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."
