Infections and Antibiotics

This blog entry is a follow-up to my last about allergy meds and antibiotics.  This one is focused on the use of antibiotics and the ineffectiveness of them because of overuse which has some serious consequences.

 

In 2003 the Joint Commission established National Patient Safety Goals (NPSG) that all accredited hospitals have to comply with.  Over 4,000 hospitals have Joint Commission accreditation, which is roughly 82% of all hospitals¹.  Failure to attain accreditation could jeopardize Medicare reimbursement, which generally accounts for 35% – 55%²  of all revenue a hospital earns.  So, as you can see, there is some incentive to follow the NPSGs. 

The NPSGs were in part a response to a 1999 U.S. Institute of Medicine report titled To Err is Human that suggested as many as 98,000 people die in U.S. hospitals each year from mistakes and errors that occurred within these hospitals.  Each year the NPSGs are updated to either add to the list based on sentinel events reported to the Joint Commission and medical care and practice concerns found during accreditation surveys, or removed from the list if the issue related to the goal has decreased significantly.  Sentinel events are any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness.    

NPSG #7 is "reduce the risk of healthcare associated infections (HAIs)."  One requirement under this goal is for hospitals to implement evidence-based practices to prevent HAIs due to multi-drug resistant organisms (MDROs) in acute care hospitals.   Evidence of Performance under this requirement includes providing education to the patients and their families as needed who are infected or colonized with a MDRO about HAI strategies.

One MDRO that was once attributed as an HAI is Methicillin-Resistant Staphylococcus Aureus (MRSA).   Unfortunately, this infection can now be acquired in the community as hospitals experience people coming to hospitals with this infection.  In 2007, the CDC reported that 14% of all MRSA infections were community acquired. 

MRSA is a bacterial staph infection.  It is spread by contact.  The garden-variety of staph are common bacteria that can reside in our body.  Many healthy people carry staph with them without getting infected and 25-30% of us have it in our noses.  Most staph infections can be treated with antibiotics. 

MRSA is a different animal.  MRSA -- have become resistant to antibiotics that once destroyed it. MRSA was first discovered in 1961. It's now resistant to methicillin, amoxicillin, penicillin, oxacillin, and many other antibiotics.  While some antibiotics still work, MRSA is constantly adapting. Researchers developing new antibiotics are having a tough time keeping up.  Though most MRSA infections aren't serious, some can be life-threatening. Many public health experts are alarmed by the spread of tough strains of MRSA. For this reason, MRSA is known as a “super bug.”

Another common MDRO is C. difficile (C. diff).  C. difficile bacteria can be found throughout the environment — in soil, air, water, and human and animal feces. A small number of healthy people naturally carry the bacteria in their large intestine. But C. difficile is most common in hospitals and other health care facilities, where a much higher percentage of people carry the bacteria.

C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile, you may then unknowingly ingest the bacteria.

People in good health don't usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.

Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon.

An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain is more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics.

Antibiotic resistance occurs when antibiotics no longer work against disease-causing bacteria. These infections are difficult to treat and can mean longer lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.

Antibiotics are effective against bacterial infections, certain fungal infections and some kinds of parasites. Antibiotics don't work against viruses. The chart shows common illnesses and whether they're caused by bacteria or viruses. Taking an antibiotic when you have a viral infection won't make you feel better — and can contribute to antibiotic resistance.

 

Bacterial infections	Viral infections
Bladder infections          Many wound and skin infections, such as staph infections          Severe sinus infections that last longer than 2 weeks          Some ear infections          Strep throat	Bronchitis         Colds         Flu (influenza)         Most coughs         Most ear infections         Most sore throats         Stomach flu (viral gastroenteritis)

 Repeated and improper use of antibiotics is the primary cause of the increase in the number of drug-resistant bacteria. Here's what you can do to promote proper use of antibiotics:

·         Understand when antibiotics should be used

      ·         Don’t pressure your doctor for antibiotics if you have a viral illness

      ·         Take antibiotics as prescribed

      ·         Never take antibiotics without a prescription (including a prior prescription where you      

             leftover pills)

      ·         Get recommended vaccinations

      ·         Practice good hand hygiene!!!!
 

I know this won’t satisfy the Element of Performance related to education for NPSG #7, but this is good stuff to know.  I am sensitive to infections and infection control.  My father acquired a HAI during the last time he was in a hospital.  That infection took its toll on him and accelerated his terminal condition.   I know I am not alone in having many antibiotic prescriptions in the course of my lifetime, but being armed with this information, you can be assured going forward, I will let the viral bug run its course without taking any antibiotics.    

¹  www.jointcommission.org

²  Hospitals and Health Networks magazine, September 2010