Monday Medical: The fight against resistant bacteria
For Steamboat Pilot & Today
STEAMBOAT SPRINGS — Though antibiotics have been around for almost 100 years, bacteria have been surviving for millions of years, which means they have some tricks up their sleeves.
“They’re going to do what they need to do to survive,” said Wes Hunter, director of pharmacy at UCHealth Yampa Valley Medical Center. “When there’s an agent sent to kill them, they figure out a way around that.”
In other words, they become resistant to antibiotics.
That’s where antimicrobial stewardship, or efforts to prevent and reduce antibiotic resistance, comes in. Below, Hunter outlines what patients need to know and how they can help.
How antibiotic resistance happens
Antibiotics work by either killing bacteria — by attaching to and destroying its cell wall — or by changing its genetic makeup so it can’t reproduce.
But bacteria can evolve to resist those attacks.
“They figure out a way to inactivate the antibiotic or a way to live with it,” Hunter said.
For instance, bacteria may secrete a substance that keeps the antibiotic from working, or they may change their composition so an antibiotic can no longer attach.
Those resistant strains of bacteria can then be passed from one person to another.
Why it matters
If bacteria become resistant to one antibiotic, there’s usually another stronger antibiotic that will work. But if those stronger antibiotics are used so much that bacteria become resistant to them, eventually you can end up with a “superbug” that can’t be treated.
“We’ve been playing a cat and mouse game for forever,” Hunter said. “We develop antibiotics, and bacteria develop a new way to get around them. The fear is we’re not going to have an antibiotic that’s ready for the next round of resistance.”
How does antimicrobial stewardship help?
“Antimicrobial stewardship is utilizing antibiotics and other antimicrobials in a way that’s wise for the patient and society,” Hunter said. “It means not using antibiotics when they’re not necessary and using the right antibiotic — or the safest, most limited choice that’s going to be effective.”
At Yampa Valley Medical Center, a team made up of a hospital-based physician, a pharmacist, a microbiologist and an infection preventionist has met weekly for the past 12 years to review which antibiotics were used at the hospital in the prior week, and then create a report for providers at the hospital and local medical community.
For instance, if a urinary tract infection caused by E. coli was treated with Cipro, an especially strong antibiotic, the group may recommend using Keflex, which is effective for that type of infection but has fewer side effects and less chance of resistance, the next time.
The efforts have worked. Medical professionals have seen a decrease in antibiotic resistance for various antibiotics. As of 2019, all hospitals are required to have an antimicrobial stewardship program.
How patients can help
The more patients understand the importance of proper antibiotic use, the better. For instance, a viral infection will not be helped by antibiotics, and many infections are viral.
“When you think of most of our common illnesses, such as bronchitis and upper respiratory infections, probably 97% to 99% of the time you don’t need antibiotics,” Hunter said.
Additionally, antibiotics come with risks, including possible side effects such as nausea, vomiting, diarrhea, tendon problems, nerve damage, allergic reactions and “superinfections” with bacteria, such as C. diff, which can be fatal.
Remember that best practices for using antibiotics change. While antibiotics used to be prescribed for two weeks, many are now prescribed for just three to five days.
Everyone plays a part when it comes to combating antibiotic resistance.
“People can say, ‘Look, doc, I don’t feel good, but I don’t want something that’s not going to make me better just to do something. If there’s a 99% chance this is a virus, then I don’t want an antibiotic,’” Hunter said. “That’s where we want to get to, and that begins with community education.”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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