We All Should Be Concerned with Antimicrobial Stewardship

We keep reading and hearing that sepsis needs to be treated quickly to save limbs and lives. We also know that the usual treatment includes fluids and antibiotics. But with the rising number of antibiotic-resistant infections, this push for antibiotics in sepsis seems to run counter to trying to reduce antibiotic use and antimicrobial stewardship. What is antimicrobial stewardship (AMS)? It’s a concerted effort, coordinated programs, that work to reduce the threat and spread of antimicrobial, including antibiotic, resistance. The two sides can work together though. What it boils down to is we need to:

1. Prevent infections to the best of our ability
2. Seek help early when infections do strike
3. Reserve antibiotics for infections that need them
4. Use antibiotics appropriately by following prescription instructions

Antimicrobials Fight Germs

Bacteria, viruses, fungi, and parasites are all microorganisms that can cause infections. Antimicrobials are products, including medications, that kill any of these microorganisms. These microorganisms are living things and just as animals and humans evolve over time, microorganisms do as well. They change and adapt according to their living conditions, but also in response to the products humans use to try to kill them or stop them from reproducing and spreading.

Not all antibiotics kill all bacteria, which is why certain bacterial infections are treated with one type of antibiotic, while others will need different antibiotics. This is normal. But as the microorganisms mutate to resist human intervention, some become multidrug resistant (MRI). This means two or more of the standard antibiotics do not work. As more of these so-called superbugs emerge, researchers have to look for better or stronger methods to regain control when infections occur. They fear that it won’t be long before we find bacteria that don’t respond to any type of antibiotic we have available to us.

The best way to avoid overuse of antimicrobials, antibiotic resistance or multi-drug resistance, is to not have an infection in the first place. It may seem simple enough, but infection prevention is a problem. There are people who balk at the thought of vaccinations. Others don’t pay close attention to infection prevention techniques, like thorough and frequent hand washing. This allows infections to continue spreading throughout communities across the country. And this is particularly timely in the COVID era, when medical experts urge people to step up safety precautions to prevent the spread of the virus. Yet, many people choose to ignore the pleas for wearing masks and social distancing. As well, on social media and in news reports, many have said that they will not get any COVID-19 vaccine researchers are racing to develop.

2019 Threat Report Addresses Antimicrobial Resistance

The Centers for Disease Control and Prevention issued its first Antibiotic Resistance Threat Report in 2013. At that point, the CDC sounded an alarm, warning about the dangers of antibiotic resistance, and how at least 2 million people in the U.S. would contract an antibiotic-resistant infection – and of these, 23,000 would die.

The 2019 AR Threat Report builds on the earlier findings and continues to share sobering information regarding antimicrobial resistance (AMR) and its effect on Americans. There are now almost 3 million cases of antibiotic-resistant infections in the U.S. every year, with 35,000 deaths. There is some good news though. Although the actual number of deaths increased, percentage wise, they dropped. So not as many people who did contract an antibiotic-resistant infection died.

Here are some of the key findings of the report:

The following types of infections dropped since 2013:

• Vancomycin-resistant Enterococcus (down 41%)
• Multidrug-resistant Pseudomonas aeruginosa (down 29%)
• Methicillin-resistant Staphylococcus aureus, or MRSA (down 21%)
• Carbapenem-resistant Acinetobacter (down 39%)
• Drug-resistant Candida (down 25%)

But others increased significantly:

• Erythromycin-resistant invasive group A strep (up 315%)
• Drug-resistant Neisseria gonorrhoeae (up 124%)
• ESBL-producing Enterobacteriaceae (up 50%)

Healthcare Facilities and Communities Must Work Together

Healthcare-acquired infections (HAIs) played a role in the increase of antibiotic-resistant bacteria. MRSA, for example, could spread easily throughout a hospital unit, as could C. Difficile. So as healthcare facilities began taking strong action to reduce infection spread, the results were positive. Infection rates were going down.

Infection prevention strategies included:

• Re-evaluating the use of invasive devices, like urinary catheters, and how long they stayed in place
• Stronger protocols to reduce the risk of infection in other devices, like central lines
• Detecting infections early and treating them aggressively
• Tracking the use of antibiotics and improving appropriate use
• Ensuring infection prevention protocols in long-term care and skilled nursing facilities

In the community, strategies included:

• Encouraging vaccination campaigns
• Screening for infectious diseases like tuberculosis and gonorrhea in high-risk groups
• Encouraging safe food handling
• Educating the public about appropriate antibiotic use

A World Without Antibiotics?

It’s a frightening prospect – a world without antibiotics. We had one before, when seemingly minor infections triggered sepsis and killed adults and children alike. When the first antibiotics were used in the early 1900s, they were miracle drugs. They saved lives. But Sir Alexander Fleming, who discovered penicillin, warned back then that overuse or misuse could result in the bacteria developing resistance. It took just a couple of decades for the first bacteria to prove his concerns true. Now, in 2020, the situation is worsening.

Each one of us can play a role in slowing this down:

• Don’t push for an antibiotic if your illness isn’t caused by a bacteria. Antibiotics do not treat colds, the flu, or any virus.
• Only take antibiotic prescriptions given to you, not anyone else’s – even if you’re sure that you have the same infection.
• Don’t stop your antibiotic prescription because you started feeling better. Complete the course. This ensures the bacteria are truly gone.
• Practicing infection prevention, by thorough and frequent hand washing, avoiding people who have infections, and getting recommended vaccinations.

Robert R. Redfield, MD, the director of the CDC wrote in the 2019 threat report, “You and I are living in a time when some miracle drugs no longer perform miracles and families are being ripped apart by a microscopic enemy. The time for action is now and we can be part of the solution.”

 

Concern of antibiotic overuse and antimicrobial resistance should not keep you from taking antibiotics if you do need them. If you suspect you have an infection, seek medical attention as soon as possible. If you show any signs of sepsis, this is a medical emergency. Call 9-1-1 or go to the closest emergency room. Tell the staff you are concerned about sepsis.

 

Learn more about sepsis and how it is related to many conditions, visit the Sepsis and… library.