What is a Superbug? The word "superbug", first used in the media in the mid 1970's to describe pollution-eating microbes, brings to mind something out of a comic book; some type of huge bionic destructive monster roaming the streets. Change the word huge to microscopic, and you might not be too far from a realistic definition of what a "superbug" is. In today's media, the word "superbug" is used to describe a microbe (usually some type of bacteria) that has become resistant to many of the best microbiotics on the market . These hardy little bugs have become one of the greatest threats to good health in our world today, and may, if we're not vigilant, cause a modern "plague" to rival any in history.




Why Should We Be Concerned About Antibiotic Resistance?





Some of the Most Common Superbugs.

The Infectious Diseases Society of America (IDSA) has made of list of 6 extremely dangerous superbugs which are not readily killed by antibiotics. They are Methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii, Aspergillus fungus, Vancomycin-resistant Enterococcus faecium (VRE), Pseudomonas aeruginosa, Escherichia coli, and Klebsiella spp. The following list includes those 6, as well as several other common superbugs.

• Staphylococcus Aureus (staph)

The Methicillin-resistant Staphylococcus aureus or MRSA bacteria kills nearly 19,000 Americans every year which is more than the annual number of AIDS deaths in the US.

MRSA affects about 2 million Americans and costs $20 billion a year due to its high incidence in health-care facilities. Health care facilities have a high immuno-compromised population with weakened immune systems, cancer and surgical patients, organ transplant recipients, HIV patients, elderly, malnourished, pregnant, new born and sick kids, who are least able to fight off invading pathogens. When MRSA adds a severe illness to a patient’s original medical condition, the death rate increases by 4 times, and hospital stays are extended, making other patients wait longer for their treatments. MRSA infections are increasingly appearing in places where people are in close contact such as locker rooms, military facilities, and prisons.




Impotant info on Staphylococcus Aureus
S. aureus is the leading cause of soft tissue and skin infections that result in boils (abscesses), furuncles and cellulitis. S. aureus can cause serious infections such as pneumonia, blood stream infections (bacteremia), and bone or joint infections. If it is suspected that someone has a S. aureus infection they need to contact their healthcare provider.
Some people can be colonized with this bacteria by may never get an infection. For those who become infected the duration of it can be day's to years. It is important to remember that many skin infections caused by S. aureus will heal without medical treatment, but there are cases when antibiotics will need to be used. In other cases surgical incision and drainage of the infected site may be needed.
S. aureus is most commonly spread through contaminated hands. People who are immunocompromised are very vulnerable to this infection and must be vigilant to not become infected. The skin is a very good barrier to this bacteria, but those persons who's skin has become breached due to trauma are at great risk for infection. Those persons who are newborn infants, breastfeeding women and those with chronic illnesses such as cancer, diabetes and vascular diseases are also at great risk for infection.

• Streptococcus Pyogenes

S. pyogenes is the cause of many important human diseases ranging from mild superficial skin infections to life-threatening systemic diseases. Infections typically begin in the throat or skin. Examples of mild S. pyogenes infections include pharyngitis ("strep throat") and localized skin infection ("impetigo"). Erysipelas and cellulitis are characterized by multiplication and lateral spread of S. pyogenes in deep layers of the skin. S. pyogenes invasion and multiplication in the fascia can lead to necrotizing fascitis, a potentially life-threatening condition requiring surgical treatment.

Infections due to certain strains of S. pyogenes can be associated with the release of bacterial toxins. Throat infections associated with release of certain toxins lead to scarlet fever. Other toxigenic S. pyogenes infections may lead to streptococcal toxic shock syndrome, which can be life-threatening.

In one study undertaken in New York City, 163 specimens of S. pyogens were collected between January 1, 2001 and January 1, 2002 at two academic institutions. Three different antibiotics were tested. These were erythromycin, clindamycin, and penicillin. It was found that 14% to 34% of the specimens were resistant to erythromycin; 0% to 28% of the specimens were resistant to clindamycin, and none were resistant to penicillin.

These numbers have come up from previous studies, and it is feared that resistance continues to grow.

• Streptococcus Pneumoniae

Streptococcus pneumoniae (also called pneumococcus), has been developing resistance over the last couple of decades. It has historically been a major cause of community-acquired infections, such as upper respiratory infections, bronchitis, pneumonia, otitis media, pharyngitis, and meningitis. Although the bacterium was once eradicated easily with penicillin, significant antibiotic resistance has now become a major problem in strains of pneumococcus.

Strains of S. pneumoniae have developed resistance to penicillin, macrolides, tetracyclines, and fluoroquinolones. In 2002, the CDC reported that 34% of all S. pneumoniae infections were resistant to at least one antibiotic and 17% were resistant to three or more antibiotics (CDC, 2003). Drug-resistant streptococcus pneumoniae (DRSP) or penicillin-resistant streptococcus pneumoniae (PRSP) became the newest superbug of concern in 2002.
S. pneumoniae is normally found in the nasopharynx of 5-10% of healthy adults and 20-40% of healthy children. If the normal colonization of the nasopharynx is carried to the eustachian tubes, middle ear infections can result.
Treatment of S. pneumoniae can be through the pneumococcal vaccine (pneumovax). This vaccine gives at least 85% protection for those aged 55 and younger for 5 years or longer. Immunization is suggested for those aged 65 or older and those at high risk for infection. The immunization should be a one time dose.

• Neisseria Gonorrhoeae (gonococcus)

Gonorrhea has been known since ancient times as a sexually transmitted disease though the Greek physician Claudius Galen once thought it was caused by an excess flow of semen. Gonorrhea which is a strict human infection occurs worldwide and ranks among the top five sexually transmitted diseases. Most cases of gonorrhea occur in people ages 18-24 years old who have multiple sexual partners. It has been shown that gonorrhea's prevalence has a fluctuating pattern especially during times of social upheaval when promiscuity increases. Transmission of gonorrhea increased during the 1960's sexual revolution when oral contraceptives were used rather then condoms to prevent pregnancy.
It has been found that an infectious dose of the gonococcus can range from 100-1,000 colony forming units and does not survive more than two hours on fomites. It is most infectious when it comes in contact with a mucous membrane through some type of sexual contact.
Symptoms of Neisseria gonorrhoeae in males elicit's urethritis, painful urination and a yellowish discharge from the urethra. In females a bloody discharge with painful urination occurs. Complications arise when the infection ascends to other reproductive structures such as the uterine tubes and uterus. PID (pelvic inflammatory disease) is a disease that can arise from gonorrhea. It is characterized by fever, tenderness and abdominal pain.
Treatment of uncomplicated gonorrhea includes a single dose of 500 mg of Ciprofloxacin and Ofloxacin.

• Escherichia Coli
• Report from FDA-2007

E. coli poses yet another challenge for humans. Hundreds of strains of E. coli live inside human and animal intestines. Most of them don't make people or animals sick as long as the bacteria stay where they belong. Around 1970 a bacteriophage invaded some E. coli bacteria. The phage carried genes from a Shigella bacterium with it. Shigella causes dysentery, a dangerous illness that causes bloody diarrhea.

A new strain of E. coli was spawned when the bacteriophage transferred those Shigella genes to the E. coli bacteria through transduction. The formerly harmless E. coli began to produce the same deadly toxin as Shigella. Scientists called the new strain E. coli O157:H7. The letters and numbers identify the specific strain of bacteria. At first E. coli O157:H7 lived harmlessly inside cattle's intestines. However, when cattle are slaughtered, their intestines can split open and contaminate the entire carcas with intestinal bacteria. That's not a big problem when someone cooks a steak. Most of the bacteria are on the surface of the meat and they're killed during cooking. In the case of ground beef, though, meat from hundreds of animals is mixed together in giant vats. The bacteria are spread throughout the ground beef. A hamburger patty is much more likely to carry E. coli O157:H7 than a steak. And since the bacteria are dispersed throughout the ground beef, it's not enough just to thoroughly cook the surface of the meat to kill the bacteria.

The first known outbreak of human E. coli O157:H7 occurred in 1982 after people ate undercooked burgers sold by a fast-food chain. A number of smaller outbreaks occurred in the next ten years. Then in 1993, more than seven hundred people fell ill and four young children died when they got E. coli O157:H7 from undercooked hamburgers from another fast-food restaurant. But burgers aren't the only culprit. People have contracted E. coli O157:H7 by drinking unpasteurized juices and by eating vegetables and fruits contaminated with animal waste. The bacteria have also been passed in salad bars by employees with dirty hands and by animals in petting zoos.

In 2006 E. coli O157:H7 infected 204 people in twenty-six states who ate raw spinach. Authorities suspect that the spinach was contaminated by cattle manure leaking into the fields from a nearby ranch. Half of the infected people were sick enough to be hospitalized, and three died.

The poison produced by E. coli O157:H7 is the third most deadly bacterial toxin after tetanus and botulism. It causes severe abdominal pain and bloody diarrhea. The toxin may attack and destroy the kidneys. E coli O157:H7 is the most common cause of sudden kidney failure in U.S. children. It sickens about seventy-three thousand people each year in the United States and kills about sixty of them. According to the CDC, more than one in ten cases of E. coli O157:H7 are resistant to antibiotics. Don't take a chance. Ask for your hamburger to be well done.

• Mycobacterium Tuberculosis
• "What is TB?"

Tuberculosis, also known as “consumption”, is a horrific wasting disease that is acquired by inhalation into the lungs, where it can cause disease (pulmonary tuberculosis), but can spread to other organs in the body, resulting in various presentations (meningitis, Pott's Disease, etc.). Prior to the discovery of antibiotics, tuberculosis was untreatable. However, even with the widespread use of antibiotics that began in the 1940s, multidrug-resistant tuberculosis (MDR-TB) has emerged and is a leading cause of death, particularly among HIV-infected individuals. MDR-TB is caused by strains of Mycobacterium tuberculosis that are resistant to at least the antibiotics isoniazid and rifampicin. A subset of MDR-TB, extensively drug-resistant tuberculosis (XDR-TB), is caused by rare strains that are resistant to isoniazid and rifampicin, as well as second-line (or follow-up) medications. Both MDR- and XDR-TB are rare in the U.S., but individuals with HIV are at greatest risk for getting infected.

• Salmonella Enteritidis

Salmonellosis, which can be caused by salmonella enteritidis, is the second most common bacterial foodborne illness in the United States. Fortunately, it is less deadly than E. coli O157:H7. Salmonella causes about 1.4 million cases of food poisoning in the United States each year. It kills about six hundred of those it sickens. Salmonella bacteria live in the intestinal tracts of animals and birds. People can get it by eating beef and poultry contaminated with animal feces, but it can turn up on nearly any food, including vegetables or fruit fertilized with animal manure. Salmonella is also easily passed from person to person by dirty hands.

People can get Salmonella in two other ways. Reptiles, especially lizards and turtles, often carry the bacteria. Salmonella doesn't make reptiles sick, but the animals can transmit the bacteria to people who handle them. And sometimes Salmonella infects chicken's ovaries. The bacteria contaminate eggs inside the chickens before the shells form. When a chicken lays an egg, the bacteria travel along with the yolk. People who eat raw eggs in the form of "health drinks", homemade mayonnaise, or raw cookie dough risk coming down with salmonella. Like other foodborne illnesses, salmonella used to be pretty easy to cure. In 1998 nearly all salmonella infections were treatable with antibiotics. But by 2001, more than half of all salmonella infections were resistant to antibiotics. In some instances, salmonella resists ten or more antibiotics. Scientists believe that the widespread use of two classes of antibiotics in food animals--the cephalosporins (such as Keflex) and fluoroquinolones (Levaquin and Cipro)--is the primary reason for the increase in antibiotic-resistant Salmonella.

• Campylobacter Jejuni
• FDA report

Campylobacyter is another genus of bacteria that is found in the intestines of chickens. This bacteria doesn't typically make the birds sick, but when poultry are treated for E. coli, the Campylobacter bacteria living in the birds intestines become resistant to whatever antibiotic is used for the E. coli. That is a problem for people who come into contact with chickens carrying the resistant strain of Campylobacter. Campylobacter jejuni can make people very sick. Campylobacter is the most common cause of foodborne illness in the United States. It sickens more than one million people each year and kills about 100 of them.

In 1997 a public health official named Kirk Smith noticed an outbreak of antibiotic-resistant Campylobacter infections in Minnesota. He sent food inspectors to sixteen different grocery stores in Minnesota's two largest cities, Minneapolis and Saint Paul. The food inspectors collected chicken parts and took them back to a laboratory. They found about nine out of every ten chickens were contaminated with Campylobacter. Even worse, two out of ten chickens carried a strain of Campylobacter that was resistant to the antibiotics most commonly used to treat it. People get infected with Campylobacter by eating under-cooked poultry and by touching plates, utensils, or cutting boards contaminated with raw meat or its juices. Campylobacter can also infect people working around poultry farms. Some strains resist up to five different antibiotics. The more different antibiotics that farmers give chickens to control E. coli, the more antibiotics Campylobacter will learn to resist.

• Enterococcus Faecium

The emergence of vancomycin-resistant enterococci (VRE) followed a worst-case scenario for nosocomial pathogens: the first VRE isolates that harbored the vanA transposon were identified in 1987 in Europe, and within 10 years VRE represented more than 25% of enterococci associated with bloodstream infections in hospitalized patients in the United States.
Enterococci are normal inhabitants of the gastrointestinal tract of humans and animals. Two species cause most enterococcal infections, Enterococcus faecalis and E. faecium. The relative importance of E. faecium as a pathogen has increased with the occurrence of high-level resistance to multiple antimicrobial drugs, such as ampicillin and vancomycin. The rapid increase of vancomycin resistance compromises physicians' ability to treat infections caused by many of these strains because often no other antimicrobial drugs are available. The epidemiology of VRE infection differs between Europe and the United States. In Europe, VRE are frequently isolated from farm animals, which have been associated with the abundant use of avoparcin as a growth promoter in the agricultural industry, until it was banned in 1997. The reported prevalence of VRE in hospitals has been low, but increasing rates (more than 10%) in stool and clinical samples were reported recently. In the United States, avoparcin was never approved for use in agriculture, and neither were any other glycopeptides; consequently, VRE have not been found in animals or healthy persons. However, nosocomial VRE infection and transmission have occurred much more frequently in the United States. Recent reports have documented, in hospitalized patients, horizontal transfer of the vanA gene from vancomycin-resistant E. faecalis to methicillin-resistant Staphylococcus aureus (MRSA), creating MRSA with high-level resistance to vancomycin. Nosocomial spread of VRE may therefore create a reservoir of mobile resistance genes for other, more virulent, nosocomial pathogens. Without extensive control measures, large-scale emergence of vancomycin-resistant S. aureus (VRSA) may be the next stage in the global crisis of antimicrobial resistance.

• Pseudomonas Aeruginosa

Pseudomonas aeruginosa is a common bacterium which can cause disease in humans. It is commonly found throughout the world. It thrives in many environments including those with small amounts of oxygen. It uses a wide range of organic material for food. This versatility enables the organism to infect damaged tissues or people with reduced immunity. The symptoms of such infections are generalized inflammation and sepsis. If such colonizations occur in critical body organs such as the lungs, the urinary tract, and kidneys, the results can be fatal. Because it thrives on moist surfaces, this bacterium is also found on medical equipment including catheters and is the bacteria responsible for hot-tub rash, a form of dermatitis associated with poor hygiene and insufficient care of hot tubs. It is so virulent that it can even grow in diesel and jet fuel!

P. aeruginosa typically infects the pulmonary tract, urinary tract, burns, wounds (the most common type of burn infection), and also causes other blood infections. Cystic fibrosis patients are also predisposed to P. aeruginosa infection of the lungs. In addition, it is the most common cause of infections of the external ear (otitis externa), and is the most frequent colonizer of medical devices. One in ten hospital-acquired infections is from Pseudomonas. It has been found that low phosphate levels can cause P. aeruginosa to be activated to express lethal toxins inside the intestinal tract and severely damage or kill the host. This can be reduced by providing excess phosphate instead of antibiotics. When P. aeruginosa is isolated from a sterile site, such as blood or bone, it should be taken seriously and generally requires treatment. Medical-grade honey may reduce colonization of many pathogens including Pseudomonas aeruginosa. In addition, probiotic prophylaxis may prevent colonization and delay onset of pseudomonas infection in an ICU setting.

• Clostridium Difficile
• Clostridium-Difficile Infections

C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. The C. difficile bacteria, which naturally reside in the body, become overgrown. The overgrowth is harmful because the bacterium releases toxins that can cause bloating, constipation, and diarrhea along with abdominal pain, which may become severe. Discontinuation of causative antibiotic treatment is often is enough. However, in more serious cases, oral administration of metronidazole or vancomycin is the treatment of choice and should be started as quickly as possible to avoid bowel perforation and/or sepsis. Probiotics have also proven to be effective in treatment. C. difficile is transmitted from person to person by the fecal-oral route. Because the organism forms heat-resistant spores, it can remain in the hospital or nursing home environment for long periods of time. It can be cultured from almost any surface in the hospital. Several disinfectants commonly used in hospitals may be ineffective against C. difficile spores, and may even promote spore formation. However, disinfectants containing bleach are effective in killing the organisms.

People are most often infected in hospitals or nursing homes, but C. difficile infection in the community, outpatient setting is increasing. The rate of C. difficile acquisition is estimated to be 13% in patients with hospital stays of up to 2 weeks, and 50% in those with hospital stays longer than 4 weeks. Increasing rates of community-acquired C. difficile-associated infection/disease have also been linked to the use of medication to suppress gastric acid production such as Prilosec or Prevacid increased the risk particularly in the elderly. It is presumed that increased gastric alkalinity, leads to decreased destruction of spores. The emergence of a new, highly toxic strain of C. difficile, resistant to fluoroquinolone antibiotics, such as Cipro (ciprofloxacin) and Levaquin (levofloxacin), said to be causing outbreaks in North America was first reported in 2005. The CDC has also warned of the emergence of an epidemic strain with increased virulence, antibiotic resistance, or both. Infection control measures, such as wearing gloves when caring for patients with CDAD, have been proven to be effective at prevention. In addition, washing with soap and water will eliminate the spores from contaminated hands, but alcohol-based hand rubs such as Avagard are insufficient.

• Acinetobacter Baumannii
• Acinetobacter baumannii- the hospital opportunist

Multidrug-resistant Acinetobacter (MDRAB) is not new; rather A. baumannii has always been naturally resistant to many antibiotics. Acinetobacter enters into the body through open wounds, catheters, and breathing tubes, etc. This organism is often cultured from hospitalized patients' sputum or respiratory secretions, wounds, and urine because it is water loving. Acinetobacter also commonly colonizes irrigating solutions and intravenous solutions. Signs and symptoms of infection vary depending on the organ involved. Nosocomial A. baumannii bacteremia has a mortality rate as high as seventy-five percent. Colonization poses no threat to people who aren't already ill or immunocompromised but colonized health care workers and hospital visitors can spread the bacteria from one patient room to the next. The number of nosocomial infections caused by A. baumannii is increasing. Most recently, A. baumannii has emerged as an important pathogen among wounded soldiers. The first military outbreaks of severe A. Baumannii infections occurred during 2003 in American soldiers returning from Iraq. It was determined that they were likely infected by field hospitals. MDRAB can be difficult and very expensive to treat. First line treatment is with a carbapenem antibiotic such as imipenem, but carbapenem resistance is increasingly common.

• Klebsiella Pneumoniae

Klebsiella pneumoniae is found in the normal flora of the skin, mouth, and intestines, along with soil. It can cause Klebsiella pneumonia, bronchitis, wound infections, and it ranks second only to E. coli for urinary tract infections in the elderly population. The most common risk factor for acquiring this disease is inadequate nutrition leading to a weakened immune system or an underlying disease and most of the infections are acquired while in the hospital after having an invasive treatment. New antibiotic resistant strains of K. pneumoniae are appearing, and it is increasingly found as a nosocomial infection. Signs and symptoms of infected persons generally include high fever, chills, flu-like symptoms and a productive cough producing a lot of mucous. The mucous that is coughed up is usually thick and blood tinged and has been referred to as "currant jelly" sputum due to its appearance. Klebsiella pneumonia is a severe, rapid-onset illness that often causes areas of destruction in the lung. Mortality in Klebsiella pneumonia is fairly high due to the underlying disease that tends to be present in affected persons. Sensitivity testing is done to determine what antibiotic(s) will work best.






Why are Bacteria Becoming Resistant to Antibiotic Treatments?

The following link provides an excellent history about the progress of antibiotic resistance and how we got where we are today: http://www.fda.gov/Fdac/features/795_antibio.html.

Antibiotics in our drinking water?
http://www.suite101.com/article.cfm/food_safety/49083
What Can You Do to Protect Yourself and Your Family Against Superbugs?

When you use antibiotics appropriately, you do the best for your health, your family's health, and the health of those around you. "We want Americans to keep their families and communities healthy by getting smart about the proper use of antibiotics," said Lauri Hicks, D.O., medical director of CDC's Get Smart campaign.

What To Do Talk with your healthcare provider about antibiotic resistance. When you are prescribed an antibiotic, Take it exactly as the doctor tells you. Complete the prescribed course even if you are feeling better. If treatment stops too soon, some bacteria may survive and re-infect you. This goes for children, too. Make sure your children take all medication as prescribed, even if they feel better. Throw away any leftover medication once you have completed your prescription

What Not To Do Do not take an antibiotic for a viral infection like a cold, a cough, or the flu. Do not demand antibiotics when a doctor says they are not needed. They will not help treat your infection. When you are prescribed an antibiotic, Do not skip doses. Do not save any antibiotics for the next time you get sick Do not take antibiotics prescribed for someone else. The antibiotic may not be appropriate for your illness. Taking the wrong medicine may delay correct treatment and allow bacteria to multiply.

What Can Hospitals Do?
Patients vulnerable to "superbugs" and infection include those with severe disease, especially those with affected host defenses from other medical conditions. For example, patients recently out of surgery, patients with indwelling medical devices (catheters, tracheostomy, feeding tubes). Hospitalized patients, especially ICU patients, tend to have more risk factors than non-hospitalized patients do, and have the highest infection rates. So how can we prevent or slow the disease in hospitals?

WASH YOUR HANDS!!!!! And wash them often. Handwashing and use of hand sanitizer is still the most effective way to prevent the spread of these nasty "superbugs".
Other helpful "standard precautions"

• Gloves
  
  • Wear gloves, when it can be anticipated that contact with blood or other potentially infectious materials, mucous membranes, nonintact skin, or potentially contaminated intact skin (e.g., of a patient incontinent of stool or urine) could occur. Remove gloves after contact with a patient and/or the surrounding environment (including medical equipment) using proper technique to prevent hand contamination. Do not wear the same pair of gloves for the care of more than one patient. Do not wash gloves for the purpose of reuse since this practice has been associated with transmission of pathogens
• PPE
  
  • Use PPE to protect the mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to generate splashes or sprays of blood, body fluids, secretions and excretions. Select masks, goggles, face shields, and combinations of each according to the need anticipated by the task performed.
• Gowns
  
  • Wear a gown, that is appropriate to the task, to protect skin and prevent soiling or contamination of clothing during procedures and patient-care activities when contact with blood, body fluids, secretions, or excretions is anticipated.

NOTE: It is important that you have supplies outside of the patient's room. To ensure the pathogens are contained it is important to put the supplies on prior to entering the room, and to discard them before exiting the room.
Superbugs in the News:
"Superbugs"
"Hospitals and mobile phones"
"The battle between engineered viruses and Superbugs"
"What is Nisin?"

Multimedia:
















STD Gonorrhea Superbug video