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.
