The discovery of penicillin in 1928 marked the beginning of the antibiotic era and dramatic improvements in health and medicine. With mass production of the new ‘wonder drug’ in the 1940s, threats from previously lethal diseases like bacterial infections and pneumonia waned. However, less than 100 years later, the Centers for Disease Control and Prevention (CDC) is sounding alarms about the increasing threat of antibiotic resistance.
The United States is edging closer to the cliff of a post-antibiotic era in which medications lose their effectiveness, the CDC cautioned in a September report, detailing the burden and threat posed by antibiotic-resistant bacteria.
Every year, more than 2 million people in the U.S. contract antibiotic-resistant infections, and at least 23,000 people die as a result. Estimates vary, but data suggest that the direct health care costs of antibiotic resistance may top $20 billion annually.
The path from remedy to resistance is rapid. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” says Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance.
The emergence of antibiotic resistance
In common infections, most bacteria are susceptible to antibiotics. But a few bacteria are resistant. When an antibiotic is administered, it attacks the susceptible bacteria as well as the healthy bacteria that protect the body from infection. The resistant bacteria gain strength and transfer resistance to other bacteria, which then spread from person to person by the patient or via unwashed hands, propagating antibiotic resistance.
The chain is a natural evolutionary process that can be contained but not eliminated. Given the creative capacity of bacteria, slowing the spread of antibiotic resistance and preserving the effectiveness of antibiotic medications requires a concerted, multi-pronged strategy, says Thomas J. Sandora, MD, MPH, medical director of Infection Prevention and Control at Boston Children’s Hospital.
The prescription for control
The CDC offered a four-part strategy to stem the tide of antibiotic resistance:
- Prevention: Fewer infections reduce the need for antibiotics. Immunizations, infection prevention in hospital settings, safe food preparation and hand washing will reduce the spread of infection and contain resistant bacteria.
- Tracking: Monitoring antibiotic-resistant infections, their causes and risk factors enables the development of strategies to prevent and contain the spread of resistant bacteria.
- Stewardship: Appropriate selection of antibiotics and reducing unnecessary use can halt the propagation of resistant bacteria.
- Drug development and diagnostic testing: New antibiotics are needed to target resistant bacteria, and new tests are needed to better track resistance.
Antibiotic resistance, according to the CDC, is not a “somewhere else” problem. It’s everywhere. And an all-hands-on-deck strategy is required to address the problem. “We all have a role to play in halting the spread of antibiotic resistance,” adds Sandora.
Boston Children’s Infection Prevention and Control Program focuses on two primary strategies to curb transmission of antibiotic-resistant bacteria. The first is hand hygiene. “The gold standard is good old-fashioned observation and recording to see whether or not staff are washing their hands,” he says.
Education coupled with monthly reviews of hand hygiene compliance data with frontline staff have enabled Boston Children’s hand hygiene compliance to top the 90 percent mark every month, reports Sandora. A recent study published in American Journal of Medical Quality suggests hand hygiene compliance at all U.S. hospitals hovers near the 50 percent mark.
Infection prevention also requires staff treating or interacting with patients colonized (or infected) with antibiotic-resistant bacteria to take appropriate precautions, donning gloves and gowns to prevent contamination of hands and clothing.
In addition to preventing the spread of antibiotic resistance, Boston Children’s practices antimicrobial stewardship to help preserve existing antibiotics. Pharmacists monitor use of broad-spectrum antibiotics, which are effective against a wide range of gram-positive and gram-negative bacteria but need to be used sparingly to preserve their effectiveness.
Take, for example, a child admitted to the intensive care unit, who appears to have a bacterial infection. The physician often initiates prompt treatment with a broad-spectrum antibiotic. A pharmacist continues to review the patient’s chart to determine which bacteria are growing in culture and can then recommend a narrower spectrum antibiotic when the bacteria is identified or discontinuation of the antibiotic, if bacteria are not the culprit. “This limits the duration of broad-spectrum antibiotic use and helps us save them for when they are truly needed,” explains Sandora.