The Grapevine

Understanding Antibiotic Resistance, And How To Prevent It: Everything You Need To Know About Superbugs

Superbugs
Prevention is key when it comes to drug-resistance bacteria and viruses. Photo courtesy of Shutterstock

Ebola found its way to the United States. Shigella is currently circulating domestically. And these two are neither the first nor last superbugs we’ll hear of.  

A Bug’s Life

Dr. Steven Gordon, chairman of the Cleveland Clinic’s infectious disease department, told Medical Daily superbugs are clinically known as multidrug-resistant organisms; it’s a term that signifies there are a limited number of treatment options. Resistance can actually be encoded in some bacteria and viruses, Gordon said, making it easier for the bacteria to multiply in the face of antibiotics. But other resistance stems results from a bacteria’s genetic mutation or acquired resistance from another bacteria species.

Tuft University’s Alliance for the Prudent Use of Antibiotics (APUA) cited mutations “occur in about one in one million to one in ten million cells,” with “different genetic mutations yield different types of resistance.” And the process of bacteria species acquiring resistance from another species is known as conjugation. APUA added bacteria have the ability to acquire “free” DNA from the environment, too.

Antibiotic-resistant strains of bacteria may seem like a fairly new phenomenon, but Gordon said shortly after Alexander Fleming introduced penicillin in the late 20s, there were rumors of resistant organisms within a couple of years. Now, some believe antibiotics are overprescribed, and too much of a certain antibiotic is how resistance spreads.

A study published in the journal Infection and Immunity recently reported antibiotic resistance is further complicated when exposed to cigarette smoke, specifically methicillin-resistant Staphylococcus aureus (MRSA). In addition to harming the human respiratory and immune cells, it literally stresses out resistance bacteria and makes it more aggressive.

That said, resistance can also be reversed albeit more slowly. Tufts cited “antibiotics cause a selective pressure by killing susceptible bacteria, allowing antibiotic-resistant bacteria to survive and multiply,” and if this pressure is removed, the bacterial population can potentially revert to one that’s responsive to antibiotics.

Super Side Effects

For Scrubs Magazine, critical care nurse Kati Kleber wrote resistant strains forces nurses and otherwise health care practitioners “to use much more toxic and potent antibiotics, which “means we have to use heavy-hitter antibiotics for infections that at one time were easily treated.” Not only do these strains require more toxic (possibly more expensive) antibiotics, but they potentially increase mortality rates, the overall cost and stay of hospital admission. Plus, nurses working with multiple patients have to be extra careful they don’t spread the resistant strains patient to patient.

“This means more patients are placed on isolation precautions, meaning direct care workers must wear appropriate protective equipment. This includes isolation gowns, gloves, masks (for droplet and airborne precautions) and disposable equipment (e.g., stethoscopes),” Kleber wrote. “Not only is this costly, but it’s tedious for the staff.”

Gordon said this presents an opportunity for all health care practitioners, which is to start using antibiotics judicially. He said most people expect antibiotics for, say, a cold, when most colds aren’t bacterial; they’re viral.  Of course, once superbugs find their way to a community, practitioners and clinicians are going to want to do what’s best for their patient. But there are different classes of antibiotics, and the one that’s most prescribed may not always be the best option.

Prevention Is Key

Presenting problematic symptoms to your primary care physician is an important step for people who suspect they have a superbug. But, Gordon said, even more important than that is an emphasis on education and prevention.

Gordon’s preventative tips mostly involve lifestyle changes, including no smoking, exercising, eating in moderation; keeping “fingers, fork, and feet,” clean and healthy. Additionally, paying attention to global health makes a difference. Shigella, for example, is a severe foodborne disease causing painful stomach cramps, diarrhea, and fever. It’s associated with international travel, but there are cluster outbreaks happening in the US. Staying on top of international outbreaks and diseases can better inform healthy habits to maintain at home, such as hand hygiene.

“Diseases don’t respect borders,” Gordon said.

Though global health concerns shouldn’t only be focused on what’s happening among humans.

“We tend to only worry about what happens to humans, but we also need to worry about animal and plant life,” he added. “Eighty percent of antimicrobials are being used for aqua culture in the food industry.”

The World Health Organization deems some of these antimicrobials “critically important” to human medicine; if humans are additionally exposed to them in their everyday food, this likely leads to resistance. Gordon referred to McDonald’s newly announced vision for antimicrobial stewardship in food animals, in which they’ll phase out chicken raised with antibiotics within two years.

To Gordon, these preventative measures are the cure. He, and presumably other practitioners and clinicians, would rather prevent disease than treat it. Empowering people to share in their health could reduce the rise in antibiotic resistant bacteria and viruses, as well as lead to new, cost-effective treatments, especially now that healthcare is relatively expensive.

Gordon wants to see patients and doctors working together, as partners, when it comes to patient health. Information is power — and the more patients have, the better.

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