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Multidrug Resistant Organisms: One of Healthcare’s Killers (Part 1)

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Multidrug Resistant Organisms: One of Healthcare’s Killers (Part 1)

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multidrug resistant organisms

Vancomycin-resistant staphylococcus aureus

The patient is in a car crash and enters the hospital with multiple wounds. He develops a healthcare-associated infection and dies.

We’ve created superbugs that are rapidly becoming resistant to the most commonly used antibiotics. These bacteria, fungus and viruses live in the community and in our healthcare facilities waiting for an opportunity to infect patients and healthcare staff. In 2011, an estimated 722,000 patients contracted an infection in the hospital in the U.S. and 75,000 of them died from the infection. That means that about 200 people die every day from hospital-acquired infections. Some of those infections resulted from the superbugs.

Where did the superbugs come from?
Multidrug resistant organisms are microorganisms (most often bacteria) that are resistant to one or more classes of antibiotics. Even worse, they are often resistant to several classes of antibiotics. A “panresistant” organism can’t be killed by any antibiotic. These organisms started fighting for survival as soon as antibiotics came into widespread use in the 1940s. The bacteria that successfully develop resistance to antibiotics are the ones that survive and pass on their genes to the next generations.

Antibiotic Use and Overuse
“I feel sick. Give me an antibiotic.” Pressure from patients or liberal use of antibiotics (overusing or misusing) antibiotics contributed to the development of multidrug resistant organisms. So does giving healthy livestock antibiotics to make them grow bigger. Some of our growing resistance to antibiotics comes from consuming the milk or meat from these animals.

How do the pharmaceutical companies respond?
Pharmaceutical companies develop new and more powerful antibiotics to fight the superbugs. But the bugs can act faster than the drug companies, which need to go through a prolonged process of developing, testing and getting approval for their medications. The pharmaceutical companies and superbugs are engaged in an ongoing battle. And that is where you come in as part of the team that fights the multidrug resistant organisms.

Meet the enemy
Meet some of the most common multidrug resistant organisms.

Clostridium difficile

Clostridium difficile

Clostridium Difficile
C. Difficile gets its name because it is difficult to treat. I worked on a case in which C. Difficle killed the patient when all of the organisms became resistant to all of the antibiotics on the market. It is one of the few infections that is both caused by antibiotics and treated with antibiotics. Most patients who get C. Difficile have received antibiotics, which destroy some of the normal bacteria in the intestines and allow C. Difficile to grow. C. Difficile forms spores and produces toxins that cause diarrhea. The diarrhea can range from mild amounts with abdominal cramping to copious amounts that result in loss of fluids, electrolyte imbalances, blood infection, low blood pressure, and death. C. Difficile is diagnosed by a stool sample. Some patients who receive antibiotics become carriers but have no symptoms. They are colonized with the organism. This is considered the most common hospital-acquired infection.

Clostridium Difficile Treatment and Prevention
Clostridium Difficile is treated by stopping the antibiotics the patient was on and giving additional antibiotics to treat the infection. C. Difficile has become resistant to some of the antibiotics. The best way to prevent the spread of C. Difficile is to use contact precautions, which are described later in this course, stringent hand cleaning with soap (alcohol rubs do not kill C. Difficile), and thoroughly cleaning the patient’s room where the spores can live on curtains, bedside stands, curtains, commodes, and tables.

enterobacter

Enterobacter

Carbapenem-resistant Enterobacteriaceae (CRE)
Enterobacteriaceae normally lives in our colons as Klebsiella, Serratia, Proteus, Enterobacter, and Escherichia Coli. They create havoc when they get into parts of the body which are normally sterile, like the bladder and blood. About half of the patients who get this difficult to treat infection will die.

Carbapenem-resistant Enterobacteriaceae (CRE) Treatment and Prevention
CRE is resistant to many antibiotics, especially the carbapenem antibiotics, which are normally considered antibiotics of last resort. There are only a few antibiotics that can be used to treat CRE infections. CRE is transmitted to patients most commonly from person to person or the hands of healthcare workers or contaminated medical equipment. We’ll talk about hand hygiene in more detail later. One of the important aspects of prevention is to avoid using temporary medical devices, like ventilators, urinary catheters and IV therapy catheters or to remove them as soon as possible. People at highest risk for CRE are those in poor health, in intensive care units and on mechanical ventilators.

Acinetobacter baumannii

Acinetobacter baumannii

Acinetobacter baumannii
This bacteria keeps getting stronger by developing resistance to new antibiotics. It is thriving in some acute care settings, particularly among those caring for wounded soldiers. This bacteria survives in wet and dry conditions, in the cities and deserts of Iraq and Afghanistan, on the hands of healthcare providers and on the inside and outside of medical equipment. It loves the ICU where it thrives in patient care equipment.

Acinetobacter baumannii Treatment and Prevention
This bacteria is relatively sensitive to most disinfectants. Cleaning the environment is effective in reducing its presence. The patient’s environment and equipment must be meticulously cleaned. Healthcare workers need to place the patient on contact precautions and thoroughly clean their hands. There are only a few antibiotics left that work with this bacteria.

Methicillin Resistant Staphylococcus Aureus (MRSA)
Many attorneys have heard of MRSA. Methicillin Resistant Staphylococcus Aureus thrives in both the healthcare environment and in the community. Staphylococcus aureus is normally on the skin, in the nose and in the genital region of healthy people. It is the most common cause of skin infections that are easily treated with skin care and antibiotics. MRSA is a type of Staphylococcus Aureus that is resistant to certain antibiotics including methicillin, penicillin, amoxicillin and oxacillin. It picks victims like people with weakened immune systems, young children, those with HIV or AIDs infections and the elderly.

Methicillin-Resistant Staphylococcus Aureus Treatment and Prevention
MRSA can be treated with antibiotics such as Vancomycin, Cleocin, Bactrim and others. Some of the bacteria have developed resistance to Vancomycin (known as Vancomycin Intermediate-resistant Staphylococcus Aureus (VISA). MRSA is spread by contact with contaminated hands or medical equipment. It can live for up to 38 weeks on curtains, table tops, equipment, patient charts, and other locations in the healthcare environment. One study found that the most effective intervention to prevent the infection was daily bathing of all ICU patients with chlorhexidrine soap and applying mupirocin ointment in their nose for 5 days.

Vancomycin Resistant Enterococcus (VRE)
VREs cause one out of three infections in the ICU. Enterococcus normally are present in the bowel and female genital tract. The bacteria cause infection when they target at risk people, including patients who have weak immune systems, have had surgery on the abdomen or chest, have medical tubes and lines, or chronic conditions like renal failure, cancer, and severe illnesses involving multiple body systems. VRE causes infection of the urinary tract, blood, brain, heart valves and open wounds.

Vancomycin-Resistant Enterococcus Treatment and Prevention
There are a few medications that can be used to treat VRE. Zyvox and quinupristin are effective against more strains, but the bacteria can develop resistance to these medications during therapy. Like many of the other superbugs, VRE can live for weeks on bedrails, side tables, medical equipment, call bells and television control devices. Nurses and others healthcare providers carry VRE on their hands from one patient to the next. VRE is spread by contact with infected blood, urine or feces of a patient with an infection or who is colonized with the organism. Hand hygiene is essential to control this infection.

In part two, I will share details about other health care killer infections.

Med League supplies well-qualified infection control and nursing experts to review medical malpractice cases involving infections. Contact us for help with your next case.

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