The Rise of the Superbug

The Rise of the Superbug

It’s a chilling plot that we’ve read in sci-fi novels or watched on the big screen numerous times now: a pathogenic plague spreads quickly around the globe, wiping out most of the population or possibly even creating a race of zombies. These storylines, which feature anarchy, dystopia, and the classic battle between good and evil, seem to fascinate modern-day audiences.

It was the media and entertainment industries that created the word “superbug,” when scientists and epidemiologists were still using phrases like “multiple-drug resistant bacteria.” Yet the term superbug has turned out to be so catchy and memorable that it has entered our professional healthcare vocabulary as well, and we understand it to generally mean a bacteria that has developed resistance to antibiotics—or even to a virus like HIV or some strains of flu that mutate to resist available medical treatments or vaccines. The CDC has even used the pop-culture meme of a zombie pathogen in a clever blog post meant to educate the public about emergency-preparedness. Here’s an excerpt:

If zombies did start roaming the streets, CDC would conduct an investigation much like any other disease outbreak. CDC would provide technical assistance to cities, states, or international partners dealing with a zombie infestation. This assistance might include consultation, lab testing and analysis, patient management and care, tracking of contacts, and infection control (including isolation and quarantine)… Not only would scientists be working to identify the cause and cure of the zombie outbreak, but CDC and other federal agencies would send medical teams and first responders to help those in affected areas.

As nurses, we’re used to hearing about specific, headline-making superbugs like MRSA. Yet the scary truth is that any bacteria can turn into a superbug. The evolutionary idea of “survival of the fittest” comes into play as soon as a microbe is exposed to an antibiotic. Although the drug is likely to kill off millions of harmful bacteria, there will inevitably be a few stragglers left behind. Some of these stragglers will have an inherent advantage—the genetic equivalent of a bullet-proof vest—in surviving the antibiotic attack, and they will pass this advantage on to their offspring as they multiply. Repeat this cycle enough times and we have a strain of bacteria that has evolved to withstand the drug most commonly used against it.

One of our best strategies in preventing new strains of resistant bacteria is the antibiotic stewardship program (ASP), defined as the targeted effort to optimize the use of antibiotics, in order to ensure good outcomes, while causing minimal harm to patients and public health. This optimization can include:

  • Ensuring an antibiotic is needed through culture and sensitivity testing
  • Prescribing narrow spectrum antibiotics whenever possible
  • Administering antibiotics orally rather than intravenously whenever possible
  • Using the shortest course and lowest dose of antibiotics feasible
  • Avoiding certain antibiotics in hospital settings, such as those that contribute to the spread of Clostridium difficile

In the past, antibiotic stewardship programs have mainly been the domain of physicians and pharmacists—and, more recently, infection preventionists. Now, a conversation has begun about involving nurses in hospital ASPs. Researchers have estimated that anywhere from 25 to 68 percent of antibiotic use in hospitals is inappropriate. Clearly someone needs to be standing watch against the next wave of superbugs. And nurses are the frontline caregivers, having the most constant presence at the bedside and playing a key role in patient safety. Participating in interdisciplinary ASPs will increase nursing’s visibility and respect within the organization and provide nurses with another avenue to become more effective patient advocates. It will position nurses as key contributors to the collaborative care team.

There are challenges, however. Nurses currently don’t have the formal training needed to contribute to antibiotic stewardship programs, including many of those trained as infection preventionists. We’ll have to close this knowledge gap through education. It’s clear that increasing nurses’ knowledge of antibiotic use and involving them in the decision making process—perhaps by including them in rounds—is likely to have a positive impact on ASP effectiveness. Even though nurses don’t prescribe, they can support or influence the decisions of other providers. For instance, in a report called the “Core Elements of Hospital Antibiotic Stewardship Programs,” the CDC suggests that nurses can ensure cultures are performed before starting antibiotics, monitor adherence to recommended guidelines, and question instances of suboptimal antibiotic therapy.

Are you ready to wage battle against the superbugs by participating in good antibiotic stewardship? Effective collaboration between physicians and RNs is more likely to occur when staff nurses are empowered with knowledge and have attained higher levels of education. American Sentinel University is an innovative, accredited provider of online nursing degrees.

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