Antibiotic Overuse and the Development of Resistant Bacteria


WJXT Channel 4 Jacksonville CDC reports resistant bacteria pose serious threat to people.

The Centers for Disease Control has a new classification of the threat levels of different types of resistant infections. The most serious bacterial infections, which are very hard to treat, are carbapenem resistant enterobactereciae, Clostridium difficile and resistant strains of gonorrhea. The U.S. Centers for Disease Control and Prevention report that more than 2 million Americans develop antibiotic-resistant infections each year and 23,000 die of the infections.

Bad Bacteria CartoonDoctors and patients can reduce the development of resistant strains of bacteria by limiting antibiotic use to illnesses that truly warrant treatment. Examples of infections that generally do not require antibiotics include upper respiratory infections. Patients should complete the entire course of antibiotics when prescribed. Stopping early or taking someone else’s antibiotic can increase the chance of developing resistant bacteria.

When you take an antibiotic, a certain number of bacteria develop resistance. These can overgrow and spread the resistance to other bacteria. When antibiotics are used, they kill bacteria throughout the body. When the beneficial bacteria in the gut are killed, serious bacterial infections, such as Clostridium difficile, can occur. Fluorescent green probioticsTalk to your doctor to see if an antibiotic is truly needed for your condition.

Resistant bacteria are in our meat supply, especially when animals are given antibiotics. Handwashing is the single most important measure to prevent ingesting these resistant bacteria. It is vital that you wash your hands before and after preparing raw meat, and don’t allow raw meat to come in contact with other foods. Washing hands after using the bathroom also helps prevent the spread of resistant bacteria.

Commonly missed areas of the hands with handwashing

Commonly missed areas of the hands with handwashing

Mayo Clinic Florida has patient safety and quality initiatives to prevent the spread of resistant bacteria and to decrease the number of hospital acquired infections.

Last updated by Dr. Vee on September 24, 2014

Is It a Wash? Antibacterial VS Regular Soap


Photograph of Child Washing Hands courtesy of Rob Monroe
Photograph of Petri Dish Courtesy of Ruth Rogers

Should you use antibacterial or “regular” soap to wash your hands? Should you use soap at all? I had a teacher in medical school who believed that rinsing hands was as good as using soap. Wrong! Studies show that just rinsing with water may get rid of some superficial dirt, but doesn’t get rid of germs.

So if you have to use soap to remove germs, should you use antibacterial or “regular” soap?

If you are simply trying to prevent the spread of viruses such as rhinoviruses or influenza (cold and flu viruses), regular soap and water work just fine. The additional benefit is that regular soap and water washing does not encourage the development of resistant strains of bacteria.

Most healthcare workers SHOULD use antibacterial soap, because this prevents the spread of bacterial infections. Some important hospital acquired infections include methicillin resistant Staphylococcus aureus, Clostridium difficile and (yikes!) vancomycin resistant Enterococcus. The concern, of course, is that using antibacterial soap will cause more resistant bacterial strains to develop.

These are very scary infections, because they represent highly virulent (hardy, infectious) bacteria which have developed in response to exposure to standard antibiotics. These strains require super antibiotic therapy to treat. Some strains are resistant to all known antibiotics. Healthcare workers definitely want to prevent the spread of these strains to other patients, themselves and other contacts (e.g. our family members!).

The other option when soap and water is not readily available is to use alcohol gel. It prevents the spread of bacteria and viruses. The only exception is to Clostridium difficile (Yikes again!), which is resistant to the alcohol gel.

Remember, hand washing is the most effective way to prevent the spread of any infections. Twenty seconds (Sing Happy Birthday twice while washing) of vigorous hand washing, including the fingernails (which harbor a lot of bacteria) is needed to effectively remove germs from the hands.

And don’t forget the web spaces between the fingers, which are commonly missed areas during handwashing.

Last updated May 2, 2010 by Dr. Vee

Patients with H1N1 at Higher Risk for Pneumococcal Pneumonia


Although most children, young adults and pregnant women are at highest risk for H1N1 swine flu infections, older adults with H1N1 infections are more likely to develop pneumonia with pneumococcus bacteria.  The Centers for Disease Control has urged physicians to make sure their adult patients are vaccinated with pneumococcal saccharide (with 23 pneumococcal components) vaccine (e.g. Pneumovax). 

Children should be completely vaccinated to their appropriate age with 7 component pneumococcal vaccine (e.g. Prevnar) to prevent pneumococcal pneumonia.  Pneumonias complicating influenza A H1N1 infections are common reasons for respiratory distress and failure in children and adults requiring hospitalization.

Last updated November 14, 2010 by Dr. Vee

Eradication of H. pylori Reduces Risk of Stomach Cancer


A recent metanalysis (pooling the results of different studies on the same research study) of randomized research studies, motly done in Asia, showed a significant reduction of stomach cancer when a bacteria called Helicobacter pylori was eliminated from patients who were originally found to have the bacteria. 

 

The bacteria is found when a tissue sample of the antrum section of the stomach is tested (by looking at the stomach with an endoscope, a long tube with a maginfying lens on the end).  It can be treated with different combination of medicines which include certain antibiotics and stomach acid reduction medicines called proton-pump inhibitors.

This finding suggests that the risk of stomach cancer can be reduced by treating the bacteria in patients where stomach cancer is endemic, such as certain Asian countries.

Last updated August 16, 2009 by Dr. Vee

Bacteria Growing on Cell Phones of Healthcare Workers


doctor cellphone

A recent study conducted in Turkey showed that cell phones used by doctors, nurses and other health care staff have significant growth of bacteria.  Ninety percent of health care workers said they never cleaned their cellphones.  

200 doctors, nurses and other health care staff agreed to have their hands and their cell phones tested for bacteria.  95% of mobile phones had growth of bacteria, and the bacterial species matched those cultured from the hands of the owners.   Even more concerning is that 52% of the staph species cultured from the phones and 38% from the hands of health care workers grew a resistant species called methicillin resistant Staphlococcus aureus (MRSA).  MRSA is often a resistant organisms which grows in hospital and other settings where patients have received many antibiotics, resulting in the proliferation of hardier strains of a bacteria.

Studies show that bacteria is found on doctors’ ties, cell phones and hands.  Handwashing and keeping personal items clean are two important things that health care workers can do to prevent the spread of bacteria to patients.

Reference:

Ulger F, et. al. Ann Clin Microbiol Antimicrob. 2009:8:7.


Last Updated August 13, 2010

Treatment of Influenza A H1N1 “Swine Flu” with Anti-Viral Medicines in High Risk Groups


Blue Swine Influenza Molecules from CDC

 

Electron MicrographView of Influenza A H1N1 Virions 

 

Two classes of antiviral drugs are available for the prevention and treatment of influenza: neuraminidase inhibitors and adamantanes, which inhibit a viral protein called M2. Influenza A H1N1, formerly known as swine flu, has been found to be resistant to adamantanes (amantadine and rimantadine). Oseltamivir (Tamiflu) and zanamivir (Relenza) are the two neuraminidase inhibitors currently available by prescription. These drugs reduce the median duration of symptoms by approximately one day and reduce the chance of contracting influenza by 70 to 90 percent when used for known influenza exposure.

 

zanamivir moleculeWho Should be Treated with Neuraminidase Inhibitors if they Contract Swine Flu?

High risk groups for the development of H1N1 influenza A, formerly known as swine flu, include children and adolescents who are on longterm aspirin therapy (which puts them at risk for the brain abnormality Reye’s Syndrome if they contract influenza), children under the age of five and pregnant women. Adults and children with chronic lung disease, cancer, heart disease, kidney dysfunction, diabetes, sickle cell anemia, HIV infection and transplant recipients are also considered high risk for complications for influenza, and should be treated with antiviral agents.

Adults and children with brain abnormalities which result in decreased ability to clear respiratory secretions should also be treated with oseltamivir or zanamivir in the event they contract or are exposed to Influena A H1N1.  Patients with cerebral palsy, Lou Gehrig’s disease, seizure disorders and spinal cord injuries would be considered at higher risk for serious complications if they were to contract influenza. Elderly patients, especially those who live in Nursing Homes are also at high risk for developing complications of influenza.

Surprisingly, most patients to date who have contracted Influenza A H1N1, formerly known as swine flu, are younger, healthier patients. Use of Neuraminadase Inhibitors in Infants Under the Age of One Treatment should be considered for infants (down to one day of age) and children with moderate to severe influenza, and those at high risk of complications, including children younger than 5 years of age. While antiviral treatment earlier in the course of infection is likely to have a greater impact on decreasing clinical illness, treatment can be started even if the duration of illness is greater than 48 hours.

 

 

virion2

Who Should Receive Preventative Treatment with Neuraminidase Inhibitors?

 

The Centers for DIsease Control (CDC) recommends consideration of antiviral prophylactic (preventive) treatment with medications in patients who have had known or probable exposure to swine flu and are at high risk for developing complications if they were to contract influenza H1N1. Pregnant women, patients over the age of 65, and patients who have the above described chronic medical conditions and who are household contacts of a suspected or confirmed case of swine flu should receive treatment with antiviral medications. A patient is believed to be infectious from one day prior to seven days after symptoms of swine flu start.

Children in daycare and school children who are at high risk for complications of swine flu and who have had close contact with someone diagnosed with swine flu is eligible for prophylactic treatment with neuraminidase inhibitors.

Travelers to Mexico who are at high risk of influenza complications should also receive preventive treatment. Prophylactic treatment with antiviral agents is available to babies under the age of three months, but is only recommended if the infant is critically ill.

Ambulance personnel, emergency medical service providers, first responders, emergency room personnel and other health care workers who are working in areas of confirmed swine flu, and who are at risk of serious influenza related complications may receive antiviral medications to prevent influenza. People who are required to have contact with others in high risk situations such as hospitals or in areas with numerous documented cases of influenza A H1N1 cases should use N95 respirators  to prevent infection.

 

 

Virion Particle

Viral Strains Resistant to Anti-Viral Medications are on the Rise

Antiviral resistance can develop to adamantanes such as rimantadine and amantadine after just two to three days of therapy with the class of antiviral agents called adamantanes. Amantadine is an example of this class of drug.

Resistance to oseltamivir, a neuraminidase inhibitor, can also form in two to three days of therapy. Resistance to neuraminidase inhibitors is being seen in some countries. It is expected that strains resistant to oseltamivir and zanamavir will be resistant to peramivir, another medication in the same class, which is currently in development.

Treatment with oseltamivir in infants under the age of one is based on age, not weight. Dosing of children between age one and twelve is based on weight. Zanamavir, which is an inhaled medication, should not be used in patients with asthma or chronic obstructive pulmonary disease (COPD) because it may cause wheezing or shortness of breath.

There have been rare reports of self-harming behavior that may be associated with neuraminidase inhibitor treatment, primarily in Japanese children. Therefore the risks and benefits of treatment with these anti-viral agents should be taken into account before they are used. Treatment or prevention with anti-viral agents does not negate the need for simple infection control measures such as hand washing to prevent the spread influenza H1 N1 infection.

 

 

Legal Disclaimer: This article is for informational purposes only and should not substitute for medical advice from your health care provider. The author is not providing personal medical opinion, diagnosis or course of treatment. Do not delay or substitute this information for medical treatment.

Last updated August 28, 2009 by Dr. Vee