Top reasons why there are superbugs
- over prescribing antibiotics for minor conditions
- improper patient use of antibiotics
- decline in new development of antibiotics
- living through conditions that would have killed them 100 years ago
- increased use of prophylactic antibiotics in the immunocompromised and surgical patient population
- Agricultural use
Bacteriostatic
slows the growth of the bacteria so that the immune system has time to catch up
Bactericidal
kills the targeted organism
How do antibiotics work?
inhibiting specific processes that are essential for the bacterium to grow
Intrinsic Resistance
result of the bacteria’s inherent mechanism of action against a particular drug
“born with it”
Why are gram negative resistant to Vanc?
bacteria have a protective outer membrane that won’t allow the drug in
Acquired Resistance
results from a change in the bacteria’s genetic composition that makes a previously effective drug ineffective
-survival of the fittest
Community-Acquired Infections
- pneumococcal pneumonia-penicillin resistant
- tick-borne dz (lyme)
- mosquito-transmitted West Nile virus (viral encephalitis)
- Increasing hepatits C
Contributing factors to the spread of resistant infections
- worldwide population growth
- increased urbanization and crowding
- human distribution of animal, plant, and microbial habitats
- increasing number of elderly
- shifting sexual behaviors
- IV drug use
- Increasing population of immunosuppressed people
- ineffective infection control and compliance
- poverty and inaccessible medical care
- decline in research and development of new antibiotics
- lack of funding
Nosocomial infections
- develops when a patient is admitted to a healthcare facility AND did not have the infection present when they arrived
- at least 5% of hosp. patients each year
- many of these are preventable
Staphylococcus Aureus Gram +
- found on skin, wounds, nose, axillae, and perineum
- 90% of all staph are resistant to PCN/Methicillin
- can cause major problems in large wounds or in the respiratory system
- common in nursing homes
- 80,000 hosp. per year
MRSA
Methicillin-resistant staph aureus
- acquired in many possible settings, esp. hosp.
- healthcare workers exposed to MRSA can become infected and spread it to others
- MRSA can live on surfaces and clothing for days
Populations with MRSA
- Children/Elderly
- Inmates
- Military recruits
- HIV
- Religious communities
- Hospitals/Nursing homes
- Football teams
- Wrestlers
- Gymnasts
- Fencing teams
- Homeless
- Immunosupressed
- ICUs
VRE Gram +
Vancomycin-Resistant Enterococci
- normally found in the bowel, female genital tract and environment
- spread by fecal-oral
- can live on environmental surfaces for weeks
C-Diff
Clostridium Difficile
- spore forming gram + rod
- part of normal bowel flora
- can live in the environment for up to 70 days
- patient rooms need a “terminal” clean with bleach
- not resp with sanitizers, must wash with soap and water
CMV
Cytomegalovirus
- once infected, virus remains for life
- transmission through body fluids
- esp dangerous to pregnant women and immunocompromised individuals
- related to the viruses that cause chickenpox, herpes simplex and mononucleosis
- mono like symptoms
- causes complications in the intestinal tract, liver, nervous system and lungs
Re-emerging Pathogens
- EVD
- Measles
- Pertussis
- Mumps
- Diphtheria
- Rubella
EVD
Formerly ebola hemorrhagic fever
- usually severe, often fatal in humans
- EVD outbreaks have a fatality rate of up to 90%
Ebola S/S
- 2 to 20 days after exposure (avg is 8-10 days)
- fever
- severe HA
- muscle pain
- weakness
- fatigue
- V/D
- Abdominal pain
- unexplained hemorrhage
Measles
- declared eliminated in US in 2000
- not true in the rest of the world
- mostly unvaccinated
- current outbreak associated with travel
- AIRBORN PRECAUTIONS
- assure 2 doses of MMR vaccine
- measles antibody titer
- 6m to 1 yr (1 dose MMR)
Measles S/S
- high fever
- cough
- runny nose
- red,watery eyes
- 2 to 3 days after, white patches in mouth
- 3 to 5 days after S/S, rash outbreak
Measles complications
- ear infections
- diarrhea
- pneumonia
- encephalitis (convulsions, deafness, developmentally disabled)
- pregnant women (premature, low birth weight)
Nursing Implications
- universal precautions with all patients
- assess the patient upon admission
- monitor labs including drug susceptibility
- use isolation when appropriate
- be aware of personal health status
- be protective of your home
- educate patients about proper use of antibiotics
- educate about risks vs. benefits of vax
- know the S/S of pathogens so you can take proper precautions when caring for these patients
