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Targeted Disinfection of High Touch Surfaces for Infection Prevention
July 16, 2018
Antibiotics

Antibiotics

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Antibiotic misuse has been the main driving force in the evolution of antibiotic resistance. A direct relationship lies between the antibiotic consumption and the emergence of antibiotic resistance. Bacteria inherit resistant genes through horizontal gene transfer among different species of bacteria (10). Despite these findings, antibiotics continue to be misused including overprescription to a nonmedical application in food industry. Studies have shown that treatment indication, agent selection or treatment duration is incorrect in 30% to 50% of cases (2). A study in the U.S. reported that pathogen detection was only in 7.6% of 17,435 patients with community-acquired pneumonia (CAP) (1).

Unnecessary antibiotic use or wrongly prescribed drugs have seen to be prevalent in healthcare practices. A multiple hospital post-prescription reviews in 10 U.S. states showed that 37% improvement can be achieved by just implementing simple practices such as the use of proper diagnostic tools, documentation of symptoms and optimizing antimicrobial treatment (11).  Another study on patients with hospital-acquired infections showed that patient who had received antimicrobial treatments had a great clinical response just within the first six days (7). A randomized controlled trial of 401 ventilator-associated pneumonia patients receiving appropriate therapy for 8 days had the same results as compared to patients receiving treatment for 15 days (7). These two studies further clarify how optimizing therapeutic regimes can effectively help in treating infections and fighting antibiotic resistance.

Gram-positive pathogen such as resistant S. aureus and Enterococcus species poses a global pandemic threat. In the U.S. MRSA kills more people than HIV, emphysema, Parkinson’s and homicide combined. Respiratory pathogens, such as Streptococcus pneumonia and Mycobacterium tuberculosis have a global spread of drug resistance causing an epidemic (2, 4, and 11). Gram-negative bacterial pathogens are particularly dangerous as they are now becoming resistant to almost all antibiotic treatments. MDR gram-negative bacilli are affecting every field of medicine (4).  Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter are some of the serious gram-negative infections affecting health care settings (5).

Due to economic and regulatory obstacles, development of new antibiotics has been stalled. To be precise, 15 out of the 18 largest pharmaceutical industries abandoned the antibiotic market. Moreover, mergers between pharmaceuticals have also reduced the research pools (1, 9). Even when companies pursue the discovery of new antibiotics, obtaining regulatory approvals is at times a stumbling block. Lack of clarity, ineffective communications, bureaucracy, random changes in regulatory rules, requirement differences among countries is some of the obstacles in pursuing regulatory approvals (5, 9).

Health experts and organizations such as the Centers for Disease Control and Prevention (CDC) recommend various steps to pursue curbing antibiotic resistance, such as antibiotic stewardship program, tracking and prescribing drugs, diagnostic improvements, prevention of infection transmission, and optimization of therapeutic regimens (2). Antibiotic stewardship involves choosing the right drug, the right dose and treatment duration, and only to use antibiotics when needed (2). A 24 studies review, from 1996 to 2010 showed that antibiotic stewardship program was able to achieve an 11% to 38% reduction in defined daily dose per 1000 patient-days (1).

Many countries today don’t have a complete picture of domestic incidence, mortality, and prevalence of bacterial resistant infections. However, the CDC has now launched the National Healthcare Safety Network which will assess and facilitate infection report, antibiotic use and its resistance (2). This will help in tracking resistance by providing a clear picture of regional antibiotic resistance. Infection prevention is one of the major areas where government agencies are working to eliminate the need for antibiotics. Healthcare personnel’s must understand the significance in terminating cross-contamination of antibiotic-resistant bacteria, especially when working with patients that are placed at high risk (6). Lastly, the effective use of vaccines must be implemented to limit the transmission of resistant bacterial infections. The newer version of Streptococcus pneumonia vaccine, launched in 2010 was successful in decreasing antibiotic-resistant pneumococcal infections (2).

Discovery of penicillin in 1928 started the modern era of antibiotics, transforming and saving lives of millions. However, shortly after a few decades, penicillin resistance became a notable clinical issue. In response, new beta-lactam antibiotics developed restored the confidence on antibiotics. But methicillin-resistant Staphylococcus aureus (MRSA) was detected in that same decade further threatening the advances made in medical sciences (2). Antibiotics work by targeting and inhibiting crucial cellular processes, thus retarding growth and causing cell death. But when these bacterias are exposed to antibiotics below the required kill dose, they are able to mutate and resist antibiotic treatment.

Antibiotic resistance threatens all the strides made by it’s initial discovery to ground zero. And despite all the alarming and increasing threats, recommended steps and novel policies continue to be ignored.  Antibiotic resistance continues to be a substantial public health and economic burden. Hence, the government and private agencies should both continue to collaborate and fight against bacterial resistance.  A successful campaign will require a considerable financial and human investment, however, the cost is going to be much higher if we fail to act now.

 

References:

  1. Bartlett JG, Gilbert DN, Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56(10):1445–1450.
  2. Centers for Disease Control and Prevention, Office of Infectious Disease Antibiotic resistance threats in the United States, 2013. Apr, 2013. Available at: http://www.cdc.gov/drugresistance/threat-report-2013.
  3. Congressional Research Service Report Life expectancy in the United States. Mar, 2005. Available at:http://www.cnie.org/nle/crsreports/05mar/RL32792.pdf.
  4. Golkar Z, Bagazra O, Pace DG. Bacteriophage therapy: a potential solution for the antibiotic resistance crisis. J Infect Dev Ctries. 2014;8(2):129–136. 13.
  5. Gould IM, Bal AM. New antibiotic agents in the pipeline and how they can overcome microbial resistance. 2013;4(2):185–191.
  6. Lushniak BD. Antibiotic resistance: a public health crisis. Public Health Rep. 2014;129(4):314–316.
  7. Luyt CE, Brechot N, Trouillet JL, Chastre J. Antibiotic stewardship in the intensive care unit. Crit Care. 2014;18(5):480.
  8. Michael CA, Dominey-Howes D, Labbate M. The antibiotic resistance crisis: causes, consequences, and management. Front Public Health. 2014;2:145.
  9. Piddock LJ. The crisis of no new antibiotics—what is the way forward? Lancet Infect Dis. 2012;12(3):249–253.
  10. Read AF, Woods RJ. Antibiotic resistance management. Evol Med Public Health. 2014;2014(1):147.
  11. Rossolini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis. Clin Opin Pharmacol. 2014;18:56–60.
  12. The antibiotic alarm. 2013;495(7440):141.