The Rise of Superbugs: How Far Have we Come?

In 1969, U.S. Surgeon General William Stewart reported to congress that it was “time to close the book on infectious diseases”. The advent of penicillin and methicillin in the 1940‘s and 50‘s changed the face of medical history and how bacterial infections were treated. The discovery and commercialization of antibiotics saved countless lives back then, but how effective are antimicrobial agents today?

In a recent publication of a study from the journal Infection Control and Hospital Epidemiology, it was reported that one in twelve adults in Canadian institutions are either colonized or infected with a superbug. Superbugs are strains of bacteria that have become resistant to one or more antibiotics, making them difficult to eliminate and contain. There is an important difference between being colonized with a superbug and being infected by one of these pathogens. Being a host to superbugs may not result in disease if the patient’s immune system is functioning correctly, but if the patient is immunocompromised, they may be at increased risk. As an example of what can happen if one is susceptible to disease and acquires a superbug, the mortality rate for those with MRSA as well as pneumonia is between 20-40% (1).

The utilization of antibiotics has increased dramatically over the past fifty years in both humans and animals. In 1954, 2 million pounds of antibiotics were produced in the United States (2) while in 2011, 29.9 million pounds of antibiotics were consumed in the U.S.(3) The rise of antibiotic consumption is due to their powerful medicinal effects but also their effectiveness as growth promoters. In fact, around 80% of all antibiotic consumption in the United States is from the agricultural industry (4). This increased usage of antimicrobials in human and animal populations has led to the rise of drug resistant bacterial strains such as MRSA (methicillin resistant Staphylococcus Aureus), VRE (vancomycin resistant Enterococci), and Clostridium difficile (C diff).

The conventional methods of treating and mitigating the spread of superbugs are to reduce unnecessary prescription of antibiotics and to enforce high standards of infection control in hospitals. Technology can also play a significant role with the use of aPDT (antimicrobial photodynamic therapy) to eliminate pathogenic bacteria. Vancouver General Hospital implemented a year long program using the MRSAidTM nasal photodisinfection system. MRSAidTM applies photodisinfection technology to decolonize harmful bacteria in the nose prior to surgery (the nose is where most MRSA reside). This process is entirely non-antibiotic, eliminates the need for patient compliance, and does not result in increased microbial resistance. In addition to reducing surgical site infections, the program was so successful that it freed up an additional 553 patient bed days, enabled 138 additional surgeries to be performed, and saved the hospital $1.9 million in costs.

This advent of nasal photodisinfection technology means that health care practitioners now have a three-fold armamentarium available to decrease the incidence of bacterial resistance while maintaining a high standard of patient care. The judicious use of antibiotics, consistent infection control procedures (such as hand hygiene compliance), and the implementation of advanced non-antibiotic technology such as nasal photodisinfection are all important tools.

With the assistance of new technology and optimal infection control practices, we are moving one step closer to what Surgeon General William Stewart declared in 1969, and perhaps may one day close the book on infectious diseases forever.

(1) http://www.cbc.ca/m/touch/canada/story/2013/05/13/antibiotic-resistant-superbug-hospital-canada.html
(2) “The Killer Within”, Michael Shanyerson and Mark Plotkin, pg. 14
(3) http://www.cbc.ca/m/touch/canada/story/2013/05/13/antibiotic-resistant-superbug-hospital-canada.html
(4) http://www.motherjones.com/tom-philpott/2013/02/meat-industry-still-gorging-antibiotics

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