Super Bugs / Multiresistant / Antibiotic Resistant Strains Inside Hospital?

Super Bugs / Multiresistant / Antibiotic Resistant Strains Inside Hospital?

Some new strains of bacteria have become resistant to antibiotics. Each time we take antibiotics, the sensitive bacteria are killed, but resistant bacteria may be left to grow and multiply. These resistant bacteria can also be spread to others in the family and community.The antibiotic action is an environmental pressure; those bacteria which have a mutation allowing them to survive will live on to reproduce. They will then pass this trait to their offspring, which will be a fully resistant generation.If a bacterium carries several resistance genes, it is called multiresistant or, informally, a superbug.

Taking antibiotics for colds and other viral illnesses not only won't work, but it also has a dangerous side effect: over time, this practice helps create bacteria that have become more of a challenge to kill. Frequent and inappropriate use of antibiotics selects for strains of bacteria that can resist treatment. These resistant bacteria require higher doses of medicine or stronger antibiotics to treat.

Repeated use and improper use of antibiotics are two of the main causes of the increase in resistant bacteria. People infected with resistant bacteria usually must be treated in the hospital. Doctors have even found bacteria that are resistant to some of the most powerful antibiotics available today.Antibiotic resistance is a widespread problem, and one that the U.S. Centers for Disease Control and Prevention calls "one of the world's most pressing public health problems.

As infections that patients pick up in hospitals grow increasingly resistant to antibiotics, facilities are turning to more aggressive measures, including a "search and destroy" approach borrowed from Europe.

Each year staph infections and other powerful bugs that thrive in hospitals kill 90,000 people and result in $4.5 billion in excess costs, according to the U.S. Centers for Disease Control and Prevention.

A study published earlier this month in the American Journal of Medical Quality found hospitals lost $27,000 for each patient who gets a preventable infection there. Insurers reimburse many hospital stays by the diagnosis rather than per day, and payment drops off the longer patients stay in the hospital.

"A lot of hospital administrators don't realize how expensive these infections are," said Lance Peterson, head of epidemiology at Evanston Northwestern Hospital, located outside Chicago. However, the costs have not escaped the notice of the government and private insurers that collectively fund most of the $2 trillion U.S. health-care tab.

Antibiotic resistant strains, or "super bugs," now account for about two-thirds of infections associated with health care. Vancomycin is most often used to treat the stubborn infections, but some have become resistant to the antibiotic.

Betsy McCaughey, founder of the nonprofit Committee to Reduce Infection Deaths, said most evidence showed that three steps could dramatically cut infection deaths in hospitals.

But she said most U.S. facilities were not implementing these practices - meticulous hand-washing between procedures, cleaning equipment between patient use, and identifying infected people before they enter the hospital.

"About 90 percent of patients treated in a hospital know well ahead of time they will be admitted, and can be tested in a doctor's office a week before," McCaughey said.

Antibiotic Resistance Precautions:

The consequences could potentially be serious for a hospitalized patient who becomes sick with an antibiotic resistant bacteria that he/she may not be able to fight off and that may not be treated effectively with medicine. Therefore, extra precautions are taken to prevent antibiotic resistant organisms from spreading around the hospital and to other patients. These precautions are called Antibiotic Resistance Precautions (A.R.P.) and are practiced in addition to the usual precautions we use for all patients to prevent the spread of any kind of microorganism (bacterial and germs). We will need to continue practicing antibiotic resistance precautions for your entire hospitalization until two separate sets of cultures taken at least a week apart come back negative for the antibiotic resistant bacteria. When you are discharged you do not need to practice any special precautions at home since the whole idea behind special precautions is to protect hospitalized patients. But if you are re-admitted we will again need to practice antibiotic resistance precautions when providing your care until one set of cultures comes back negative for the antibiotic resistant bacteria. When initiating antibiotic resistance precautions a green sign will be placed on your door outlining the extra precautions the staff will need to take when providing your care.


The CDC suggests that hospitals screen high-risk patients, such as those with weak immune systems, but does not recommend testing all patients for infection. That leaves hospitals to experiment with myriad approaches, resulting in a lack of consistency, experts said.

In fact, big for-profit chains like Tenet Healthcare Corp. and Triad Hospitals Inc. leave policies on handling infections up to local administrators.

Evanston Northwestern, affiliated with Northwestern University and part of a small local network, is one of a handful of U.S. hospitals to implement "universal surveillance" -- testing every patient that walks in the door for an infection. When it gets a positive result, it isolates the patient, gives him or her a powerful antibiotic, and requires all people going into the room to wear gowns and gloves.

For every patient with an untreated infection, four or five start carrying it in their nose, Northwestern's Peterson said.

The hospital's "search and destroy" approach steals a page from some European countries like the Netherlands, where hospital-acquired infections are rare.

A key component of Evanston's effort is Becton Dickinson & Co.'s new gene-based test, which gives results in a few hours, compared to a few days with an older product.

About 160 of the 5,000 U.S. hospitals use the test, up from 60 a few months ago. But some experts question whether the rapid gene-based test is more cost-effective than the older -- and much cheaper -- culture-based version that takes a few days to interpret.

Robert Weinstein, a doctor at Chicago's Cook County hospital and the recipient of a CDC grant to study the issue, said the new test needed peer-reviewed data to support widespread use.

Tenet spokesman Steven Campanini said the company did not deem the test as essential. Each test costs about $25, and the equipment needed to run it costs about $30,000. If hospitals don't want to make that capital investment, there are leasing and other payment options.

McCaughey says the test is definitely preferred for emergency patients who can't be tested ahead of time, but does not make the old test obsolete for other patients. "It is easier to use," she said. "If you don't have a rapid test, you have to isolate the patient until the test comes back."


Meanwhile, public and private insurers are employing both a carrot and a stick to push hospitals to make changes.

On a national level, the U.S. government is considering halting payments for avoidable infections to patients on Medicare, the federal health insurance program for about 43 million elderly and disabled.

Illinois, Pennsylvania and a handful of other states require reporting infection rates, and about two dozen others are considering a mandate.

States fund health care through the Medicaid insurance program for the nation's 53 million needy. In Illinois, private insurer Blue Cross Blue Shield is giving Evanston Northwestern a bonus payment of about 10 percent for avoided infections.

Many insurers are also "trying to ratchet down the payments" for the preventable infections, Peterson said. In Texas, about two dozen hospitals in the Blue Cross Blue Shield network agreed to use a software tracking system that seeks to identify the infections, made by Cardinal Health Inc.

The insurer shares the cost with each hospital, and the hospital must share the results with the insurer, said Rick Haddock, senior director of special programs of Blue Cross of Texas.

"We're trying to find a better mousetrap," he said, adding that the effort has saved $1.6 million and prevented 326 infections over several years.


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