Introduction
Envision you have taken three rounds of antibiotics for an illness, and your body still struggles to fight off the infection. Or imagine visiting the hospital for an emergency, and once discharged, you are informed of an infection with a resistant organism. How do you manage this implication to your everyday life? What comes next?
Antimicrobials are helpful agents that aim to reduce the possibility of infection and sepsis, including antibiotics, antiseptics, and anti-fungals. Since its introduction in the 1940s, antibiotics like penicillin have become vital in keeping us healthy. While antibodies are your first line of defense for fighting germs, antibiotics often aid antibodies when they can no longer fight the germs alone. How can our bodies continue to stand against their opponent when their helper is defenseless as well?
Antimicrobial Resistance
The World Health Organization (WHO) defines antimicrobial resistance (AMR) as the impact of bacteria, viruses, fungi, and parasites evolving over time and no longer responding to medicines. AMRs can lead to ineffective treatments, making infections increasingly difficult or impossible to treat. This occurrence makes conditions harder to combat and may increase the risk of disease spread, severe illness, and sometimes death.
Killing at least 1.27 million people (about the population of New Hampshire) worldwide, antimicrobial-resistant organisms (AMROs) are a critical public health threat, as they were associated with approximately five million deaths in 2019. In the U.S., more than 2.8 million AMR infections occur yearly. Antibiotics and anti-fungals are becoming ineffective in treating uncomplicated conditions, such as urinary tract infections (UTIs). This can become an issue at any stage or age of life.
AMROs can be found in many sources, such as people, animals, food, plants, and even the environment. While a plethora of factors contribute to the exposure and transmission of AMROs, they can often go undetected, specifically in healthcare facilities.
Have you ever imagined what germs could be on a hospital bed; wondered whom your doctor administered care to before you; or thought about how often environmental services thoroughly disinfected your local healthcare facilities?
The Centers for Disease Control and Prevention (CDC) reported that on any given day, about 1 in 31 hospital patients has at least one healthcare-associated infection. Healthcare facilities have a high transmission rate causing the infection to transfer from person to person. Once the patient’s body begins to resist treatment, like antibiotics, they become multi-drug resistant.
Multi-drug Resistant Organisms (MDROs)
Bacteria are considered a multi-drug resistant organisms (MDROs) once they becomes resistant to more than one antibiotic. When an organism becomes resistant to antibiotics, they are considered less effective in killing bacteria. To better understand MDROs and their importance in healthcare, here’s a short clip from The Hartmann Science Center entailing their risk in better detail.
Gonococcal Resistant Infections
Gonorrhea, a sexually transmitted disease (STD) caused by the Neisseria gonorrhoeae bacterium (N. gonorrhoeae), is the second-highest reported bacterial STD in the United States. Responsible for an estimated 1.6 million new gonococcal infections in the United States in 2018, gonorrhea is quite common, as it infects the mucous membranes of the reproductive tract in both women and men. In fact, its common occurrence has allowed it to become skilled at outsmarting antibiotics by developing resistance to all the antibiotics used for its treatment.
While antibiotics play an integral role in the treatment and prevention of bacterial infections, it is imperative to highlight AMR which often results in higher drug dosages, an increase in expense for certain medications and the usage of toxic alternatives when deemed necessary.
While numerous medications are marketed to treat its signs and symptoms, studies have shown that over time certain gonococcal infections may go untreated due to its growing resistance to its targeted medications. As we continue to advocate for healthier communities, we must bring awareness to AMRs as well as advocate for an increase in surveillance, education, and testing for all diseases to stop the spread of such conditions to others.
Prevention and Control Measures
Prevention of AMRs in Healthcare Facilities
Prevention of transmission in healthcare facilities can create another line of defense from AMR exposure. Healthcare professionals must follow proper protocols and procedures to ensure appropriate safety measures are always in place. Below are recommendations, by the CDC, healthcare professionals can implement to prevent and control the spread of antibiotic-resistant organisms:
Administrative Support – Required in implementing changes within a healthcare facility.
Education – Enhances adherence to behavior changes through improved understanding and creating a culture that supports and promotes behavior change.
Judicious Use of Antimicrobial Agents – Focuses on effective antimicrobial treatment of infections.
MDRO Surveillance – Allows the detection of newly emerging pathogens, monitoring epidemiologic trends, and measuring the effectiveness of interventions.
Infection Control Precautions – Use standard and contact precautions protocols for MDROs.
Environmental Measures – The facility can adopt interventions that include using dedicated noncritical medical equipment, assigning dedicated cleaning personnel, and increasing cleaning and disinfection of high-touch areas.
Decolonization – Treatment of persons colonized with a specific MDR to eradicate carriage of that organism.
Prevention of Antibiotic Resistance
Microbes are constantly learning to modify themselves and adapt to their environment, making them impossible to eliminate. Below are steps powered by WHO that may aid in an individual lowering their risk of developing resistance to an antibiotic:
Wash your hands regularly.
Only take antibiotics when you need them.
Take antibiotics prescribed for you. Do not take someone else's medicine.
Even if you feel better, take all the medicine as the provider prescribes. If you stop an antibiotic too soon, bacteria can start to grow again, and they may develop resistance.
Never share or use leftover antibiotics.
Conclusion
"If we do not act now, our medicine cabinets will be empty, and we will not have the antibiotics we need to save lives." -CDC Director Tom Frieden
We must understand the importance that AMR and MDROs play in the future of public health. These issues may not only alter the advancement of public health, but they can also threaten to reverse the miracle of medicine on society.