With drug-resistant ‘superbug’ in the country, hospitals are on alert

  • Antibiotic resistance graphic from the Centers for Disease Control. Courtesy photo—

Monitor staff
Published: 5/29/2016 12:06:54 AM

The nation’s health care system received very bad news Thursday, when it was reported that a strain of bacteria has been found in the United States that is resistant to all known antibiotics, including last-ditch antibiotics saved for particularly virulent microbes.

Very bad, but not unexpected.

“It was just a matter of time,” said Lynda Caine, RN, infection prevention officer for Concord Hospital.

The report from federal researchers said that E. coli bacteria carrying what is known as the mcr-1 gene has been found in a woman from Pennsylvania. Such bacteria, often called superbugs, do not succumb to any known antibiotic. The gene was also found in E. coli in an intestine of a pig on a Texas farm, a reflection of widespread antibiotic overuse in agriculture.

Such superbugs had previously been found elsewhere in the world, and it was assumed that the problem would eventually show up here. Some observers have cautioned that they are so bad we may be entering a “post-antibiotic world,” similar to conditions that existed a century ago, when relatively minor infections could be fatal because no medicine could contain them.

The New Hampshire Epidemic Control Committee, consisting of scores of clinicians, warned in a 2015 report that multidrug-resistant organisms and a related problem called CID “are increasingly recognized as major threats to public health,” whose “escalating prevalence over the last two decades poses significant challenges for both public health and clinical care settings.”

The 56-page report outlines a variety of steps that hospitals and health-care facilities should take to minimize the problem, some as simple as better hand-washing and some as complex as developing and using “narrow-spectrum agents” – a program that Caine describes as “the right drug for the right bug.”

Caine said such work is a large part of her job and the job of cohorts at other hospitals and health-care facilities.

“There is a heightened level of awareness,” she said. “There’s a close-knit network throughout the state; we have conference calls, communicating about the situation.”

She pointed to a program that hospitals run called antibiogram. “It’s like a report card so providers can look and see where we have resistance; we look at them throughout all hospitals to see if there are patterns.”

If the “superbug” shows up in New Hampshire, she said, “we’d go into combat.” It’s one of the reasons that Concord Hospital bought two robots that use ultraviolet light to disinfect rooms by killing bacteria, fungus and other microbes.

The problem of resistance to antibiotics isn’t unexpected: Andrew Fleming, the man who discovered penicillin, warned of it in the speech he gave when he received the Nobel Prize in medicine in 1945.

But it has grown much more serious in recent years.

“There are so many (bacteria), and they reproduce so quickly, they have the advantage – they’re constantly evolving,” Caine said. “It takes so long to make a new antibiotic, you can never keep up.”

“The main reason is we overuse, overtake, overprescribe antibiotics,” she said.

Overuse of the medicine causes the problem in this way:

In any population of bacteria there are some random mutations, and occasionally these mutations can provide protection from an antibiotic. If the rest of the bacteria are weakened or killed off by an antibiotic then the resistant mutation has no more competition and can reproduce more quickly. Should that situation continue, the population of resistant bacteria can become well established and eventually spread.

Because this possibility is inherent in any use of antibiotics, as Fleming warned in 1945, the medicines should be used judiciously by mixing different antibiotics, avoiding antibiotics when they aren’t necessary, and otherwise allowing nonresistant bacteria to thrive and compete with the mutant varieties.

But that isn’t happening. In agriculture, for example, broad-spectrum antibiotics are regularly given in low doses to millions of cows, pigs and chickens because this makes them grow more quickly, for reasons that aren’t fully understood. That situation that has long been decried by researchers as a perfect breeding ground for resistant bacteria.

In humans, antibiotic use can also be poorly controlled, with the drugs being prescribed when they aren’t needed, a situation fueled by increasing medical options to patients.

“If people don’t get what they want in one place, they’re going to go someplace else to get it,” Caine said.

Caine said patients can help keep the problem from getting worse by not demanding antibiotics unless they’re called for – for example, the flu is caused by a virus rather than a bacteria and so does not respond to antibiotics – and always taking the entire dose of medicine that is prescribed, so as not to leave behind lingering populations of bacteria that are more susceptible to mutation.

And make sure you don’t spread bacterial disease if you’re sick or pick it up from others.

“If you touch that doorknob you’d better be using that hand gel,” she said.

(David Brooks can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek)

David Brooks bio photo

David Brooks is a reporter and the writer of the sci/tech column Granite Geek and blog granitegeek.org, as well as moderator of Science Cafe Concord events. After obtaining a bachelor’s degree in mathematics he became a newspaperman, working in Virginia and Tennessee before spending 28 years at the Nashua Telegraph . He joined the Monitor in 2015.

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