Many proclaim that the discovery of penicillin was perhaps the most important medical discovery of all times. With the use of penicillin, patients survived previous deadly infections and life expectancy rose. Many of the complications that arose from infections, such as rheumatic heart disease, became nearly eradicated. Following that, many more new and more powerful antibiotics were discovered. However, this implementation and innovation stopped in the last decade.
We all saw the news from UCLA’s Ronald Reagan Medical Center that many people have been exposed to CRE ( carbapenem-resistant Enterobacteriaceae). Two of those exposed died from the infection and 179 others have possibly been exposed. Five others contracted this deadly infection. This outbreak reflects the rising incidence we observed in superbug infections over the past several years. This outbreak originated from certain endoscopes used by doctors doing certain procedures. MRSA (Methicillin-resistance stap. aureus) perhaps, sounds a bell with everyone. The battle against MRSA rages over the past decade. Treatment often requires 2 or 3 antibiotics. But we can expect to see new superbugs. MRSA and CRE represent just the tip of the infectious disease iceberg.
Why are superbug infections on the rise?
1. The prescription of antibiotics occurs many times when they are not needed. This gives rise to organisms developing resistance to antibiotics. Antibiotic resistance is rising around the world. Diseases that were easily treated years ago now require more to treat them. This occurs for many reasons. Many parents pressure doctors for unnecessary antibiotics. And many doctors prescribe antibiotics when there are no clear indications to do so. Both sides bear some responsibility in this. Doctors need to do a better job educating patients about proper antibiotic use. And then they need to stand by it. Unless we tackle the problem of antibiotic over-prescription and resistance, we are facing a huge crisis.
2. Pharmaceutical companies failed to develop any new antibiotics or antibiotic classes in recent years. The antibiotics we now possess lost much of their efficacy. We need new tools to battle these super-infections. The reason for this seem unclear but perhaps it is tied into pharmaceutical company profits. There needs to be much more research into developing new ways to treat infections.
3. The life expectancy is higher than it ever has been. This means that people live with more chronic and complex diseases. Many of these diseases require hospital stays. Hospitals contribute the most to the development of superbugs.
4. In the same vein, patients take many more immunosuppressant medications. Their risk of succumbing to infections exceeds healthy patients already. They are at much more risk for being infected with these superinfections.
5. More technological tools are being employed in medical care these days. In the current CRE outbreak, certain endoscopes hosted the superbugs. As we implement more and more tools, breakdowns in sterilization protocols seep in. We need to be ever more diligent in the procedures we follow to maintain a sterile environment. We cannot follow manufacturer guidelines blindly. We need to develop protocols to ensure the highest level of sterility.
The times require a re-evaluation of our anti-microbial tools we own, from antibiotics to sterilization products to genetic and nanotechnology treatments. Superbugs flourish and we require more powerful tools to win this battle. Unless we step up our attack, we risk slipping back into early 20th century infectious disease states.
Dr. Linda Girgis MD, FAAFP is a family physician in South River, New Jersey. She has been in private practice since 2001. She holds board certification from the American Board of Family Medicine and is affiliated with St. Peter's University Hospital and Raritan Bay Hospital. She teaches medical students and residents from Drexel University and other institutions. Dr. Girgis earned her medical degree from St. George's University School of Medicine. She completed her internship and residency at Sacred Heart Hospital, through Temple University where she was recognized as intern of the year. She is a blogger for Physician's Weekly and MedicalPractice Insider as well as a guest columnist for HIT Outcomes. She has had articles published in several other media outlets. She is on the medical advisory board of SERMO. Recently, she has authored the book, “Inside Our Broken Healthcare System” and "The War on Doctors". She has been interviewed in US News and on NBC Nightly News.
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