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Fighting ‘superbugs’ like MRSA takes smart antibiotic use

December 10, 2015 | UCI Health
Taking antibiotics

For too long, our nation has been overusing antibiotics, leading to a rise in antibiotic-resistant infections such as MRSA and C. diff.

These infections are called superbugs — bacteria that have developed a resistance to many antibiotics — and they cause more than 2 million illnesses and 23,000 deaths each year in the United States, according to the Centers for Disease Control and Prevention.

The good news is that there are steps physicians, healthcare facilities and you can take to help prevent these superbugs from increasing.

How superbugs gain hold

Let’s take a closer look at C. diff (Clostridium difficile), as an example. C. diff is a potentially fatal bacterium that causes colon inflammation and often manifests as diarrhea. According to the CDC, it affects more than 450,000 Americans each year.

Today, 40 percent of patients admitted here with C. diff were infected at other healthcare institutions, long-term care centers and private homes. This is not necessarily because anyone is doing anything wrong. It’s because C. diff is now constantly present; it lives in all of us all the time, but isn’t usually a problem. However, when a patient takes an antibiotic that kills other bugs, but not C. diff, and if they are really sick, then C. diff may overgrow and cause trouble.

The other 60 percent of patients with C. diff have it because healthcare providers activated it after they were admitted to the hospital. How does this happen? C. diff is, to some degree, in all of us. But if a physician prescribes multiple antibiotics to treat a different infection, all the bacteria — including beneficial bacteria — but the C. diff may be killed off. The C. diff then grows unchecked and can make a patient very sick.

Infections such as MRSA (methicillin-resistant staphylococcus aureus) — a strain of staph bacteria that has become resistant to antibiotics — work in much the same way. If we don’t prescribe just the right antibiotic or if we overuse them — giving you three when we could give you one — we actually can create a problem where one didn’t exist.

Prescribing the right antibiotic

One of the most important things we can do as healthcare providers is to choose the best antibiotic for the job and not overwhelm a patient with multiple antibiotics.

Also, we should not prescribe antibiotics when they aren’t needed, such as for a viral illness. A good example of this is a typical sore throat and runny nose. The vast majority of those illnesses never need an antibiotic, and by giving someone an antibiotic in that situation, it can make those bacteria that are on and around us all the time more dangerous, as has happened with the rise of MRSA.

UCI Health has an antibiotic stewardship protocol — the best thing since sliced bread, in my opinion — that helps us make sure we prescribe correctly. This requires that within 72 hours of any physician prescribing an antibiotic, an antibiotic expert reviews the order.

This is important because while a physician can look up an infection in a book and see which antibiotics are recommended, the physician may not be familiar with the organism’s unique local profile. Bugs of the same name vary from community to community and even from hospital to hospital in their resistance to antibiotics. Because our community uses antibiotics in a way that is unique to Orange County, the organism profile also is unique to Orange County. 

With our protocol of reviewing all antibiotic orders, we can help a physician pick the right set of antibiotics to cure the targeted infection and reduce the chance that we’ll activate a superbug.

How patients can help

Patients — and parents of sick children — also have a role in these efforts. By following these tips, you can help prevent antibiotic-resistant infections:

  • Take antibiotics exactly as prescribed.
  • Complete the entire course of antibiotics, even if you feel better before you finish the prescription.
  • Do not save antibiotics for a later infection.
  • Do not share antibiotics with others.
  • Do not insist on an antibiotic if your physician doesn’t think you need one.
  • Practice good hygiene, such as washing your hands frequently with soap and water.

Next in infection control

Infectious disease specialist Dr. Susan Huang and her colleagues have determined that controlling infectious bacteria requires a coordinated response among regional hospitals and care facilities. They showed, using computerized modeling, that you can eliminate some of these infections if there’s a coordinated effort between all healthcare institutions in an area.

Dr. Huang has received federal grants to coordinate monitoring and prevention efforts across the county’s dozens of healthcare settings. This is an early study, but we expect to see great results.

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Comments

Janelle Sommer
June 03, 2016

mupirocin,PI and alcohol are all effective at killing MRSA. Iodine and alcohol have been shown to be more effective than Mupirocin in actual use w/o contributing to antibiotic resistance. The real ? is how do PI and alcohol compare on: Price ,Ease of Use, Speed of action, Safety (pt allergic reactions), Pt Satisfaction, Ability to maintain decolonization, NOZIN can decolonization the nares easily& efficiently. www.nozin.com or 7149049836

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