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Superbugs

Jan 17, 2019, 14:40 PM
By Mark Wallace, MD - Skagit Regional Health Infectious Disease Specialist
As people who work in healthcare, you may be hearing about “superbugs.” You may wonder – what does that term mean? How do I protect myself and my patients? What’s new? This column is designed to answer those questions.

The term “superbug” has no accepted definition, but usually is meant to mean a bacterial organism which is a) resistant to many commonly used antibiotics and b) capable of causing human disease. Though calling an organism a “superbug” makes it sound menacing, it does not imply that these organisms are necessarily super dangerous or super contagious; the term really should be “super-resistant.” Tuberculosis remains by far the world’s number one infectious killer every year and flu caused the greatest and most lethal pandemic in modern history 100 years ago, but neither get the “superbug” moniker as both are old foes, unsexy and not often drug resistant (though still deadly!).

MRSA (methicillin resistant Staphylococcus aureus) and VRE (vancomycin resistant Enterococcus) are drug-resistant versions of two Gram positive bacterial species, which are common causes of human disease. Both came to prominence in the 1990s and might properly be termed the original “superbugs.” Fortunately, multiple new and effective antibiotics have been developed to combat MRSA and VRE. We isolate inpatients with MRSA and VRE to prevent spread to other patients via hands or clothing. Health care workers sometimes “pick up” MRSA at work and about 5 percent are asymptomatically colonized with it (usually in the nose), but it’s worth remembering that 35 percent of all humans are colonized with MSSA (methicillin sensitive Staphylococcus aureus), which is equally capable of causing serious disease. Attention to universal precautions - hand washing and gloves when appropriate - are essential to prevent the spread of “bad” microbes in all health care settings, and are effective tools to reduce transmission of MRSA and VRE among patients or health care workers.

The “superbugs” causing the excitement lately are highly resistant Gram negative bacteria, especially ESBL (extended spectrum beta lactamase) and CRE (carbapenem resistant) organisms. These bacteria are not spread by the respiratory route and may cause sepsis or complicated GI or urinary tract infections. Until recently, they were primarily an issue in very ill hospital patients, but we are now occasionally seeing infections in previously healthy patients from the community. These bugs are called “super” because they are resistant to many standard antibiotics and we must use our most powerful antibiotics to treat infected patients. We use contact isolation for these Gram negative, highly resistant organisms in the hospital, both to prevent spread within the health care setting and to protect the health care worker from colonization or infection. Despite the “superbug” label, transmission within the hospital is infrequent with proper precautions (universal plus contact when indicated) are followed. These “superbugs” rarely cause serious illness in health care workers, though asymptomatic colonization of the GI tract sometimes occurs.

Infectious risks to health care workers are real but manageable. Hepatitis B, and to a lesser degree, influenza, can be prevented by vaccination. Droplet and/or airborne precautions protect against influenza, other respiratory viruses and TB, which remain the primary risk to health care workers. Needle sticks from HIVinfected patients can be managed and infection prevented by a 28-day course of therapy. Hepatitis C from needle sticks can be readily diagnosed and easily treated with modern agents. Universal and specific contact isolation is quite effective to prevent hospital transmission of the Gram negative “superbugs,” which pose minimal risk to health care workers but are of potentially grave import to seriously ill patients in the health care setting.

As an aging Infectious Disease physician who sees infected patients on a daily basis, my concerns about acquiring infection from patients are limited to respiratory viruses (influenza, RSV, parainfluenza) and scabies. My only concern about seeing “superbug” patients is that I might be sloppy and inadvertently spread these drug resistant bugs to a sick patient who is unable to tolerate another problem – so I make sure to take all of the appropriate precautions to safeguard against that.

  • Some reminders to keep yourself and your patients safe:
  • Follow contact precautions
  • Wash your hands
  • Get your flu vaccine annually
  • Remind your peers to do the same (we are all on the same team)

Dr. Mark Wallace graduated from Saint Louis University School of Medicine, completed residency at the University of Washington and an Infectious Disease Fellowship at Naval Medical Center San Diego. He has special interests in HIV, tropical medicine

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Last post : 09/18/2019

Superbugs

Jan 17, 2019, 14:40 PM
By Mark Wallace, MD - Skagit Regional Health Infectious Disease Specialist
As people who work in healthcare, you may be hearing about “superbugs.” You may wonder – what does that term mean? How do I protect myself and my patients? What’s new? This column is designed to answer those questions.

The term “superbug” has no accepted definition, but usually is meant to mean a bacterial organism which is a) resistant to many commonly used antibiotics and b) capable of causing human disease. Though calling an organism a “superbug” makes it sound menacing, it does not imply that these organisms are necessarily super dangerous or super contagious; the term really should be “super-resistant.” Tuberculosis remains by far the world’s number one infectious killer every year and flu caused the greatest and most lethal pandemic in modern history 100 years ago, but neither get the “superbug” moniker as both are old foes, unsexy and not often drug resistant (though still deadly!).

MRSA (methicillin resistant Staphylococcus aureus) and VRE (vancomycin resistant Enterococcus) are drug-resistant versions of two Gram positive bacterial species, which are common causes of human disease. Both came to prominence in the 1990s and might properly be termed the original “superbugs.” Fortunately, multiple new and effective antibiotics have been developed to combat MRSA and VRE. We isolate inpatients with MRSA and VRE to prevent spread to other patients via hands or clothing. Health care workers sometimes “pick up” MRSA at work and about 5 percent are asymptomatically colonized with it (usually in the nose), but it’s worth remembering that 35 percent of all humans are colonized with MSSA (methicillin sensitive Staphylococcus aureus), which is equally capable of causing serious disease. Attention to universal precautions - hand washing and gloves when appropriate - are essential to prevent the spread of “bad” microbes in all health care settings, and are effective tools to reduce transmission of MRSA and VRE among patients or health care workers.

The “superbugs” causing the excitement lately are highly resistant Gram negative bacteria, especially ESBL (extended spectrum beta lactamase) and CRE (carbapenem resistant) organisms. These bacteria are not spread by the respiratory route and may cause sepsis or complicated GI or urinary tract infections. Until recently, they were primarily an issue in very ill hospital patients, but we are now occasionally seeing infections in previously healthy patients from the community. These bugs are called “super” because they are resistant to many standard antibiotics and we must use our most powerful antibiotics to treat infected patients. We use contact isolation for these Gram negative, highly resistant organisms in the hospital, both to prevent spread within the health care setting and to protect the health care worker from colonization or infection. Despite the “superbug” label, transmission within the hospital is infrequent with proper precautions (universal plus contact when indicated) are followed. These “superbugs” rarely cause serious illness in health care workers, though asymptomatic colonization of the GI tract sometimes occurs.

Infectious risks to health care workers are real but manageable. Hepatitis B, and to a lesser degree, influenza, can be prevented by vaccination. Droplet and/or airborne precautions protect against influenza, other respiratory viruses and TB, which remain the primary risk to health care workers. Needle sticks from HIVinfected patients can be managed and infection prevented by a 28-day course of therapy. Hepatitis C from needle sticks can be readily diagnosed and easily treated with modern agents. Universal and specific contact isolation is quite effective to prevent hospital transmission of the Gram negative “superbugs,” which pose minimal risk to health care workers but are of potentially grave import to seriously ill patients in the health care setting.

As an aging Infectious Disease physician who sees infected patients on a daily basis, my concerns about acquiring infection from patients are limited to respiratory viruses (influenza, RSV, parainfluenza) and scabies. My only concern about seeing “superbug” patients is that I might be sloppy and inadvertently spread these drug resistant bugs to a sick patient who is unable to tolerate another problem – so I make sure to take all of the appropriate precautions to safeguard against that.

  • Some reminders to keep yourself and your patients safe:
  • Follow contact precautions
  • Wash your hands
  • Get your flu vaccine annually
  • Remind your peers to do the same (we are all on the same team)

Dr. Mark Wallace graduated from Saint Louis University School of Medicine, completed residency at the University of Washington and an Infectious Disease Fellowship at Naval Medical Center San Diego. He has special interests in HIV, tropical medicine