Antibiotic-resistant has prevailed from lack of prophylaxis in hospitals

By Avishek Majumder & Abhinash on February 19, 2019

Recent researches found that certain strains of bacteria have grown the ability to resist antibiotics (Khan, Beattie and Knapp, 2016). Antibiotics are mainly used in hospitals to reduce the chances of infections amongst the patients. Recent reports also indicated outbreaks of superbugs related diseases, infections, and even deaths especially in the hospitals (Podolsky, 2018). However, challenges remain with respect to the management of infections from antibiotic-resistant bacteria.

Dangers of antibiotic-resistant bacteria

According to a report by CDC, (2013) approx 2 million Americans face cases of antibiotic-resistant bacterial infections. Furthermore, the report also implied that antibiotic-resistant infections can cause a level of global economic damage by 2050 if the use of antibiotics is not controlled. India, China, and the United States are the highest users of antibiotics globally. According to a report by the Department of Biotechnology, Government of India in 2017 indicated that antibiotic resistance was seen in A. baumannii (70%), K. pneumoniae (56.6%), P. aeruginosa (41.8%) and E. coli (16.2%) obtained from various samples of urine, stool, and blood (Department of Biotechnology, 2017).

Antibiotic-resistant bacteria have been reported to cause infections of the urinary tract, pneumonia, and skin infections to people admitted in hospitals and post-operative patients (Andersson and Hughes, 2017). Furthermore, in one of the recent cases of E. coli strain NDM 1 caused the death of a patient post-operation. New resistance mechanisms are emerging and spreading globally, threatening the ability to treat common infectious diseases (WHO, 2018). A growing list of infections due to antibiotic-resistant bacteria such as;

  • pneumonia,
  • tuberculosis,
  • blood poisoning,
  • gonorrhoea,
  • and foodborne diseases.

Different types of identified antibiotic-resistant bacteria

According to Agrawal et al., (2017) meticillin-resistant staphylococcus aureus (MRSA) is the most active and popular antibiotic resistance microorganism and is continuously replicating and mutating. Almagor et al., (2018) identified E. faecium CC17, E. coli ST131 and K. pneumoniae clonal group 258 as antibiotic-resistant bacteria (ARB) that mutates on the overuse of antibiotics in hospitals. Yao et al., (2016) identified E. coli strains with genes NDM-1, NDM-9 and MCR-1 highly resistant to antibiotics like Ampicillin, Cefotaxime, Cefoxitin, Apramycin, Neomycin, Streptomycin, and Ciprofloxacin. Khan & Khan, (2016) identified different strains of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacteriaceae as the most common antibiotic-resistant bacteria.

Type of antibioticsList of antibiotic-resistant bacteriaReference
Ciprofloxacin,
Ampicillin,
Cefotaxime,
Ceftazidime,
Tigecycline,
Cefquinome,
Florfenicol,
Cefoxitin,
Imipenem,
Meropenem,
Co-trimoxazole,
Colistin,
Fosfomycin,
Amikacin,
Gentamicin,
Apramycin,
Neomycin,
Streptomycin,
Doxycycline,
Tetracycline		Streptococcus pyogene,
E.coli,
Acinetobacter baumannii,
Mycobacterium tuberculosis,
Neisseria gonorrhoea,
Klebsiella pneumoniae,
Clostridium difficile,
Pseudomonas aeruginosa,
Burkholderia cepacia,
Staphylococcus aureus,
Salmonella,
Shigella,
Vibrio cholerae
(Yao et al., 2016;
Kumar et al., 2013)

The need of the hour

According to WHO, (2018), to prevent and control the spread of antibiotic resistance, has laid some points for policy makers, health professionals, health industry, and agriculture sector.

  • Ensure a robust national action plan to tackle antibiotic resistance is in place.
  • Improve surveillance of antibiotic-resistant infections.
  • Strengthen policies, programmes, and implementation of infection prevention and control measures.
  • Regulate and promote the appropriate use and disposal of quality medicines.
  • Make information available on the impact of antibiotic resistance.
  • Prevent infections by ensuring your hands, instruments, and environment are clean.
  • Prescribe and dispense antibiotics when they are needed, according to current guidelines.
  • Report antibiotic-resistant infections to surveillance teams.
  • Talk to patients about how to take antibiotics correctly, antibiotic resistance and the dangers of misuse.
  • Talk to patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing).
  • Not use antibiotics for growth promotion or to prevent diseases in healthy animals.
  • Vaccinate animals to reduce the need for antibiotics and use alternatives to antibiotics when available.
  • Promote and apply good practices at all steps of production and processing of foods from animal and plant sources.

Inability to control infections from antibiotiotic-resistant bacteria

There is a lack of incompetent response systems to the growing cases of antibiotic-resistant superbugs. Therefore, lack of appropriate knowledge and epidemiological resource leads to lack of efficient prophylaxis for control and management of antibiotic-resistant superbugs in hospitals. Lack of epidemiological studies also hampers the assessment of the efficacy of control and management strategies by the policymakers as well as the hospital administration. In addition, gaps include research of studies on the prevalence of antibiotic-resistant superbugs cases in hospitals globally. Lack of different antibiotic-resistant prophylaxis in the hospitals globally or availability of global policies. Therefore, it is important to further investigate the effectiveness of different antibiotic-resistant prophylaxis against the prevalence of mortality and infections in hospitals.

Apart from prophylaxis, Kumar et al., (2013) identified the most common challenges or factors causing an inability to control infections from antibiotic-resistant bacteria;

  • Strengthening of Surveillance Data.
  • Standard Operating Guidelines.
  • Improvement in antibiotic prescription practices.
  • Over the counter sale of antibiotics.
  • Poor sanitation, endemic infections, and malnutrition.
  • Limited public awareness and government commitment.
  • Lack of coordination and fragmentation of effort.
  • Perverse incentives.

References

  • Agrawal, A. et al. (2017) ‘A review on Superbugs different stains & their susceptibility.’, International Journal of Pharmacy & Life Sciences, 8(5), pp. 51 – 51. Available at: http://proxygw.wrlc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=124964302&site=ehost-live.
  • Almagor, J. et al. (2018) ‘The impact of antibiotic use on transmission of resistant bacteria in hospitals: Insights from an agent-based model’, PLoS ONE, 13(5). doi: 10.1371/journal.pone.0197111.
  • Andersson, D. I. and Hughes, D. (2017) ‘Selection and Transmission of Antibiotic-Resistant Bacteria’, Microbiology Spectrum, 5(4). doi: 10.1128/microbiolspec.MTBP-0013-2016.
  • CDC. (2013). Antibiotic Resistance Threats in the United States. Available online: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf.
  • Department of Biotechnology. (2017). Scoping Report on Antimicrobial Resistance in India. Available online: http://www.dbtindia.nic.in/wp-content/uploads/ScopingreportonAntimicrobialresistanceinIndia.pdf.
  • Khan, S., Beattie, T. K. and Knapp, C. W. (2016) ‘Relationship between antibiotic- and disinfectant-resistance profiles in bacteria harvested from tap water’, Chemosphere, 152, pp. 132–141. doi: 10.1016/j.chemosphere.2016.02.086.
  • Khan, S. N., & Khan, A. U. (2016). Breaking the spell: combating multidrug resistant ‘superbugs’. Frontiers in microbiology, 7, 174.
  • Kumar, S. G., Adithan, C., Harish, B. N., Sujatha, S., Roy, G., & Malini, A. (2013). Antimicrobial resistance in India: A review. Journal of natural science, biology, and medicine, 4(2), 286.
  • Podolsky, S. H. (2018) ‘The evolving response to antibiotic resistance (1945–2018)’, Palgrave Communications, 4(1), p. 124. doi: 10.1057/s41599-018-0181-x.
  • WHO. (2018). Antibiotic resistance. Available online: https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance.
  • Yao, X., Doi, Y., Zeng, L., Lv, L., & Liu, J. H. (2016). Carbapenem-resistant and colistin-resistant Escherichia coli co-producing NDM-9 and MCR-1. The Lancet infectious diseases, 16(3), 288-289.

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