients who don’t need them and people not taking them properly has led to the evolution of superbugs that are almost impossible to treat. We as nurses can help change the culture to one that recognizes the role of good bacteria in our lives, while at the same time recognizing the danger of the superbugs. Nurses Announcements Archive Article

Superbugs On The Rise; How Can Nurses Help to Exterminate Them?

What Defines A Superbug?

Dr. Stephen Calderwood says of superbugs, "in fairness, there is no real definition," in the article, " Superbugs: What They Are and How You Get Them," by Kelli Miller. Doctors use the term, "multidrug-resistant bacteria," to describe bacteria resistant to two or more antibiotics. A term seen in some articles call some of these bacteria, pan-resistant bacteria. The prefix "pan" means "all", or "whole", meaning there are some bacteria resistant to all of the antibiotics available to modern medicine.

The scary fact is, that any bacteria can become a superbug. These resistant bacteria are those which won't be eradicated even with numerous antibiotics. The number one reason is the incorrect (taking them when not needed, and/or not finishing them) use of antibiotics.

Patients who have multiple hospital exposures/admissions and patients who take a lot of antibiotics are also at risk for developing the superbugs. On the flip side of that, cancer, chemotherapy, surgery patients depend on antibiotics. "Antibiotics are the foundation on which all modern medicine rests...If you can't treat those, then we lose the medical advances we have made in the last 50 years," states Brian Coombes, PhD.

Below are some of the bacteria considered to be a threat according to the White House 2015 report:

Carbapenem-Resistant Enterobacteriaceae (CRE)- Found in our guts, usually contacted in hospitals or nursing homes. They are hard to remove from medical equipment such as side viewing scopes, breathing tubes, and catheters. Up to 50% die from CRE.

Neisseria gonorrhoeae- An STD, spread through lady partsl, anal, and oral sex or childbirth.

Clostridium Difficile (C.diff)- Lives in the intestines and most patients get it while receiving medical care, especially antibiotics. It can knock out the healthy bacteria that naturally lives in our bodies. Can be passed by spores left on toilets, linens, and clothing.

Multidrug-Resistant Acinetobacter- can live on skin for days from water and soil. The strain Acinetobacter baumannii is a dangerous one. Found in hospitalized patients and is easily spread. Can become resistant faster than other bacteria and forms a protective shield against antibiotics.

MRSA (methicillin-resistant Staphylococcus aureus)- Easily spread and resistant to penicillin. Seen mostly in hospitals, spread through infected wounds and infect tissue and blood.

Antibiotic Overuse

For those of us nurses who work in the hospital and nursing homes, it does not come as a surprise that an article was published early this year telling us that an outbreak of C-diff was caused by the overuse of antibiotics. British hospitals did a study on the use of fluoroquinolones like Cipro and Levaquin, showing data that will help American hospitals contain outbreaks. According to the article, "Antibiotic Overuse Behind 'Superbug' Outbreak," beginning in 2006, the overuse of antibiotics generated a "severe diarrhea outbreak in British hospitals."

They found that reducing the use of fluoroquinolones in treating C diff showed a decline in the epidemic. Fluoroquinolone use has no restrictions in America, so these findings may help the outbreaks of C diff if the information is heeded. These antibiotics wipe out the good bacteria in the gut, allowing antibiotic resistant bacteria to grow.

Once the use of the fluoroquinolone use was curbed and deep cleaning occurred, C diff infections were reduced by 80% according to the article. Derrick Crook the study's co-author said this, "Our study shows that the C. difficile epidemic was an unintended consequence of intensive use of an antibiotic class, fluoroquinolones, and control was achieved by specifically reducing use of this antibiotic class, because only the C. difficile bugs that were resistant to fluoroquinolones went away."

Deep cleaning and handwashing were very important in cutting down on the spread of C. diff, and as nurses we must be proactive in carrying out these guidelines.

Death By Superbug

Some of you may have heard of the woman in Nevada that died last September of an infection that was resistant to every available antibiotic. If this doesn't scare you, it should. She was treated with 26 different antibiotics and the bacteria was resistant to every one of them. This type of bacteria is called pan-resistant bacteria as mentioned earlier meaning it can resist every antibiotic thrown it's way.

Traveling from different countries can bring these pan-resistant bacteria to the United States. The patient in Nevada had been over in India for long periods of time and hospitalized for an infected broken femur. She had been in the hospital in India just last June. In India, according to the article, "A Nevada Woman Dies of a Superbug Resistant to Every Available Antibiotic in the U.S." by Helen Braswell, bacteria that are multidrug resistant are more common in India.

The patient had CRE, more specifically Klebsiella pneumoniae, a bacteria that causes urinary infections. Samples were given to the CDC who tested it and they found that nothing in the U.S. would have been able to fight it.

What Is The Nurse's' Role?

Nurses must be proactive in their role to prevent infections. Hand washing is key, and that may seem elementary but cutting corners is not an option. Being educated is important as well. Knowing what is a threat and how to help is our job as nurses. Being educated ourselves in the first step, educating our patients is crucial. Being a part of infection control in our facilities as well as on committees are steps we can take in curbing the spread of the superbugs.

A recently approved drug called bezlotoxumab(Zinplava) has been found to cut C diff infections by 40% according to an article by Amy Norton, "Drug May Be New Weapon Against a 'Superbug'." Zinplava will be available this year.

Conclusion

Taking the superbug seriously can save lives. Nurses should mention to their doctors the new research to back up using less of the antibiotics that lead to C. diff. Communication from facility to facility when transferring a patient with a superbug is important so they can put the patient in isolation. Deep cleaning rooms and equipment will decrease the superbugs and of course the staple - hand washing. Education ourselves and our patients will help patient by patient to make the superbug extinct.

Do you feel that your facility does everything possible to prevent the spread of infections? Share your experiences.

References

Branswell, Helen. "A Nevada Woman Dies of a Superbug Resistant to Every Available Antibiotic in the U.S." Statnews.com. 12 Jan. 2017. Web. 9 Feb. 2017.

Carlson, Keith. "Superbugs, Nurses, and Antibiotic Resistance." Nurse.org. 26 Jan. 2017. Web.

Miller, Kelli. "Superbugs: What They Are and How You Get Them." WebMD. 17 April, 2017. Web. 9 Feb. 2017. 26 Feb. 2017.

Norton, Amy. "Drug May Be New Weapon Against a 'Superbug'." WebMD. 25 Jan. 2017. Web. 9 Feb. 2017.

"Antibiotic Overuse Behind 'Superbug' Outbreak." WebMD. 25 Jan. 2017. Web. 9 Feb. 2017.

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Brenda F. Johnson

About Brenda F. Johnson, MSN

Gastrointestinal Columnist

Brenda F. Johnson, BSN, RN Specialty: 25 years of experience in Gastrointestinal Nursing

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Love your article. Thanks.

Being educated ourselves! What would you do or say when you see fellow nurses going to Dr. Easygoing and ask for and receive a prescription for an antibiotic because their cold isn't going away. One nurse even asked for a prescription because she had "aspirated" that morning in the break room, (she was drinking coffee and it went down the wrong pipe). She thought she might develop aspiration pneumonia!

Specializes in LTC, assisted living, med-surg, psych.
Love your article. Thanks.

Being educated ourselves! What would you do or say when you see fellow nurses going to Dr. Easygoing and ask for and receive a prescription for an antibiotic because their cold isn't going away. One nurse even asked for a prescription because she had "aspirated" that morning in the break room, (she was drinking coffee and it went down the wrong pipe). She thought she might develop aspiration pneumonia!

Did the doctor give it to her? I hope not...

Yep, he sure did. Those were just the two times I saw it with my own eyes. I'm sure these aren't the only times it happens!

Specializes in Gastrointestinal Nursing.
Love your article. Thanks.

Being educated ourselves! What would you do or say when you see fellow nurses going to Dr. Easygoing and ask for and receive a prescription for an antibiotic because their cold isn't going away. One nurse even asked for a prescription because she had "aspirated" that morning in the break room, (she was drinking coffee and it went down the wrong pipe). She thought she might develop aspiration pneumonia!

Maybe she had a UTI and used aspiration of coffee as an excuse?!! Talk about overkill, Lol

I work in a walk in clinic and this is a common issue here. We are located in an affluent area where people are use to being told yes. It's frustrating. We have people who come in frequently for "just-in-case" antibiotics to take with them on their cruise or moms who give their kids their sibling's antibiotic, because she "swears" they have the same thing. I got into it with someone (Not at work...) who was giving her children each other's antibiotics and I told her how dangerous AND illegal that is. She claimed it was perfectly safe, because her one semester of pharmacology said so and that she "knows" her kids, because she has "mom" hands. I would never normally doubt a mother's intuition when she says something is up with her kid, but that should be the feeling that propels you to take them to the doctor, not take crazy risks and give your kid an antibiotic they may or may not need. And might I add... she calls hand sanitizer "goo". I just couldn't deal with her. lol

Specializes in Gastrointestinal Nursing.
I work in a walk in clinic and this is a common issue here. We are located in an affluent area where people are use to being told yes. It's frustrating. We have people who come in frequently for "just-in-case" antibiotics to take with them on their cruise or moms who give their kids their sibling's antibiotic, because she "swears" they have the same thing. I got into it with someone (Not at work...) who was giving her children each other's antibiotics and I told her how dangerous AND illegal that is. She claimed it was perfectly safe, because her one semester of pharmacology said so and that she "knows" her kids, because she has "mom" hands. I would never normally doubt a mother's intuition when she says something is up with her kid, but that should be the feeling that propels you to take them to the doctor, not take crazy risks and give your kid an antibiotic they may or may not need. And might I add... she calls hand sanitizer "goo". I just couldn't deal with her. lol

I think you hit on a common note that doctors won't say no to patients. Are they afraid because they think they will lose patients? What do you think. If so, it comes down to $$$

Specializes in Wound care; CMSRN.

If this is a subject that really interests you just google the phrase It's easily a weeks worth of exploratory reading.

What we don't know about the global, let alone human, microbiome, is staggering.

If I ground you up to soup and sorted the resultant varieties of DNA I got from that, something like 90% would not be human.

Each human being carries their own unique and personally identifiable bacterial "fingerprint". We leave it behind us in the breeze when we walk. It's essentially part of what bloodhounds track that make us smell differently from each other.

Human infants in hospital nurseries are reservoirs of Clostridium difficile bacteria, by which they are not effected.

(I. Adlerberth, H. Huang, et al; Toxin-producing Clostridium difficile strains as long-term gut colonizers of healthy infants. Journal of Clinical Microbiology, 2013);

The most effective treatment for C. diff infection is the introduction of "poop" from a healthy individual into the gut of someone who has been robbed of their resistance to C. diff by injudicious or even critically necessary antibiotic therapy. Fluoroquinolones are the main offenders, yet we require a person fail three rounds of antibiotic tx (usually oral Vancomycin) for C. diff before we'll allow them to undergo a tx which is >90% effective, in all studied cases, with few or no side effects. (Gastroenterol Hepatol (N Y). 2012 Mar; 8(3): 191–194).

All of this just points up how essentially ignorant clinicians can be about "germs".

Just was discussing this during a new job's general orientation. Two employees were not impressed with the company's affiliated walk in clinic because the NP on staff would not provide antibiotics for sinus exacerbation. As a home infusion nurse, I related a story about one of my patients who received 6 week run of Vanco and was back on service again 6 weeks later for another round. She never improved. I'm not sure my antidote computed. They just wanted their antibiotics.

The stomach......the most important organ and one of the most neglected. Many times providers practice backward, either out of naivety or patient non-compliance. For example, proton pump inhibitor (PPI) use has dramatically increased the risk of C-diff. A provider that prescribes an antibiotic (ABT) on top of that is no less than stupid. Unless a patient is at risk for Barretts Esophagus or has or is at risk for a severe infection complication, neither PPIs or ABTs should be prescribed. For most folks, GERD can be eliminated prior to developing Barretts Esophagus or CA. But it takes lifestyle choice changes that most patients are just not willing to comply with. Nonetheless, prescribers should start putting their foot down and expecting more from their patients as it relates to lifestyle choices.

All of this just points up how essentially ignorant clinicians can be about "germs".

Not so much ignorance as it is CYA and greed.

By the way, Metronidazole is actually the first-line drug of choice and should be prescribed in most cases and Vanco should be avoided unless the symptoms are severe, the patient is pregnant, or can't tolerate Metronidazole. If treatment failure occurs, Fidaxomicin has a similar cure rate compared to Vanco and actually kills C. diff instead of merely inhibiting its growth like Vanco. In addition, Fidaxomicin has a narrow spectrum which preserves normal gut flora. But like most other things in healthcare, it is not utilized and efficacy is thrown out the window due to high costs of the medication.

This is what socialized medicine and/or free markets mixing with socialized medicine give you in the end......no access. Providers need to educate themselves on and promote the benefits of a TRUE free market and how customers and competition naturally keep prices at a minimum.

Two year lurker here but I found this article worrisome, especially as someone who's had multiple UTIs and also sees so many of them on my floor.

UTIs Are Becoming Untreatable With the Rise of Antibiotic Resistance — NOVA Next | PBS