Antibiotic resistance is a hot issue in the medical community and even in the popular press. And for good reason. Antibiotics that cured certain bacterial infections just a few years ago are rapidly becoming less effective, or even ineffective, against the same infections today. ‘Superbugs’ are emerging that appear to outsmart some of the most modern antibiotics, reducing the options physicians have for treating serious bacterial infections. Although some individuals – the very young, the elderly, and those with chronic health problems – are most vulnerable to the effects of antibiotic resistance, it is truly a concern for the entire community.

Evolution of a superbug
Living things that adapt to their environment survive. That’s as true formicroorganisms as it is for plants and animals. When bacteria are bombarded by an antibiotic, the weak ones die and the ones that are able to change in some way (mutate) to evade the antibiotic, survive and multiply. Most of these mutated survivors are no longer affected by the antibiotic designed to kill the original form of the bacteria; they have become resistant to that particular antibiotic.When a different antibiotic is used to kill the mutated bacteria, once again theweak die and newlymutated bacteria survive, creating a strain of bacteria that’s resistant to the new antibiotic. And so it goes.

Some antibiotic-resistant bacteria can move like ‘regular’ bacteria from person to person through direct contact or through sneezing and coughing, for example. If such bacteria reach people with weakened immune systems, an infection can take hold that’s more challenging to treat. That’s because these bacteria have evolved beyond what would be considered ‘standard’ antibiotics. So, it’s the bacteria that are resistant to the antibiotics, and not the person’s body. Continuing mutations create stronger and stronger ‘superbugs,’ which can be very difficult to treat with any antibiotic.

Survival of the fittest
‘Survival of the fittest’ is part of the natural order. The first evidence of this in regard to antibiotics was noted when penicillin – a true medical miracle at the time – was widely used to treat infected wounds during World War II. Just four years after mass production of this antibiotic began in 1943, bacteria began to appear that could resist it. Pharmaceutical companies then developed the ampicillin group of antibiotics, which worked admirably... until some bacteria evolved that were resistant to these antibiotics. Then came methicillin, a highly effective and very dependable family of antibiotics – until recently.

Bacteria resistant to methicillin are called MRSA bacteria, and they are showing up not only in institutional settings (nursing homes, hospitals), but also in the community. MRSA stands for methicillin-resistant Staphlococcus aureus, with Staphlococcus aureus representing a group of bacteria implicated in many infections. “We’ve seen MRSA in all kinds of patients including kids involved in contact sports who come into the Emergency Department with what appears to be a ‘spider bite,’” says Clare Edelmayer, RN, Doylestown Hospital’s Infection Control Coordinator. “When we send a sample to the lab, we find that it’s actually MRSA. The scientific community feels that this troubling trend may indeed be due to the overuse of antibiotics in the community or to genetic mutation.”

Protecting hospital patients and staff
Infection control in the hospital is a daunting task, since many hospital patients are very ill or have depressed immune systems, leaving them exposed to infections that might not develop in a healthier person. Also, the combination of bacteria that patients might bring with them and the antibiotics used to treat them can potentially result in the evolution of a generation of antibiotic-resistant bacteria in a relatively short time and in relatively close quarters. The Centers for Disease Control (CDC) estimates that more than 70 percent of the bacteria that cause hospital-acquired infections are resistant to at least one of the drugs commonly used to treat them. Because of this, says Clare, “we put a great deal of effort into staying one step ahead of the bugs.”

In her position, Clare develops and monitors projects to reduce infections, teaches proper infection-control techniques, gathers statistics and identifies trends, and is the main infection control contact for the hospital. She directs the hospital’s participation in the CDC’s National Healthcare Safety Network (NHSN), the only national system for tracking hospital-acquired infections. Doylestown Hospital is one of just 300 hospitals nationwide (out of more than 7,500 hospitals in the United States) participating in the system. Through the data it gathers, Doylestown Hospital and the other hospitals in the NHSN help infection control professionals and hospitals stay abreast of the rapidly expanding science and practice of infection prevention and control, as well as better manage episodes of hospital-associated infections.

New interventions, excellent tradition
The hospital also works with the Institute for Healthcare Improvement (IHI), building on and adapting IHI initiatives in multiple areas of care, including infection control. “For example,” says Clare, “patients connected to ventilators are historically more prone to respiratory infections and pneumonia. Doylestown Hospital’s ISLT [Improving Systems Leadership Team] looked at IHI best practices related to combating ventilator-associated pneumonia, adapted them, and dramatically reduced the occurrence here from 12.1 incidences per 1,000 vent days to just 2.8. We’re currently working on special interventions aimed at preventing surgical site infections, central line (IV) infections, and urinary tract infections.”

Scott Levy, MD, Doylestown Hospital’s Chief Medical Officer, is proud to note that the hospital’s infection control activities pre-date by years the recent flurry of information in the popular press about superbugs and the like. “Doylestown Hospital has been working on infection control for a long time,” states Dr. Levy. “We were taking major steps to minimize infection well before this was a popular topic. Some hospitals are just now focusing on areas that are prominent on the public’s radar screen … areas that yield numbers that are publicly reported,” he continues. “But numbers are just the tip of the iceberg. We have always focused on improving the entire continuum of care, and reducing infection is a large part of that.” In spite of the copious amounts of paperwork, tracking, and reporting involved, Clare readily acknowledges that successful infection control … and monitoring the entire continuum of care…is not a desk job. “You’ve got to be out on the floors, talking to patients and staff, observing, teaching. Everyone here understands that they’re a vital part of this effort.”