Antibiotic stewardship


At the 103rd Annual Clinical Congress of the American College of Surgeons (ACS) last week in San Diego, California, I met several surgeons from the Philippines who flew in to attend congress.  As a Fil-Am surgeon, I always enjoy and savor meeting my colleagues from my native land.  One of them happened to be an old friend, Dr. Enrique T. Ona, former Secretary of Health of the Philippines. This yearly continuing surgical education event attracts hundreds of surgeons from all over the world.

One of the hot topics at this international convention was Antibiotic Stewardship, a vital global program ACS is spearheading that could save humanity as a whole from deadly superbugs that could wipe out civilization, if not prevented or contained, an issue I have discussed in a previous column.

According to the World Health Organization (WHO), “antibiotic resistance is one of the major threats to human health, especially because some bacteria have developed resistance to all known classes of antibiotics.”

Improper use

The U.S. Center for Disease Control and Prevention (CDC) reported that “30 percent to 50 percent of prescribed antibiotics in hospitals are administered in settings where an antibiotic is unnecessary or is ineffective against the pathogenic organisms…. Increased and inappropriate antibiotic use leads to increased risks of antibiotic resistance, as well as contributing to clostridium difficile (C. difficile) infections.”

Pandemic of superbugs

While terrorism is holding peace hostage around the world today, a more rampant but under the radar killer is on the loose and becoming more widespread, wiping out lives, as the medical community helplessly battles this pandemic situation of super bugs resistant to all drugs we currently have. Being at the mercy of these powerful and defiant microorganisms is a most scary situation. And they seem to be ahead of us.

Pneumonia and wound infections killed hundred of millions of people globally before penicillin was discovered in 1928 by Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital in London. Today, these conditions and hundreds of other infections respond well to penicillin and the other more sophisticated antibiotics, savings hundreds of million of lives every century…until now, with the explosion of super bugs!

Scary statistics

At least 2 million Americans develop drug resistant infections a year and more than 23,000 of them die, 10 million deaths a year worldwide. This translates to $100 trillion sacrificed gross national products. Most of these scary infections occur in hospital settings, but they are also noted in the general community. These could be the commonly known conditions, like pneumonia or wound infection, but this time caused by drug-resistant bacteria, and hence, deadly. It is like retro-transporting us back to the early 1900, the pre-penicillin era.

Lessons from the past

While two of the most devastating outbreaks of the Black Death (plague) that wiped out more than half of the population of Europe in the 14th century killing about 75 million, leading to the final demise of the Roman Empire, was caused by two different strains of infectious agents from the black rats, one drug resistant infection today could kill much more around the globe.

Just like us, humans, bacteria are active living microorganisms, with  survival “instinct,” and when exposed to the drugs that aim to kill them, have the capacity to adapt by mutation and replication to become resistant to the drugs, When they become super bugs, they are untouchable killers, unless we develop new drugs effective against them.

Who to blame

We cannot blame the bacteria, who simply want to survive just like all living things. We, humans, healthcare providers and lay people, who abuse antibiotics, are to blame. Whether prescribed indiscriminately or purchased over the counter by self-medicating individuals, the widespread abuse of antibiotics make the bacteria mutate and grow resistance to them.

Currently, there are at least six common pathogens that are drug-resistant, Klebsiella pneumoniae, E. Coli, and MRSA, and 3 global diseases: HIV, TB and malaria. There are many others. Unless science discovers fast ways to fight and kill these resistant superbugs with new drugs or methodology and we, the people, do not abuse their use, any and all of them will continue to kill humans and other animals with impunity around the world.

Bacteria are on ALL surfaces

These microorganisms are on our skin, on our entire body. They are also all around us, in all surfaces, in our kitchen (which has more bacteria than our bathroom), all over our home, and in all public areas, like escalator hand rails, door knobs, cabinets, microwave oven door handle, countertops, tables, chairs, etc.. Paper money and coins are loaded with bacteria. If bacteria are on our skin and everywhere, why do we not always get infected? The reasons are factors like our skin integrity. If our skin is intact, the bacteria cannot invade us, except though our mucus linings (in our eyes, nose, mouth, ears, anus). This is where personal hygiene is essential. Touching our face  contaminates it with bacteria. The other factor is the type and dose (number) of bacteria. Even if we have a skin abrasion or cut, if we thoroughly wash the affected area right away, the dose of bacteria will be so reduced our immune system can handle them to prevent infection. If the dose is not reduced, then we get skin infection. This is why all wounds must be washed clean immediately after sustaining them.

Simple handwashing

On the prophylactic side, the simple habit of washing our hands religiously, at least 8 times a day (after going to the bathroom, before and after eating or working around the house or outside) can prevent contamination and infections, eliminating the need for antibiotics. This practice can also prevent viral infections, like common cold, for which some misinformed or uninformed individuals might opt to take antibiotics. Viral infections do NOT respond to antibiotics. This is just a waste of money, and worse, it will “encourage” bacteria in our body to develop antibiotic resistance. When treated longer than necessary, even bacterial infections commonly sensitive to specific antibiotics will increase the risk of the bacteria developing resistance. Skin sanitizers, preferably with skin moisturizer, in liquid, gel or foam, are helpful in minimizing infection. Those with sixty to 95 percent alcohol are most effective

Antibiotic Stewardship is also our individual responsibility as a member of society. Let’s all help prevent a super bug pandemic that could wipe us out of this wonderful world.

***

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States. Email: scalpelpen@gmail.com

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