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Prevention is key to keeping new ‘superbugs’ at bay

September 05, 2010

Yale Medical Group doctors are joining colleagues in medical centers across the country in taking steps to protect patients from so-called “superbugs”—infections caused by bacteria that resist modern antibiotics.

The latest superbugs have surfaced in hospitals in more than 35 states, according to recent reports. They usually strike in healthcare settings, often hit patients who are critically ill, and are fatal in 30 to 60 percent of cases.

“These new superbugs are a different class of bacteria, and the number of antibiotics we have to treat them is very limited,” says Yale Medical Group infectious diseases specialist Thomas Scot Murray, MD, PhD.

Treatment is limited

Similar to any infection, superbugs can surface in any number of ways—as respiratory infections, skin boils, urinary tract infections or wounds. What differentiates them is their resistance to the antibiotics that could treat them.

Most people are more familiar with methicillin-resistant Staphylococcus aureus (MRSA) which has received widespread publicity since community-acquired cases first surfaced 15 years ago. Since then, pharmaceutical companies have produced new antibiotics that target MRSA, however, resistance continues to be a problem in this organism and in other bacteria.

A more recent problem is the bacteria Klebsiella pneumoniae that carries carbapenamase (KPC), an enzyme produced by the offending bacteria that disables carbapenam antibiotics, which are used to treat infections that don’t respond to other drugs. Carbapenam-resistant germs are diagnosed mostly in hospital patients at this time.

Murray is studying ways to identify KPC resistance patterns, while Yale Medical Group infectious diseases specialist Louise-Marie Dembry, MD, MS, MBA, is figuring out how to determine which patients should be tested for it. “People think there is a magic test for all of these things and there is not,” she says. The Centers for Disease Control and Prevention advises doctors to perform hand hygiene, and wear gowns and gloves around patients diagnosed with carbapenam-resistant germs.

Focus on washing hands

Meanwhile, the two most important preventive measures are hand washing and judicious use of antibiotics. “I hope we can provide some reassurance for patients who come to Yale-New Haven Hospital (YNHH) that we take antibiotic-resistant bacteria seriously, and we have an ongoing and active infection prevention program,” says Murray. “By far and away, the most important thing you can do to prevent any infection is to promote hand washing. We wash hands any time we’re around anyone who is sick, before we go into any patient’s room and after we come out.”

Initiatives at YNHH have driven hand washing compliance among healthcare workers to close to 90 percent before patient contact, and near 95 percent after contact, well above national averages, says Dembry.

Dembry would like to see similar precautions taken outside of hospitals. “This isn’t just about hospitals. This is happening in all of health care, and that includes doctors’ offices. Germs don’t know where they are,” she says.

In addition, doctors treating patients either in the hospital or in the community should prescribe antibiotics judiciously, since overuse of antibiotics has contributed to antibiotic resistance. At YNHH, a pediatric infectious diseases specialist must approve the prescription of certain antibiotics before they are given to young patients, and an infectious diseases doctor monitors use of antibiotics throughout the hospital with the pharmacy department, Murray says.

Take steps to stay safe

Meanwhile, everyone should learn to take precautions, and that begins with paying more attention to personal hand washing routines. “Think about where your hands have been before you touch your eyes, your nose or your mouth, or any open skin or cut,” Dembry says. “The world is not sterile, it’s not meant to be sterile, but the way we interact with our environment is through our hands. If you pet the dog before you leave the house, then stop at the gas station on your way to work and pump gas, then pick up coffee and a muffin, you should wash your hands before you eat the muffin.”

Other tips for preventing infection include:

  • When you wash your hands, do it thoroughly with soap and water, or use an alcohol-based sanitizer.
  • Stay home if you’re sick.
  • Avoid unnecessary use of antibiotics. Only take them if your doctor has diagnosed a bacterial infection that requires an antibiotic.
  • Take all antibiotics as they are prescribed, even if your symptoms subside.
  • Talk to your doctor if you have been prescribed an antibiotic and are concerned about taking it.
  • If you are hospitalized, make sure you understand the infection prevention protocols, and speak up if you see a health care worker not following them.
Submitted by Mark Santore on January 16, 2014