06 Sep Manipulating Antibiotic Resistance
“War of the Worlds”
October 30th, 1938. Imagine a slower, simpler time before the internet, smart phones, and television. It’s Halloween night and Orson Welles is presenting an adaptation of “The War of the Worlds” by H.G. Wells (reference). Unfortunately, your family is one of the dozens that miss the announcement that the show is for entertainment only and by the end of the hour long show, everyone has been thrown into a panic thinking the world is coming to an end. Some call the radio station while others call the police. The Mercury Theater has just caused wide-spread panic over it’s listening area by faking an alien invasion! In the end, though, humanity is saved by the very thing that makes us sick.
Bacteria, the hero?
Bacteria, bacterium, classified as prokaryotes, single-cell organisms that lack a nucleus, and yet, they can bring a grown man to his knees (or kill alien invaders) (reference). In the “War of the Worlds”, it was the bacteria our bodies have acclimated to fight that defeated the entire alien army (reference). Bacteria are microscopic, but they are mighty in numbers and adaptability. Bacteria can adapt to almost any condition, there are bacteria that live in anaerobic (without air) conditions, some thrive in extreme heat or cold, while others have learned to adapt to the ever changing world of antibacterial drugs.
Antibiotics, the antagonist?
The first modern antibiotic, Penicillin was discovered in 1928 by Dr. Alexander Flemming (reference). Mass-production began in the early 1940’s and by the time the U.S. began using Penicillin to treat troops during World War II, it was being heralded as a miracle drug (reference). By the late 1940’s, it was being introduced into agriculture to boost poultry production (reference). Despite Dr. Flemming’s caution that bacteria could start mutating to resist Penicillin if not used cautiously, the first resistant strains of bacteria were already being identified in the mid to late 1940’s (reference). According to Harvard Magazine, resistant staph infections in hospitals rose from 14 percent in 1946 to 59 percent in 1948 (reference). The trend of antibiotic resistance has continued and, with it, the emergence of “superbugs” or Multidrug Resistant Organisms (MDRO). The overuse and misuse of antibiotics, not just to treat humans, but in agriculture as well, has led those microscopic, one-celled organisms to do what they do best: survive.
Setting the stage for change
Fortunately, we know more now about bacteria and antibiotics then we did in the 1940’s. As Maya Angelo once said, “I did then what I knew best, when I knew better, I did better.” (reference). We now know better, so we must do better. The Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), as well as many more agencies and organizations across the world have recognized the current and potential threat of antibiotic resistance. There are new mandates, recommendations, education, and regulations being put into place, but some are too little, too late. In order to make a difference, the healthcare community is going to have to become proactive and change the environment in which bacteria lives (or dies).
The Plot Thickens…
We know that we can change the tide of antibiotic resistance. Just as we have forced bacteria into creating or mutating a resistance, we can “turn down” the pressure so to speak of antibiotics being used in a specific area by decreasing or eliminating the use of certain antibiotics. The idea is that we are creating a better, safer environment for the bacteria and will, therefore, decrease the need to create a resistance. “When there is a concerted effort made by all of a facility’s physicians and nurses to coordinate together intelligently, resistance and its complications can be controlled,” Dr. Robert Yancey, ID and Antibiotic Stewardship Expert.
The Plot Twist!
How does that work, exactly? Simply, bacteria are everywhere, they are on everybody, in the environment, can live in different conditions. However, as “normal flora” and “healthy flora” can live outside the body for a period of time, so can “Superbugs” and MDRO’s. They are in the environment and, therefore, spread to others. If you imagine a building as a petri dish with a few isolated areas of MDROs or Healthcare Acquired Infections (HAI), we know these infections will spread unless there is some intervention. This is why isolating infected patients and environmental cleaning, handwashing , and observing infection control guidelines are so important. Now imagine there are antibiotics introduced into that petri dish, the bacteria may respond to those antibiotics at first, but just like with the introduction and overuse of Penicillin, the bacteria develops a resistance. When antibiotics are overused and misused in a facility (building = petri dish), a resistance builds in that environment, not just in the affected person. Though we isolate those that already have MDRO’s, not every person that has bacteria in or on them are isolated and, therefore, bacteria and the antibiotics used to treat them are not isolated.
What can you do? As in antibiotic stewardship, everyone has a role. However, the most important roles as it pertains to manipulating bacterial resistance are the information gatherer, the information giver or reporter, and the prescriber. The information gatherer and reporter (giver) is typically the nurse caring for a resident or client. Nurses are expected to know and understand how to assess a resident, identify what is wrong, gather data such as vital signs, assessment findings, and lab reports and call the physician. The physician then has to rely on what the nurse is telling him or her and make the best possible decision with the information given, and they already know. This isn’t ideal for manipulating antibiotic resistance. The physician isn’t going to have the latest and greatest antibiotic prescribing guidelines nor are they going to have an up to date facility antibiogram in their back pocket. The nurse isn’t expected to know what an antibiogram is, much less how to report it to the prescriber and he or she is not expected to know about any resistance “brewing” in the facility. This makes antibiotic resistance manipulation difficult at best, impossible at worst.
How is manipulation of antibiotic resistance a solution if it’s difficult, hopeless possibly impossible to attain? Because there is a solution that makes it not only attainable, but easy. SmartSteward enables the nurse and prescriber to be equipped with the most up to date antibiogram, the most proficient prescribing and a recommendation engine that automatically gives the top 3 antibiotic choices while removing the threat of prescribing antibiotics that are developing a resistance in the facility. By using these tools, doctors and nurses can truly work together in a concerted effort to control resistance and it’s complications.
- Angelou, Maya. Retrieved on September 4, 2019 from https://www.goodreads.com/quotes/9821-i-did-then-what-i-knew-how-to-do-now
- Bushak, Lecia. (2016, February 17). A Brief History Of Antibiotic Resistance: How A Medical Miracle Turned Into The Biggest Public Health Danger Of Our Time. Retrieved on September 4th, 2019 from https://www.medicaldaily.com/antibiotic-resistance-history-373773
- Penicillin. (2019). In Encyclopaedia Britannica (Ed.), The Encyclopaedia Britannica. Retrieved from http://www.britannica.com/science/penicillin
- The War of the Worlds (1938 Radio Drama). (n.d.). In Wikipedia. Retrieved September 4th, 2019, from https://en.wikipedia.org/wiki/The_War_of_the_Worlds_(1938_radio_drama)
- Vidyasaga, Aparnar. (2019,April 25) What Are Bacteria? Retrieved on September 6th, 2019 from https://www.livescience.com/51641-bacteria.html
- Well, H.G. (1898). The War of the Worlds. London, England. William Heinemann of London.
- Xue, Katherine. (2015). Superbug: An Epidemic Begins. Retrieved on September 4th, 2019 from https://harvardmagazine.com/2014/05/superbug